Quinn Griffin, Mary T; Klein, Deborah; Winkelman, Chris
As genomic health care becomes commonplace, nurses will be asked to provide genomic care in all health care settings including acute care and critical care. Three common cardiac conditions are reviewed, Marfan syndrome, bicuspid aortic valve, and hypertrophic cardiomyopathy, to provide acute care and critical care nurses with an overview of these pathologies through the lens of genomics and relevant case studies. This information will help critical care nursing leaders become familiar with genetics related to common cardiac conditions and prepare acute care and critical care nurses for a new phase in patient diagnostics, with greater emphasis on early diagnosis and recognition of conditions before sudden cardiac death.
Hernández-Fabà, Eva; Sanfeliu-Julià, Cristina
Since 2008, the Institut Catala de la Salut (ICS) introduced the nurses management plan for acute pathology, in primary care centres. In the implementation of this system of organization, the ICS introduced various diseases protocols with performance algorithms. To raise awareness of the the practice of acute pathology, we present a clinical case. An urgent consultation of a 30 year-old male, with fever, sore throat and cough, which was managed and resolved by a nurse. The aim of this new management plan is that nursing is the first health professional to take care of patient coming to primary care centre without a scheduled visit, to avoid saturating the general clinic or hospital emergencies. This new organisational system involves an increase in the responsibilities of nursing in the diagnosis and treatment of patients.
Davidson, Patricia M; Introna, Kate; Cockburn, Jill; Daly, John; Dunford, Mary; Paull, Glenn; Dracup, Kathleen
Advances in the practice of medicine and nursing science have increased survival for patients with chronic cardiorespiratory disease. Parallel to this positive outcome is a societal expectation of longevity and cure of disease. Chronic disease and the inevitability of death creates a dilemma, more than ever before, for the health care professional, who is committed to the delivery of quality care to patients and their families. The appropriate time for broaching the issue of dying and determining when palliative care is required is problematic. Dilemmas occur with a perceived dissonance between acute and palliative care and difficulties in determining prognosis. Palliative care must be integrated within the health care continuum, rather than being a discrete entity at the end of life, in order to achieve optimal patient outcomes. Anecdotally, acute and critical care nurses experience frustration from the tensions that arise between acute and palliative care philosophies. Many clinicians are concerned that patients are denied a good death and yet the moment when care should be oriented toward palliation rather than aggressive management is usually unclear. Clearly this has implications for the type and quality of care that patients receive. This paper provides a review of the extant literature and identifies issues in the end of life care for patients with chronic cardiorespiratory diseases within acute and critical care environments. Issues for refinement of acute and critical care nursing practice and research priorities are identified to create a synergy between these philosophical perspectives.
To improve the nursing care quality in acute care hospitals in Taiwan after the 2003 SARS epidemic, the Taipei City Government Department of Health has allocated about US dollars 6 million for nurse aides' salaries and costs for recruitment, training, and administration of this program. Yet, there have been no corresponding changes in payments for nursing services by the National Health Insurance system in Taiwan such as increasing nurse fees for inpatient services. This article examines the roles of nurse aides and family members in providing acute patient care in Taiwan and discusses issues of nursing care quality as related to nurse staffing in acute care hospitals.
Young, John P.; And Others
A critical review of literature on factors affecting nurse staffing in acute care hospitals, with particular regard for the consequences of a movement from team nursing to primary nursing care, was conducted. The literature search revealed a need for more research on the philosophy of nursing and nursing goals and policy as they relate to nurse…
Walsh, Mary E.; Buchanan, Marla J.
A large body of research provides evidence of workplace injuries to those in the nursing profession. Research on workplace stress and burnout among medical professionals is also well known; however, the profession of acute care nursing has not been examined with regards to work-related stress. This qualitative study focused on acute care nurses'…
Choo, Janet; Johnston, Linda; Manias, Elizabeth
This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.
Björkdahl, A; Palmstierna, T; Hansebo, G
Demanding conditions in acute psychiatric wards inhibit provision of safe, therapeutic care and leave nurses torn between humanistic ideals and the harsh reality of their daily work. The aim of this study was to describe nurses' caring approaches within this context. Data were collected from interviews with nurses working in acute psychiatric intensive care. Data were analysed using qualitative analysis, based on interpretive description. Results revealed a caring-approach continuum on which two approaches formed the main themes: the bulldozer and the ballet dancer. The bulldozer approach functioned as a shield of power that protected the ward from chaos. The ballet dancer approach functioned as a means of initiating relationships with patients. When examining the data from a theoretical perspective of caring and uncaring encounters in nursing, the ballet dancer approach was consistent with a caring approach, while the bulldozer approach was more complex and somewhat aligned with uncaring approaches. Conclusions drawn from the study are that although the bulldozer approach involves a risk for uncaring and harming actions, it also brings a potential for caring. This potential needs to be further explored and nurses should be encouraged to reflect on how they integrate paternalistic nursing styles with person-centred care.
Piredda, M; Ghezzi, V; De Marinis, M G; Palese, A
Longitudinal three-time point study, addressing how neurological adult patient care dependency varies from the admission time to the 3rd day of acute hospitalization. Nursing care dependency was measured with the Care Dependency Scale (CDS) and a Latent Growth Modeling approach was used to analyse the CDS trend in 124 neurosurgical and stroke inpatients. Care dependence followed a decreasing linear trend. Results can help nurse-managers planning an appropriate amount of nursing care for acute neurological patients during their initial stage of hospitalization. Further studies are needed aimed at investigating the determinants of nursing care dependence during the entire in-hospital stay.
Kruse, Barbara G; Melhado, Lolita W; Convertine, Linda; Stecher, Jo
Providing quality care to the dying has become a primary concern in the United States. Eighty percent of deaths still occur in the hospital even though nurses report they do not think that good deaths are routinely possible within a hospital setting due to lack of appropriate education on end-of-life care. The aim of this pilot study was to test the best method for changing acute nurse's perceptions about end-of-life care. A 3-group experimental design tested the efficacy of a nurse-led hospice collaborative. Hypotheses were: (1) nurses who receive classroom instruction will have greater change in perceptions than the control group and (2) nurses who receive a combination of classroom and hospice experiences will demonstrate greater changes than the classroom or control group. No significant differences were found among the 3 groups. However, the intervention group showed increased guilt about not having enough time to spend with the dying.
The nursing discipline is vital throughout patients' hospital progression. One of the most critical moments in the hospital stay is the postoperative period. Neurosurgical patients require a high level of nursing care and vigilance and additional postoperative monitoring in intensive care units designed specifically for this demographic. In the postoperative setting, patient care must be transferred from anesthesia to nursing in a manner that is continuous and safe. This article focuses on neurosurgical patients in the postoperative period, the assessment of these patients, and critical care nursing, with emphasis on common issues and interventions for this dynamic patient population.
Acute care nurse practitioner roles have been introduced in many countries. The acute care nurse practitioner provides nursing and medical care to meet the complex needs of patients and their families using a holistic, health-centred approach. There are many pressures to adopt a performance framework and execute activities and tasks. Little time may be left to explore domains of advanced practice nursing and develop other forms of knowledge. The primary objective of praxis is to integrate theory, practice and art, and facilitate the recognition and valuing of different types of knowledge through reflection. With this framework, the acute care nurse practitioner assumes the role of clinician and researcher. Praxis can be used to develop the acute care nurse practitioner role as an advanced practice nursing role. A praxis framework permeates all aspects of the acute care nurse practitioner's practice. Praxis influences how relationships are structured with patients, families and colleagues in the work setting. Decision-makers at different levels need to recognize the contribution of praxis in the full development of the acute care nurse practitioner role. Different strategies can be used by educators to assist students and practitioners to develop a praxis framework.
Bridges, Jackie; Nicholson, Caroline; Maben, Jill; Pope, Catherine; Flatley, Mary; Wilkinson, Charlotte; Meyer, Julienne; Tziggili, Maria
Aims To synthesize evidence and knowledge from published research about nurses' experiences of nurse-patient relationships with adult patients in general, acute inpatient hospital settings. Background While primary research on nurses' experiences has been reported, it has not been previously synthesized. Design Meta-ethnography. Data sources Published literature from Australia, Europe, and North America, written in English between January 1999–October 2009 was identified from databases: CINAHL, Medline, British Nursing Index and PsycINFO. Review methods Qualitative studies describing nurses' experiences of the nurse-patient relationship in acute hospital settings were reviewed and synthesized using the meta-ethnographic method. Results Sixteen primary studies (18 papers) were appraised as high quality and met the inclusion criteria. The findings show that while nurses aspire to develop therapeutic relationships with patients, the organizational setting at a unit level is strongly associated with nurses' capacity to build and sustain these relationships. The organizational conditions of critical care settings appear best suited to forming therapeutic relationships, while nurses working on general wards are more likely to report moral distress resulting from delivering unsatisfactory care. General ward nurses can then withdraw from attempting to emotionally engage with patients. Conclusion The findings of this meta-ethnography draw together the evidence from several qualitative studies and articulate how the organizational setting at a unit level can strongly influence nurses' capacity to build and sustain therapeutic relationships with patients. Service improvements need to focus on how to optimize the organizational conditions that support nurses in their relational work with patients. PMID:23163719
Stevens, Kathleen R; Engh, Eileen P; Tubbs-Cooley, Heather; Conley, Deborah Marks; Cupit, Tammy; D'Errico, Ellen; DiNapoli, Pam; Fischer, Joleen Lynn; Freed, Ruth; Kotzer, Anne Marie; Lindgren, Carolyn L; Marino, Marie Ann; Mestas, Lisa; Perdue, Jessica; Powers, Rebekah; Radovich, Patricia; Rice, Karen; Riley, Linda P; Rosenfeld, Peri; Roussel, Linda; Ryan-Wenger, Nancy A; Searle-Leach, Linda; Shonka, Nicole M; Smith, Vicki L; Sweatt, Laura; Townsend-Gervis, Mary; Wathen, Ellen; Withycombe, Janice S
Frontline nurses encounter operational failures (OFs), or breakdowns in system processes, that hinder care, erode quality, and threaten patient safety. Previous research has relied on external observers to identify OFs; nurses have been passive participants in the identification of system failures that impede their ability to deliver safe and effective care. To better understand frontline nurses' direct experiences with OFs in hospitals, we conducted a multi-site study within a national research network to describe the rate and categories of OFs detected by nurses as they provided direct patient care. Data were collected by 774 nurses working in 67 adult and pediatric medical-surgical units in 23 hospitals. Nurses systematically recorded data about OFs encountered during 10 work shifts over a 20-day period. In total, nurses reported 27,298 OFs over 4,497 shifts, a rate of 6.07 OFs per shift. The highest rate of failures occurred in the category of Equipment/Supplies, and the lowest rate occurred in the category of Physical Unit/Layout. No differences in OF rate were detected based on hospital size, teaching status, or unit type. Given the scale of this study, we conclude that OFs are frequent and varied across system processes, and that organizations may readily obtain crucial information about OFs from frontline nurses. Nurses' detection of OFs could provide organizations with rich, real-time information about system operations to improve organizational reliability. © 2017 Wiley Periodicals, Inc.
National Academies Press, 2010
The Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the IOM, seeks to transform nursing as part of larger efforts to reform the health care system. The first of the Initiative's three forums was held on October 19, 2009, and focused on safety, technology, and interdisciplinary collaboration in acute care. Appended are: (1)…
Cowin, Leanne S
Poor collegial relations can cause communication breakdown, staff attrition and difficulties attracting new nursing staff. Underestimating the potential power of nursing team relationships means that opportunities to create better working environments and increase the quality of nursing care can be missed. Previous research on improving collegiality indicates that professionalism and work satisfaction increases and that staff attrition decreases. This study explores challenges, strengths and strategies used in nursing team communication in order to build collegial relationships. A qualitative approach was employed to gather nurses experiences and discussion of communication within their nursing teams and a constant comparison method was utilised for data analysis. A convenience sampling technique was employed to access both Registered Nurses and Enrolled Nurses to partake in six focus groups. Thirty mostly female nurses (ratio of 5:1) participated in the study. Inclusion criteria consisted of being a nurse currently working in acute care settings and the exclusion criteria included nursing staff currently working in closed specialty units (i.e. intensive care units). Results revealed three main themes: (1) externalisation and internalisation of nursing team communication breakdown, (2) the importance of collegiality for retention of nurses and (3) loss of respect, and civility across the healthcare workplace. A clear division between hierarchies of nurses was apparent in how nursing team communication was delivered and managed. Open, respectful and collegial communication is essential in today's dynamic and complex health environments. The nurses in this study highlighted how important nursing communication can be to work motivation and how leadership fosters teamwork.
The purpose of this scoping review was to survey the most recent (5 years) acute care, community health, and mental health nursing workload literature to understand themes and research avenues that may be applicable to school nursing workload research. The search for empirical and nonempirical literature was conducted using search engines such as…
Orique, Sabrina B; Patty, Christopher M; Woods, Ellen
This study replicates previous research on the nature and causes of missed nursing care and adds an explanatory variable: unit-level nurse workload (patient turnover percentage). The study was conducted in California, which legally mandates nurse staffing ratios. Findings demonstrated no significant relationship between patient turnover and missed nursing care.
Jusela, Cheryl; Struble, Laura; Gallagher, Nancy Ambrose; Redman, Richard W; Ziemba, Rosemary A
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions
Spath, M; Buttlar, L
The majority of nurses surveyed used the library on a regular but limited basis to obtain information needed in caring for or making decisions about their patients. A minority indicated that the libraries in their own institutions totally met their information needs. In fact, only 4% depended on the library to stay abreast of new information and developments in the field. Many of the nurses had their own journal subscriptions, which could account in part for the limited use of libraries and the popularity of the professional journal as the key information source. This finding correlates with the research of Binger and Huntsman, who found that 95% of staff development educators relied on professional journal literature to keep up with current information in the field, and only 45% regularly monitored indexing-and-abstracting services. The present study also revealed that nurses seek information from colleagues more than from any other source, supporting the findings of Corcoran-Perry and Graves. Further research is necessary to clarify why nurses use libraries on a limited basis. It appears, as Bunyan and Lutz contend, that a more aggressive approach to marketing the library to nurses is needed. Further research should include an assessment of how the library can meet the information needs of nurses for both research and patient care. Options to be considered include offering library orientation sessions for new staff nurses, providing current-awareness services by circulating photocopied table-of-contents pages, sending out reviews of new monographs, inviting nurses to submit search requests on a topic, scheduling seminars and workshops that teach CD-ROM and online search strategies, and providing information about electronic databases covering topics related to nursing. Information on databases may be particularly important in light of the present study's finding that databases available in CD-ROM format are consulted very little. Nursing education programs should
Donaldson, Nancy; Shapiro, Susan
California is the first state to enact legislation mandating minimum nurse-to-patient ratios at all times in acute care hospitals. This synthesis examines 12 studies of the impact of California's ratios on patient care cost, quality, and outcomes in acute care hospitals. A key finding from this synthesis is that the implementation of minimum nurse-to-patient ratios reduced the number of patients per licensed nurse and increased the number of worked nursing hours per patient day in hospitals. Another finding is that there were no significant impacts of these improved staffing measures on measures of nursing quality and patient safety indicators across hospitals. A critical observation may be that adverse outcomes did not increase despite the increasing patient severity reflected in case mix index. We cautiously posit that this finding may actually suggest an impact of ratios in preventing adverse events in the presence of increased patient risk.
Cioffi, R N Jane
Communication with culturally and linguistically diverse (CLD) patients has been shown to be difficult. This study describes nurses' experiences of communicating with CLD patients in an acute care setting. A purposive sample of registered nurses and certified midwives (n=23) were interviewed. Main findings were: interpreters, bilingual health workers and combinations of different strategies were used to communicate with CLD patients; some nurses showed empathy, respect and a willingness to make an effort in the communication process with others showing an ethnocentric orientation. Main recommendations were: prioritising access to appropriate linguistic services, providing nurses with support from health care workers, e.g., bilingual health care workers who are able to provide more in-depth information, increasing nurses' understanding of legal issues within patient encounters, supporting nurses to translate their awareness of cultural diversity into acceptance of, appreciation for and commitment to CLD patients and their families.
Cashen, Margaret S; Bradley, Victoria; Farrell, Ann; Murphy, Judy; Schleyer, Ruth; Sensmeier, Joyce; Dykes, Patricia C
A focus group using nursing informatics experts as informants was conducted to guide development of a survey to explore the impact of health information technology on the role of nurses and interdisciplinary communication in acute care settings. Through analysis of focus group transcripts, five key themes emerged: information, communication, care coordination, interdisciplinary relationships, workflow, and practice effectiveness and efficiency. This served as the basis for development of a survey that will investigate perceptions of acute care providers across the United States regarding the impact of health information technology on the role of nurses and interdisciplinar communication in acute care settings. The purpose of this paper is to describe the process of survey development including analysis of transcripts, emergence of key themes, and the processes by which the themes will be employed to inform survey development.
Shoulders, Bridget; Follett, Corrinne; Eason, Joyce
The complexity of patients in the critical and acute care settings requires that nurses be skilled in early recognition and management of rapid changes in patient condition. The interpretation and response to these events can greatly impact patient outcomes. Nurses caring for these complex patients are expected to use astute critical thinking in their decision making. The purposes of this article were to explore the concept of critical thinking and provide practical strategies to enhance critical thinking in the critical and acute care environment.
Andersson, Sten-Ove; Dahlgren, Lars Owe; Lundberg, Lars; Sjöström, Björn
Emergency medical care for seriously injured patients in war or warlike situations is highly important when it comes to soldiers' survival and morale. The Swedish Armed Forces sends nurses, who have limited experience of caring for injured personnel in the field, on a variety of international missions. The aim of this investigation was to identify the kind of criteria nurses rely on when assessing acute trauma and what factors are affecting the emergency care of injured soldiers. A phenomenographic research approach based on interviews was used. The database for the study consists of twelve nurses who served in Bosnia in 1994-1996. The criteria nurses rely on, when assessing acute trauma in emergency care, could be described in terms of domain-specific criteria such as a physiological, an anatomical, a causal and a holistic approach as well as contextual criteria such as being able to communicate, having a sense of belonging, the military environment, the conscript medical orderly and familiarity with health-caring activity. The present study shows that the specific contextual factors affecting emergency care in the field must also be practised before the nurse faces military emergency care situations. This calls for realistic exercises and training programs, where experience from civilian emergency care is interwoven with the knowledge specific to military medical care.
Daggenvoorde, Thea; Geerling, Bart; Goossens, Peter J J
Patients with a bipolar disorder and currently experiencing acute mania often require hospitalization. We explored patient problems, desired patient outcomes, and nursing interventions by individually interviewing 22 nurses. Qualitative content analysis gave a top five of patients problems, desired patient outcomes and nursing interventions, identified as most important in the interviews. We then conducted three focus group meetings to gain greater insight into these results. Intensive nursing care is needed, fine-tuning on the patient as a unique person is essential, taking into account the nature and severity of the manic symptoms of the patient.
Urban, Ann-Marie; Wagner, Joan I
Hospitals are situated within historical and socio-political contexts; these influence the provision of patient care and the work of registered nurses (RNs). Since the early 1990s, restructuring and the increasing pressure to save money and improve efficiency have plagued acute care hospitals. These changes have affected both the work environment and the work of nurses. After recognizing this impact, healthcare leaders have dedicated many efforts to improving the work environment in hospitals. Admirable in their intent, these initiatives have made little change for RNs and their work environment, and thus, an opportunity exists for other efforts. Research indicates that spirit at work (SAW) not only improves the work environment but also strengthens the nurse's power to improve patient outcomes and contribute to a high-quality workplace. In this paper, we present findings from our research that suggest SAW be considered an important component in improving the work environment in acute care hospitals.
Chan, Regina; Molassiotis, Alexander; Chan, Eunice; Chan, Virene; Ho, Becky; Lai, Chit-ying; Lam, Pauline; Shit, Frances; Yiu, Ivy
A cross-sectional survey was conducted to investigate the nurses' knowledge of and compliance with Universal Precautions (UP) in an acute hospital in Hong Kong. A total of 450 nurses were randomly selected from a population of acute care nurses and 306 were successfully recruited in the study. The study revealed that the nurses' knowledge of UP was inadequate. In addition, UP was not only insufficiently and inappropriately applied, but also selectively practiced. Nearly all respondents knew that used needles should be disposed of in a sharps' box after injections. However, nurses had difficulty in distinguishing between deep body fluids and other general body secretions that are not considered infectious in UP. A high compliance was reported regarding hand-washing, disposal of needles and glove usage. However, the use of other protective wear such as masks and goggles was uncommon. The results also showed no significant relationships between the nurses' knowledge and compliance with UP. It is recommended that UP educational programmes need to consider attitudes in conjunction with empirical knowledge. Nurse managers and occupational health nurses should take a leadership role to ensure safe practices are used in the care of patients.
Fairbrother, Greg; Jones, Aaron; Rivas, Ketty
Agreement was reached with 12 acute medical and surgical wards/units at Sydney's Prince of Wales Hospital to participate in a trial of team nursing (TN). Six units employed action research principles to undertake a change to a team nursing model and six remained with the pre-existing individual patient allocation (IPA) model. Task-based teaming was widely discarded by the team nursing units in favour of allocating patients within the team and introducing more supportive and communicative processes aimed at fostering responsibility sharing. Localised team-based models of care arose in the change wards and were outlined, implemented and refined using social action research principles. A 12-month prospective experimental comparison of job satisfaction and staff retention between the TN and IPA groups indicated statistically significant job satisfaction benefits and practically important staff retention benefits associated with moving away from an IPA model of nursing care delivery towards a team-based model of care delivery. Perhaps not surprisingly, job satisfaction gains were most marked among new graduate nurses, who reported real benefits from a teaming inspired shift in model of care in the acute inpatient environment.
Hodges, Helen F; Keeley, Ann C; Troyan, Patricia J
New nurses typically begin their practice in acute care settings in hospitals, where their work is characterized by time constraints, high safety risks for patients, and layers of complexity and difficult problems. Retention of experienced nurses is an issue central to patient safety. The purpose of this qualitative study was to explore the nature of professional resilience in new baccalaureate-prepared nurses in acute care settings and to extrapolate pedagogical strategies that can be developed to support resilience and career longevity. Findings revealed a common process of evolving resilience among participants. New nurses spend a significant amount of time learning their place in the social structure. With positive experiences, they begin to feel more competent with skills and relationships and become increasingly aware of discrepancies between their ideas of professional nursing and their actual experiences in the work setting. The risk of new nurses leaving their practice is constantly present during these struggles. Acceptable compromises yield a reconciliation of the current crisis, typically occurring long after formal precepting has ended. Personal growth is evident by the evolving clarity of professional identity, an edifying sense of purpose, and energy resources to move forward. For new nurses, professional resilience yields the capacity for self-protection, risk taking, and moving forward with reflective knowledge of self.
Hart, Patricia; Davis, Nancy
This article presents the findings from a study that evaluates the relationships between staffing indicators and patient outcomes at the hospital unit level. Nursing administrators should not only evaluate the impact staffing decisions have on patient outcomes at the hospital level but also examine these relationships at the unit level. The findings from this study have implications for nursing practice in the areas of staff orientation, education, and patient outcome monitoring.
Mark, Barbara A; Jones, Cheryl Bland; Lindley, Lisa; Ozcan, Yasar A
Using an innovative statistical approach-data envelopment analysis-the authors examined the technical efficiency of 226 medical, surgical, and medical-surgical nursing units in 118 randomly selected acute care hospitals. The authors used the inputs of registered nurse, licensed practical nurse, and unlicensed hours of care; operating expenses; and number of beds on the unit. Outputs included case mix adjusted discharges, patient satisfaction (as a quality measure), and the rates of medication errors and patient falls (as measures of patient safety). This study found that 60% of units were operating at less than full efficiency. Key areas for improvement included slight reductions in labor hours and large reductions in medication errors and falls. The study findings indicate the importance of improving patient safety as a mechanism to simultaneously improve nursing unit efficiency.
Carpenter, Joan G
Although palliative care consultation teams are common in U.S. hospitals, follow up and outcomes of consultations for frail older adults discharged to nursing facilities are unclear. To summarize and critique research on the care of patients discharged to nursing facilities following a hospital-based palliative care consult, a systematic search of PubMed, CINAHL, Ageline, and PsycINFO was conducted in February 2016. Data from the articles (N = 12) were abstracted and analyzed. The results of 12 articles reflecting research conducted in five countries are presented in narrative form. Two studies focused on nurse perceptions only, three described patient/family/caregiver experiences and needs, and seven described patient-focused outcomes. Collectively, these articles demonstrate that disruption in palliative care service on hospital discharge and nursing facility admission may result in high symptom burden, poor communication, and inadequate coordination of care. High mortality was also noted. [Res Gerontol Nurs. 2017; 10(1):25-34.].
Ngako, Kgalabi J; Van Rensburg, Elsie S J; Mataboge, Sanah M L
Psychiatric nurse practitioners (PNPs) working with mental health care users presenting with acute symptoms work in a complex environment. This environment is characterised by mental health care users who may present with a history of violence, sexual assault and substance misuse. The objectives of this study were twofold: firstly, to explore and describe the experiences of PNPs working with mental health care users (MHCUs) presenting with acute symptoms; and secondly, to make recommendations for the advanced PNPs to facilitate promotion of the mental health of PNPs with reference to nursing practice, research and education. A qualitative, explorative, descriptive and contextual design was used. The target population was PNPs working with MHCUs presenting with acute symptoms in a public mental health care institution in Gauteng. Data were collected by means of four focus group interviews involving 21 PNPs. The researcher made use of drawings, naïve sketches and field notes for the purpose of data triangulation. Data were analysed in accordance with Tesch's method of open coding. The three themes that emerged were: PNPs experienced working with these MHCUs as entering an unsafe world where care became a burden; they experienced negative emotional reactions and attitudes towards these MHCUs that compromised quality nursing care; and they made a plea for a nurturing environment that would enhance quality nursing care. The PNPs suggest skills and competency development, organisational support, and a need for external resources. Creation of a positive environment and mobilisation of resources as well as the identification and bridging of obstacles are essential in the promotion of the overall wellbeing and mental health of PNPs.
Atwal, Anita; Caldwell, Kay
Multidisciplinary teamwork is viewed as one of the key processes through which care is managed in the British National Health Service, and yet is often viewed as one of the most problematic. Working in a multidisciplinary team requires many skills, which involves understanding not only one's own role but also the role of other professionals. The aim of this study was to explore nurses' perceptions of multidisciplinary teamwork in acute health-care. Nineteen nurses were interviewed using the critical incident approach to obtain their perceptions of multidisciplinary teamwork. Direct observation was conducted to record interactions between nurses and health-care professionals in multidisciplinary teams. In total, 14 meetings were attended in elder care and orthopaedics and seven in acute medicine. The findings of this study identified three barriers that hindered teamwork: (i) differing perceptions of teamwork; (ii) different levels of skills acquisitions to function as a team member; and (iii) the dominance of medical power that influenced interaction in teams. Thus, education establishments and nursing managers need to ensure that the acquisition of team-playing skills is an integral part of continued professional development.
Eckman, Thea; Haley, Rebecca; Bradley, Elisabeth; Albert, Maria; Kolm, Paul; Jurkovitz, Claudine
An acronym, a button, a script card, and a lot of fun are all an educator needs to turn dreaded education into a great learning experience for nurses as well as the patients. A multidisciplinary team pilot tested a new learning approach on a cardiac step-down unit. The goal was to educate both nurses and patients about the American Heart Association's Get-With-the-Guidelines Program for Coronary Artery Disease. The educational strategies were successful, and data revealed an increase in nursing knowledge of core measures. After a two-phase study, the program was eventually rolled out hospital-wide. The study results show that nurses' compliance with and knowledge of the AHA core measures increased as a direct result of the program.
Bowblis, John R; McHone, Heather S
For the affluent elderly, continuing care retirement communities (CCRCs) have become a popular option for long term care and other health care needs related to aging. While CCRCs have experienced significant growth over the last few decades, very little is known about the quality of care CCRCs provide. This paper is the first to rigorously study CCRCs on a national scale and the only study that focuses on nursing home quality. Using a national sample from 2005, we determine if the quality of post-acute care provided by CCRC nursing homes is superior to traditional nursing homes. To mimic randomization of patients, instrumental variables analysis is used with relative distance as an exclusion restriction to handle the endogeneity of the type of facility where care is provided. After adjusting for endogeniety, we find that CCRC nursing homes provide post-acute care quality that is similar or lower to traditional nursing homes, depending on the quality measure.
Provisional NQF (n=13) ANA (n=10) Death in low mortality DRG X Decubitus /pressure ulcer X X X Failure to rescue X X X Infection due to medical care X...overlap in these measure sets, with the exception of decubitus /pressure ulcer and failure to rescue. Caution should be taken since the measure intent...patient falls, pressure ulcers , and mortality, with increasing detail in measure specification.11 For example, nosocomial infections are broken down into
Hogan, Pamela; Moxham, Lorna; Dwyer, Trudy
It is paramount that there is an adequate nursing workforce supply for now and in the future, to achieve equitable and quality health outcomes and consumer access to healthcare, regardless of geographic location. Nursing forms the largest body of employees in the health care system, spanning all segments of care. A shortage of nurses, particularly in the acute care settings in hospitals, jeopardizes the provision of quality health care to consumers. This article provides a literature review of Australian State and Federal Government reports into nurse retention. All reports discuss staff turnover rates; the average age of nurses; enrolment numbers in nursing courses; workloads; nursing workforce shortfalls and the effect on the work environment; leadership and management styles; organizational culture; change management; the mobility of nursing qualifications both locally and internationally and the critical need to value nurses. Then why has the situation of nurse retention not improved? Possible reasons for the continued nurse shortage and the promise of strategic HRM in addressing nurse retention are discussed.
Chatfield, Sheryl L; Nolan, Rachael; Crawford, Hannah; Hallam, Jeffrey S
Objective: Occurrences of healthcare-associated infections are associated with substantial direct and indirect costs. Improvement in hand hygiene among acute care nurses has potential to reduce incidence of healthcare-associated infections. Findings from reviews of intervention research have not conclusively identified components that are more or less efficient or effective. Much prior qualitative research has focused on descriptive analysis of policies and practices rather than providing interpretive explorations of how individuals’ perceptions of hygiene might drive practices. Methods: We conducted qualitative interview research with eight nurses in the United States who were employed in various patient-care roles. We analyzed the data using an interpretative phenomenological analysis methodology to explore how nurses described their perceptions of, and experiences with, hygiene. We developed themes that explored individual, workplace, and management influences on perception of hygiene. Results: Developed themes include practical hygiene, risky business, and hygiene on trial; the latter theme described the conflict between how nurses perceived their own hygiene practices and how they felt hospital management perceived these practices. Other findings included that participants distinguished between policy-mandated use of sanitizer and a personal sense of cleanliness; the latter was more likely to be associated with scrubbing or removal of contaminants than with use of protectants. Conclusion: While participants asserted support for facility hand hygiene policies, their behavior in certain instances might be mediated by broadly defined emergent situations and a belief that it is not currently possible to establish a causal link between an healthcare-associated infections and a specific individual or occurrence. Researchers and infection prevention practitioners might consider soliciting greater input from nurses in planning hand hygiene improvement interventions
Parker, Karen M; Harrington, Ann; Smith, Charlene M; Sellers, Kathleen F; Millenbach, Linda
Horizontal violence (HV) is prevalent in nursing. However, few strategies are identified to address this phenomenon that undermines communication and patient safety. Nurses at an acute care hospital implemented multiple interventions to address HV resulting in increased knowledge of hospital policies regarding HV, and significantly (p < .05) less HV prevalence than was reported by nurses in other organizations throughout New York State. With the aid and oversight of nursing professional development specialists, evidence-based interventions to address HV were developed including policies, behavioral performance reviews, and staff/manager educational programs.
Roscigno, Cecelia I.
Objective A child’s severe traumatic brain injury (TBI) creates a family crisis requiring extensive cultural, informational, psychological, and environmental support. Nurses need to understand parents’ expectations of caring in early acute care so they can tailor their attitudes, beliefs, and behaviors appropriately to accommodate the family’s needs. Methods In a previous qualitative study of 42 parents or caregivers from 37 families of children with moderate to severe TBI, parents of children with severe TBI (n = 25) described their appraisals of nurse caring and uncaring behaviors in early acute care. Swanson’s theory of caring was used to categorize parents’ descriptions in order to inform nursing early acute care practices and family-centered care. Results Caring nurse encounters included: (a) involving parents in the care of their child and reflecting on all socio-cultural factors shaping family resources and responses (knowing); (b) respecting that family grief can be co-mingled with resilience, and that parents are typically competent to be involved in decision-making (maintaining belief); (d) actively listening and engaging parents in order to fully understand family values and needs (being with); (e) decreasing parents’ workload to get information, emotional support, and providing a safe cultural, psychological, and physical environment for the family (doing for), and; (f) providing anticipatory guidance to navigate the early acute care system and giving assistance to learn and adjust to their situation (enabling). Conclusion Application of Swanson’s caring theory is prescriptive in helping individual nurses and early acute care systems to meet important family needs following children’s severe TBI. PMID:26871242
Turunen, Hannele; Partanen, Pirjo; Kvist, Tarja; Miettinen, Merja; Vehviläinen-Julkunen, Katri
Nurse managers (NMs) and registered nurses (RNs) have key roles in developing the patient safety culture, as the nursing staff is the largest professional group in health-care services. We explored their views on the patient safety culture in four acute care hospitals in Finland. The data were collected from NMs (n = 109) and RNs (n = 723) by means of a Hospital Survey on Patient Safety Culture instrument and analyzed statistically. Both groups recognized patient safety problems and critically evaluated error-prevention mechanisms in the hospitals. RNs, in particular, estimated the situation more critically. There is a need to develop the patient safety culture of hospitals by discussing openly about them and learning from mistakes and by developing practices and mechanisms to prevent them. NMs have central roles in developing the safety culture at the system level in hospitals in order to ensure that nurses caring for patients do it safely.
Caring behaviors displayed toward nurses by nurse managers and nurse peers play a significant role in establishing relationships that promote a healthy work environment. A qualitative study was done to identify behaviors perceived to be caring toward nurses. The theoretical background used for the study was Nursing as Caring by Boykin and Schoenhofer. Data were collected from focus groups consisting of registered nurses currently employed in the practice setting. Content analysis was used for the analysis. The overarching category that was identified was tending to a caring environment. The following emergent categories were also found: caring through helping and supporting, caring through appreciating, and acknowledging unappreciated caring. The findings suggest that nurses demonstrate caring behaviors toward their colleagues by coming to know them on both a professional and a personal level. These behaviors form the foundation for an environment that supports a consistent demonstration of caring.
Ayala, Elizabeth; Carnero, Andrés M.
Background Evidence on the prevalence and determinants of burnout among military acute and critical care nursing personnel from developing countries is minimal, precluding the development of effective preventive measures for this high-risk occupational group. In this context, we aimed to examine the association between the dimensions of burnout and selected socio-demographic and occupational factors in military acute/critical care nursing personnel from Lima, Peru. Methods and Findings We conducted a cross-sectional study in 93 nurses/nurse assistants from the acute and critical care departments of a large, national reference, military hospital in Lima, Peru, using a socio-demographic/occupational questionnaire and a validated Spanish translation of the Maslach Burnout Inventory. Total scores for each of the burnout dimensions were calculated for each participant. Higher emotional exhaustion and depersonalisation scores, and lower personal achievement scores, implied a higher degree of burnout. We used linear regression to evaluate the association between each of the burnout dimensions and selected socio-demographic and occupational characteristics, after adjusting for potential confounders. The associations of the burnout dimensions were heterogeneous for the different socio-demographic and occupational factors. Higher emotional exhaustion scores were independently associated with having children (p<0.05) and inversely associated with the time working in the current department (p<0.05). Higher depersonalization scores were independently associated with being single compared with being divorced, separated or widowed (p<0.01), working in the emergency room/intensive care unit compared with the recovery room (p<0.01), and inversely associated with age (p<0.05). Finally, higher personal achievement scores were independently associated with having children (p<0.05). Conclusion Among Peruvian military acute and critical care nursing personnel, potential screening and
Battisto, Dina; Pak, Richard; Vander Wood, Melissa A; Pilcher, June J
To improve the healthcare environment where nurses work and patients receive care, it is necessary to understand the elements that define the healthcare environment. Primary elements include (a) the occupants of the room and what knowledge, skills, and abilities they bring to the situation; (b) what tasks the occupants will be doing in the room; and (c) the characteristics of the built environment. To better understand these components, a task analysis from human factor research was conducted to study nurses as they cared for hospitalized patients. Multiple methods, including a review of nursing textbooks, observations, and interviews, were used to describe nurses' capabilities, nursing activities, and the environmental problems with current patient room models. Findings from this initial study are being used to inform the design and evaluation of an inpatient room prototype and to generate future research in improving clinical environments to support nursing productivity.
Piscotty, Ronald J; Kalisch, Beatrice
The purpose of the study was to explore relationships between nurses' perceptions of the impact of health information technology on their clinical practice in the acute care setting, their use of electronic nursing care reminders, and episodes of missed nursing care. The study aims were accomplished with a descriptive design using adjusted correlations. A convenience sample (N = 165) of medical and/or surgical, intensive care, and intermediate care RNs working on acute care hospital units participated in the study. Nurses from 19 eligible nursing units were invited to participate. Adjusted relationships using hierarchical multiple regression analyses indicated significant negative relationships between missed nursing care and nursing care reminders and perceptions of health information technology. The adjusted correlations support the hypotheses that there is a relationship between nursing care reminder usage and missed nursing care and a relationship between health information technology and missed nursing care. The relationships are negative, indicating that nurses who rate higher levels of reminder usage and health information technology have decreased reports of missed nursing care. The study found a significant relationship between nursing care reminders usage and decreased amounts of missed nursing care. The findings can be used in a variety of improvement endeavors, such as encouraging nurses to utilize nursing care reminders, aid information system designers when designing nursing care reminders, and assist healthcare organizations in assessing the impact of technology on nursing practice.
Fulmer, T; Ashley, J; Reilly, C
In conclusion, it is important to reiterate the interdependent nature of the functional health patterns as they relate to the geriatric patient in the acute care setting. Further, the combination of the primary nursing model with the functional health pattern approach that leads to subsequent nursing diagnoses provides a comprehensive care approach, which is so important for the elderly patient. As elders live longer, become frailer, and are subject to increasingly frequent hospitalizations, it will become more and more important to provide care in a manner that decreases fragmentation, increases individualization, and makes provisions for comprehensive and wholistic continuing care.
Welton, John M; Harper, Ellen M
The value of nursing care as well as the contribution of individual nurses to clinical outcomes has been difficult to measure and evaluate. Existing health care financial models hide the contribution of nurses; therefore, the link between the cost and quality o nursing care is unknown. New data and methods are needed to articulate the added value of nurses to patient care. The final results and recommendations of an expert workgroup tasked with defining and measuring nursing care value, including a data model to allow extraction of key information from electronic health records to measure nursing care value, are described. A set of new analytic metrics are proposed.
Adams, Judith A; Bailey, Donald E; Anderson, Ruth A; Docherty, Sharron L
The objective of this paper is to analyze the literature concerning nurses' roles and strategies in EOL decision making in acute care environments, synthesize the findings, and identify implications for future research. We conducted searches in CINAHL and PubMed, using a broad range of terms. The 44 articles retained for review had quantitative and qualitative designs and represented ten countries. These articles were entered into a matrix to facilitate examining patterns, themes, and relationships across studies. Three nursing roles emerged from the synthesis of the literature: information broker, supporter, and advocate, each with a set of strategies nurses use to enact the roles. Empirical evidence linking these nursing roles and strategies to patients and family members outcomes is lacking. Understanding how these strategies and activities are effective in helping patients and families make EOL decisions is an area for future research.
Bellury, Lanell; Hodges, Helen; Camp, Amanda; Aduddell, Kathie
Teams of unlicensed personnel and registered nurses have provided hospital-based nursing care for decades. Although ineffective teamwork has been associated with poor patient outcomes, little is known of the perspectives of nursing assistive personnel (NAP). The purpose of this study was to gain insights into the perceptions of NAP and professional registered nurses (RNs) on teamwork in acute care. In a qualitative descriptive approach in a metropolitan hospital in the southeastern United States, 33 NAP participated in audio-recorded focus group sessions, and 18 RNs provided responses to open-ended electronic survey questions. Findings were examined in relation to previously identified coordinating mechanisms of teamwork: shared mental models, closed-loop communication, and mutual trust. None of the mechanisms was strongly represented in these data. In contrast to RNs' mental models, NAP perceptions of teamwork included the centrality of holistic caring to the NAP role, functional teams as NAP-only teams, NAPs and RNs working in parallel spheres rather than together, and team coordination in silos. Closed-loop communication was less common than one-way requests. Mutual trust was desired, but RNs' delegation of tasks conveyed to NAP a lack of value and respect for the NAP role, while RNs perceived a professional obligation to delegate care to ensure quality of care amid changing patient priorities. Further empirical research into NAP practice is needed to enhance understanding of teamwork issues and direct effective interventions to improve work environments and ultimately patient outcomes. © 2016 Wiley Periodicals, Inc.
Kalisch, Beatrice J; Tschannen, Dana; Lee, Hyunhwa; Friese, Christopher R
Quality of nursing care across hospitals is variable, and this variation can result in poor patient outcomes. One aspect of quality nursing care is the amount of necessary care that is omitted. This article reports on the extent and type of nursing care missed and the reasons for missed care. The MISSCARE Survey was administered to nursing staff (n = 4086) who provide direct patient care in 10 acute care hospitals. Missed nursing care patterns as well as reasons for missing care (labor resources, material resources, and communication) were common across all hospitals. Job title (ie, registered nurse vs nursing assistant), shift worked, absenteeism, perceived staffing adequacy, and patient work loads were significantly associated with missed care. The data from this study can inform quality improvement efforts to reduce missed nursing care and promote favorable patient outcomes.
Wyder, Marianne; Ehrlich, Carolyn; Crompton, David; McArthur, Leianne; Delaforce, Caroline; Dziopa, Fiona; Ramon, Shulamit; Powell, Elizabeth
Inpatient psychiatric care requires a balance between working with consumers' priorities and goals, managing expectations of the community, legal, professional and service responsibilities. In order to improve service delivery within acute mental health units, it is important to understand the constraints and facilitating factors for good care. We conducted a systematic narrative synthesis, where findings of qualitative studies are synthesised to generate new insights. 21 articles were identified. Our results show that personal qualities, professional skills as well as environmental factors all influence the ability to provide recovery focused care. Three overarching themes which either facilitated or hindered were identified. These included: (i) Complexity of the nursing role (clinical care; practical and emotional support: advocacy and education; enforcing aspects of the Mental Health Act. and, maintaining ward safety); (ii) Constraining factors (operational barriers; change in patient characteristic; and competing understandings of care); and (iii) Facilitating factors (ward factors; nursing tools; nurse characteristics; approach to people; approach to work and ability to self-care). We suggest that the therapeutic use of self is central to the provision of recovery oriented care. However person-centred practice can be fragile and fluid and a compassionate system of support is needed to enable an understanding of context and self. It is critical to have a work environment which fosters hope and optimism and is supportive of autonomy, ensures workload balance, and is safe.
This paper offers a wide ranging analysis of the drivers that resulted in scrutiny of medical, nursing, and healthcare professional roles. It suggests that what is needed is a coherent vision of the future shape of the health workforce. This requires moving beyond the presumption that reforming working practices primarily involves "delegating doctors" responsibilities to nurses. The paper argues that it is self evident that the implications of changes in healthcare roles and the ability of existing professionals to function effectively in the future will require education, training, and human resource investment supportive of the changes. It suggests a clear definition of competence and a national standard to practice is essential for nurses working in acute and acute critical settings. There should therefore be a correlation between levels of practice, levels of education, and remuneration. Furthermore, education programmes for senior nurses should sit coherently alongside the education programmes required by Modernising Medical Careers. Finally, the realisation of the government's service and modernisation agenda will require a culture change within higher education institutions, postgraduate deaneries, professional organisations, workforce development confederations, and NHS trusts. PMID:15579609
Gausvik, Christian; Lautar, Ashley; Miller, Lisa; Pallerla, Harini; Schlaudecker, Jeffrey
Efficient, accurate, and timely communication is required for quality health care and is strongly linked to health care staff job satisfaction. Developing ways to improve communication is key to increasing quality of care, and interdisciplinary care teams allow for improved communication among health care professionals. This study examines the patient- and family-centered use of structured interdisciplinary bedside rounds (SIBR) on an acute care for the elderly (ACE) unit in a 555-bed metropolitan community hospital. This mixed methods study surveyed 24 nurses, therapists, patient care assistants, and social workers to measure perceptions of teamwork, communication, understanding of the plan for the day, safety, efficiency, and job satisfaction. A similar survey was administered to a control group of 38 of the same staff categories on different units in the same hospital. The control group units utilized traditional physician-centric rounding. Significant differences were found in each category between the SIBR staff on the ACE unit and the control staff. Nurse job satisfaction is an important marker of retention and recruitment, and improved communication may be an important aspect of increasing this satisfaction. Furthermore, improved communication is key to maintaining a safe hospital environment with quality patient care. Interdisciplinary team rounds that take place at the bedside improve both nursing satisfaction and related communication markers of quality and safety, and may help to achieve higher nurse retention and safer patient care. These results point to the interconnectedness and dual benefit to both job satisfaction and patient quality of care that can come from enhancements to team communication.
Resler, Julia; Hackworth, Jodi; Mayo, Erin; Rouse, Thomas M
Missed injuries contribute to increased morbidity in trauma patients. A retrospective chart review was conducted of pediatric trauma patients from 2010 to 2013 with a documented missed injury. A significant percentage of missed injuries were identified (3.01% during July 2012 to December 2013 vs 0.39% during January 2010 to July 2012) with the addition of acute care trained pediatric nurse practitioners to the trauma service at a pediatric trauma center. The increase is thought to be due to improvement in charting, consistent personnel performing tertiary examinations, and improved radiology reads of outside films.
Lundberg, Scott; Wali, Soma; Thomas, Peggy; Cope, Dennis
The institution of resident duty hours limits by the Accreditation Council for Graduate Medical Education (ACGME) has made it difficult for some programs to cover inpatient teaching services. The medical literature is replete with editorials criticizing the hour limits and the resulting problems but is nearly silent on the topic of constructive solutions to compliance. In this article, the authors describe a new program, initiated in 2003 at the Olive View-UCLA Medical Center, of using acute care nurse practitioners to allow for compliance with the "24 + 6" continuous duty hours limit, as well as the 80-hour workweek limit. Each post-call team is assigned a nurse practitioner for the day, allowing residents to sign out by 2 pm while ensuring quality care for patients. Nurse practitioners participate in evaluation of residents and, in turn, are evaluated by them. Using this system, the authors report 99% compliance with ACGME work-hour restrictions, with average work hours for inpatient ward residents decreasing from 84 to 76 hours per week. Physician satisfaction with the new system is high; anonymous evaluation by residents and faculty returned average scores of 8.8 out of 9 possible points. The authors report that using nurse practitioners on post-call days provides excellent, continuous patient care without impinging on scheduling and without sacrificing responsibility, continuity, or education for the residents. This system has several potential advantages over previously described work-hour solutions. Addition of a nurse practitioner to the post-call team is an effective solution to the problem of compliance with resident duty hours limitations.
McGillis Hall, Linda; Peterson, Jessica; Baker, G Ross; Brown, Adalsteinn D; Pink, George H; McKillop, Ian; Daniel, Imtiaz; Pedersen, Cheryl
This study examined relationships between financial indicators for nurse staffing and organizational system integration and change indicators. These indicators, along with hospital location and type, were examined in relation to the nursing financial indicators. Results showed that different indicators predicted each of the outcome variables. Nursing care hours were predicted by the hospital type, geographic location, and the system. Both nursing and patient care hours were significantly related to dissemination and benchmarking of clinical data.
Care of the acutely ill adult - an essential guide for nurses Fiona Creed Care of the acutely ill adult - an essential guide for nurses and Christine Spiers (Eds) Oxford University Press 576pp £27.95 978 0 19 956438 5 0199564388 [Formula: see text].
This guide is an invaluable resource for nurses and nursing students. It contains the key information to update and review the essential knowledge and skills needed to recognise the acutely ill patient and to respond accordingly. The essential link between a sound theory base and delivery of effective care is clearly and practically demonstrated throughout.
Lentz, Shaynie; Luther, Brenda
Fragmented and uncoordinated care is the third highest driver of U.S. healthcare costs. Although less than 10% of patients experience uncoordinated care, these patients represent 36% of total healthcare costs; care management interaction makes a significant impact on the utilization of healthcare dollars. A literature search was conducted to construct a model of care coordination for elective surgical procedures by collecting best practices for acute, transitions, and post-acute care periods. A case study was used to demonstrate the model developed. Care management defines care coordination as a model of care to address improving patient and caregiver engagement, communication across settings of care, and ultimately improved patient outcomes of care. Nurse-led care coordination in the presurgical, inpatient, and post-acute care settings requires systems change and administrative support to effectively meet the goals of the Affordable Care Act of reducing redundancy and costs while improving the patient experience. Nursing is the lynchpin of care management processes in all settings of care; thus, this model of care coordination for elective surgical admissions can provide nursing care management leaders a comprehensive view of coordinating care for these patient across settings of care during the predetermined time period of care. As bundled payment structures increasingly affect hospital systems, nursing leaders need to be ready to create or improve their care management processes; care coordination is one such process requiring immediate attention.
Nursing care wall planners are not a tool for assessing workload, but a means of providing coherence and individualised monitoring of care. Its application is focused not only on team organisation, but also on the patient's needs.
De Astis, V; Corbella, A; Bafico, F; Spinelli, E; Porcu, G; Bottari, L; Petrini, M; Madeddu, V
The Elderly Services of USL 3 "Genovese" together with the team for Continuing Education designed and implemented a survey on the elderly clients referred to the home care and nursing home services. The aim of the study was to describe the frequency, distribution and severity of pressure ulcers. The data were collected during a period of seven months: from 1st November 1997 to 31st May 1998. One thousand seven hundred and twenty nine clients were observed; 705 (41%) had single or multiple pressure ulcers. Patients with multiple pressure ulcers accounted for 42% of the total. The sacrum was the most affected site (43% of the patients with a single ulcer and 33% with multiple ulcers). Patients with severe pressure ulcers (stages 3 degrees and 4 degrees NPUAP classification) accounted for 42% of the total. Pressure sores were observed in 15% of "at no risk" patients and in 40% of those at low risk (Norton Scale score). The study highlighted a lack of documentation (90% patients) on treatments performed in the hospital and prescribed at discharge for the pressure sores. These findings reflects possibly the fact that this aspect of care is unduly disregarded by nursing personnel, and that a goal-oriented retraining, underlining also the need of appropriate documentation, is warranted.
Aujard, Ségolène; de Brisoult, Béatrice; Broussard, Daniel; Petitclerc-Roche, Solenne; Lefort, Hugues
In France, nurses practising in the prison environment work in a health care unit, for somatic care, or in a regional medical-psychological unit for large facilities and psychological care. These units belong to the regional hospitals. Located at the heart of the prison, they cater for prisoner-patients. On the frontline, the nurse has specific autonomy and responsibility in this unique context.
This article provides a general overview of nursing care principles including an approach to developing a nursing care plan using the nursing process as its foundation. The nursing process is a problem-solving approach used in planning patient care. This article also focuses on nursing care as it pertains to the respiratory, cardiovascular, and renal systems (fluid balance) as well as care of the recumbent patient. Knowledge of nursing care techniques and risk factors for complications puts the care provider in a position of being proactive rather than reactive to patient care needs.
Ensuring Quality Nursing Home Care Before you choose a nursing home Expert information from Healthcare Professionals Who Specialize in the Care ... Nearly 1.6 million older Americans live in nursing homes in the United States. The move to ...
The research pertaining to the delivery of nursing care in the ICU was reviewed to describe: the impact of the unit structure and organization, including policies and procedures, on patients, nurses, and families; the process of critical care nursing; the outcomes of critical care nursing; some of the ethical issues germane to the care of the critically ill patient. Although these areas of inquiry are quite diverse, a number of similarities can be identified. The most obvious of the similarities was that, with few exceptions, the studies pertaining to delivery of nursing care were performed by researchers from a variety of disciplines other than nursing, including medicine, psychology, public health, and economics. In many instances, such as the studies of patients' stress experiences in ICUs, these efforts enhanced our knowledge of the phenomena and complemented or replicated the efforts of nurse researchers. Unfortunately, in some areas nurse researchers were quite absent, with the result that the studies lacked a nursing perspective. For example, the large body of knowledge related to the effects of critical care on patient outcome reflected medicine's orientation toward cure. While it is important to measure the effect of nursing care in the ICU on patient survival, the effect of nursing efforts on short- and long-term quality of life, functional status, and health maintenance is also critical and remains unknown. Nurse researchers need to build on the data base already acquired about critical care. Even more important, they need to fashion programs of research focused on the concepts central to the discipline of nursing. A second similarity relates to the increasing quality of the reported research over the past decade. In general, early descriptive studies were conducted in a single critical care unit with a small and often biased sample. These gave way to more carefully designed, multicenter studies, although lack of randomization procedures continued to be
Reyniers, Thijs; Houttekier, Dirk; Cohen, Joachim; Pasman, H Roeline; Deliens, Luc
While the focus of end-of-life care research and policy has predominantly been on 'death in a homelike environment', little is known about perceptions of the acute hospital setting as a place of final care or death. Using a qualitative design and constant comparative analysis, the perspectives of family physicians, nurses and family carers were explored. Participants generally perceived the acute hospital setting to be inadequate for terminally ill patients, although they indicated that in some circumstances it might be a 'safe haven'. This implies that a higher quality of end-of-life care provision in the acute hospital setting needs to be ensured, preferably by improving communication skills. At the same time alternatives to the acute hospital setting need to be developed or expanded.
Lima-Rodríguez, Joaquin Salvador; Lima-Serrano, Marta; Sáez-Bueno, Africa
Nursing has experienced an important methodological development, in which it gives priority to the individual, although at a socioeconomic level a marked interest is seen in the health care of the family unit and the NANDA (North American Nursing Diagnosis Association), NIC (Nursing Interventions Classification) and NOC (Nursing Outcomes Classification) nursing guidelines, using diagnoses, criteria of results and interventions orientated towards this aim. We consider to the family as an opened system consisted of human elements, with a common history, which they form a functional unit been ruled by own procedure. In this paper we look at those aspects that must be taken into account in nursing assessment of families from a systemic perspective, including some tools for data collection and analysis of information. In addition, we identify specific areas of intervention. We believe that the family must be studied from a nursing care point of view with its own characteristics as opposed to those possessed individually by each of its members. We also believe that, when assessment is centred on the Henderson unaided activities study or the Gordon functional health patterns, they are not useful in assessing the family unit. This work offers an assessment method centred on the family unit, which helps to identify the nursing diagnoses applicable to it. Our proposal, which has been successfully used by nursing students over the last few years, hopes to contribute to quality clinical practice with a tool orientated towards the family.
Schultz, Carl H; Koenig, Kristi L; Whiteside, Mary; Murray, Rick
The training of medical personnel to provide care for disaster victims is a priority for the physician community, the federal government, and society as a whole. Course development for such training guided by well-accepted standardized core competencies is lacking, however. This project identified a set of core competencies and performance objectives based on the knowledge, skills, and attitudes required by the specific target audience (emergency department nurses, emergency physicians, and out-of-hospital emergency medical services personnel) to ensure they can treat the injuries and illnesses experienced by victims of disasters regardless of cause. The core competencies provide a blueprint for the development or refinement of disaster training courses. This expert consensus project, supported by a grant from the Robert Wood Johnson Foundation, incorporated an all-hazard, comprehensive emergency management approach addressing every type of disaster to minimize the effect on the public's health. An instructional systems design process was used to guide the development of audience-appropriate competencies and performance objectives. Participants, representing multiple academic and provider organizations, used a modified Delphi approach to achieve consensus on recommendations. A framework of 19 content categories (domains), 19 core competencies, and more than 90 performance objectives was developed for acute medical care personnel to address the requirements of effective all-hazards disaster response. Creating disaster curricula and training based on the core competencies and performance objectives identified in this article will ensure that acute medical care personnel are prepared to treat patients and address associated ramifications/consequences during any catastrophic event.
Increasing numbers of advanced practice nurses who practice within the WOC specialty are challenged by the need to justify their role by demonstrating clinical and fiscal benefits to the employing agency. This View From Here column describes the steps I took while completing such an analysis for a position for a nurse practitioner with WOC certification in upstate New York. PMID:24918767
Nickless, Lesley J
The increase in patient acuity in primary and secondary settings is continuing, with a corresponding increase in the need for technological competence in these areas. Evidence, however, both nationally and internationally, suggests that these expectations are not being met. This paper offers a review of the literature on acute care, with a specific focus on pre-registration nursing students and the development of acute care skills. Three themes are discussed: factors contributing to the acute care skills deficit, the knowledge and skills required to work in acute care and strategies used to support the acquisition of acute care skills. In response to the review, and based upon the evidence-based solutions identified, the clinical skills team at Bournemouth University designed and developed two teaching sessions, using simulation and role play to support the acquisition of acute care skills in pre-registration students. Student evaluations identify that their knowledge, competence and confidence in this area have increased following the teaching sessions, although caution remains regarding transferability of these skills into the practice environment.
Kalisch, Beatrice J; Lee, Kyung Hee
Previous studies have shown that missed nursing care is a significant problem in acute care hospitals. Other studies have demonstrated that teamwork is a critical element in assuring patient safety and quality of care. The purpose of this study was to determine if the level of nursing teamwork impacts the extent and nature of missed nursing care. A sample of 2 216 nursing staff members on 50 acute care patient care units in 4 hospitals completed the Nursing Teamwork Survey and the MISSCARE Survey. The response rate was 59.7%. Controlling for occupation of staff members (eg, RN/LPN, NA) and staff characteristics (eg, education, shift worked, experience, etc), teamwork alone accounted for about 11% of missed nursing care. The results of this study show that the level of nursing teamwork impacts the nature and extent of missed nursing care. The study results point to a need to invest in methods of enhancing teamwork in these settings.
Schofield, Irene; Tolson, Debbie; Fleming, Valerie
Delirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease-based classification systems and clinical guidelines. There is little systematic study of nurses' day-to-day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses' care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses' language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person-centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion.
Caine, R M
Mentoring is an active process that is currently receiving widespread attention in education, in the corporate world, and increasingly in health care. Job satisfaction of the critical care nurse may be related to the fulfillment of personal needs and goals. The attainment of these needs and goals ultimately will lead to increased job productivity, which in turn will promote cost-effectiveness, an outcome cherished by management. Therefore, recognizing the worth of job satisfaction to the institution and the possibility that mentoring may have an effect on it among the professional staff may be a key to the future of improved health care and cost reduction in an increasingly specialized and technologic health care environment. Certainly, the nursing shortage is no longer news to the lay public or those of us engaged in the practice of nursing. In critical care that shortage is acutely apparent. Attrition of qualified critical care nurses is increasing and various solutions to the shortage have been proposed, some being met with more enthusiasm than others. A more basic solution might be to answer the question, "How can we maintain a high quality of patient care while promoting job satisfaction and instilling a sense of self-worth within the critical care nurse?" Critical care nurses need to play a pivotal role in nurturing and developing other critical care nurses as a means to retain those individuals. How can they do that effectively? Mentoring is one answer.
Shamian, J; Kerr, M S; Laschinger, H K; Thomson, D
The purpose of this study was to explore the relationship between hospital-level indicators of the work environment and aggregated indicators of health and well-being amongst registered nurses working in acute-care hospitals in Ontario, Canada. This ecological analysis used data from a self-reported survey instrument randomly allocated to nurses using a stratified sampling approach. Multivariable linear regression models were used to examine hospital-level associations for burnout, musculoskeletal pain, self-rated general health, and absence due to illness. The unit of analysis was the hospital (n = 160), with individual nurse responses (n = 6,609) aggregated within hospitals. After controlling for basic differences in nurse workforces, including mean age and education, higher (better) work-environment scores were found to be generally associated with higher health-indicator scores, while a larger proportion of full-time than part-time nurses was found to be associated with lower (poorer) health scores. This study may provide direction for policy-makers in coping with the recruitment and retention of nursing staff in light of the current nursing shortage.
Navarro Aldana, M C
The presence of Acute Pulmonary Edema represents a severe emergency condition that requires immediate and efficient treatment; otherwise, imminent death of the patient occurs. Therefore it is of utter importance to perform frequent reviews of the literature to keep up with the newest procedures to warrant the best quality nursing care of our patients. This article reviews the physiopathology, clinical manifestations, and medical treatment of the Acute Pulmonary Edema, emphasizing on the nursing aspects of the treatment and pointing out the need to treat the predisposing cardiac alteration as soon as possible.
Bally, Jill M G
High rates of retirement among older nurses and horizontal violence among younger nurses heighten the importance of mentoring in the context of overall organizational stability and performance. Viewing the essentials of mentoring in the context of organizational culture and leadership as a long-term commitment and solution rather than a short-term task will lead to improved staff retention, satisfaction, and, ultimately, patient outcomes. Using Bass's four leadership initiatives, a culture for mentoring can be achieved through inspirational motivation, individualized consideration, idealized influence, and intellectual stimulation. Alignment of organizational and mentoring goals is essential to a successful approach given that the qualities associated with leadership and mentorship are closely aligned. Mentoring cultures also depend upon elements of a stable infrastructure such as managerial and executive support, scheduling flexibility, incentives, and recognition. Transformational leadership practices are key to achieving the sustainable effects of mentoring programs that are rooted deeply in organizational culture.
Isobel, Sophie; Edwards, Clair
Without agreeing on an explicit approach to care, mental health nurses may resort to problem focused, task oriented practice. Defining a model of care is important but there is also a need to consider the philosophical basis of any model. The use of Trauma Informed Care as a guiding philosophy provides a robust framework from which to review nursing practice. This paper describes a nursing workforce practice development process to implement Trauma Informed Care as an inpatient model of mental health nursing care. Trauma Informed Care is an evidence-based approach to care delivery that is applicable to mental health inpatient units; while there are differing strategies for implementation, there is scope for mental health nurses to take on Trauma Informed Care as a guiding philosophy, a model of care or a practice development project within all of their roles and settings in order to ensure that it has considered, relevant and meaningful implementation. The principles of Trauma Informed Care may also offer guidance for managing workforce stress and distress associated with practice change.
Golden, Julia Rose
The role of the pediatric advanced practice registered nurse continues to evolve within the ever-changing field of health care. In response to increased demand for health care services and because of a variety of changes in the health care delivery system, nurse practitioner patient care teams are an emerging trend in acute care settings. Care provided by nurse practitioner teams has been shown to be effective, efficient, and comprehensive. In addition to shorter hospital stays and reduced costs, nurse practitioner teams offer increased quality and continuity of care, and improved patient satisfaction. Nurse practitioner patient care teams are well suited to the field of pediatric oncology, as patients would benefit from care provided by specialized clinicians with a holistic focus. This article provides health care professionals with information about the use of nurse practitioner patient care teams and implications for use in pediatric oncology.
Within health care, market forces increasingly determine what services have economic value. For nursing to survive this economic onslaught, nurses must clarify their values and roles. While nurses working in intensive care develop useful technical skills and normally work within a constructive multi-disciplinary team framework, they have a potentially unique contribution to care, focusing on the patient as a whole person rather than intervening to solve a problem. The need for both physiological and psychological care creates a need for holistic values, best achieved through humanistic perspectives. Humanistic nursing places patients as people at the centre of nursing care, as illustrated by the limitations of reality orientation compared with the potentials of validation therapy. Intensive care nurses asserting and developing such patient-centred roles offer a valuable way forward for nursing to develop into the 21st century.
Hakkarainen, Timo W.; Arbabi, Saman; Willis, Margaret M.; Davidson, Giana H.; Flum, David R.
Objectives To evaluate previously independent older patients discharged to skilled nursing facilities (SNFs) and identify risk factors for failure to return home and death and development of a predictive tool to determine likelihood of adverse outcome. Background Little is known about the likelihood of return to home, and higher than expected mortality rates in SNFs have recently been described, which may represent an opportunity for quality improvement. Methods Retrospective cohort of older hospitalized patients discharged to SNFs during 2007 to 2009 in 5 states using Centers for Medicare & Medicaid Services linked minimum data set data from SNFs. We assessed mortality, hospital readmission, discharge to home, and logistic regression models for predicting risk of each outcome. Results Of 416,997 patients, 3.8% died during the initial SNF stay, 28.6% required readmission, and 60.5% were ultimately discharged home. Readmission to a hospital was the strongest predictor of death in the years after SNF admission (unadjusted hazard ratio, 28.2; 95% confidence interval, 27.2–29.3; P < 0.001). Among all patients discharged to SNFs, 7.8% eventually died in an SNF and overall 1-year mortality was 26.1%. Risk factors associated with mortality and failure to return home were increasing age, male sex, increasing comorbidities, decreased cognitive function, decreased functional status, parenteral nutrition, and pressure ulcers. Conclusions A large proportion of older patients discharging to SNFs never return home. A better understanding of the natural history of patients sent to SNFs after hospitalization and risk factors for failure to return to home, readmission, and death should help identify opportunities for interventions to improved outcome. PMID:26445466
Kalisch, Beatrice J
Missed nursing care is a pervasive problem in acute care hospitals as is dysfunctional nursing teamwork. Given that teamwork has a significant impact on healthcare quality and patient safety, the author reports findings from a study that examined differences in perceptions between RNs and nursing assistants as to the extent of missed nursing care and the reasons for missing that care. Study findings point to a lack of essential elements of teamwork (ie, closed-looped communication, leadership, team orientation, trust, and shared mental models). The author analyzes what this reveals about teamwork between these 2 groups of nursing personnel who work side by side caring for the same patients and offers specific interventions.
Kalisch, Beatrice J; Landstrom, Gay; Williams, Reg Arthur
This study examines what and why nursing care is missed. A sample of 459 nurses in 3 hospitals completed the Missed Nursing Care (MISSCARE) Survey. Assessment was reported to be missed by 44% of respondents while interventions, basic care, and planning were reported to be missed by > 70% of the survey respondents. Reasons for missed care were labor resources (85%), material resources (56%), and communication (38%). A comparison of the hospitals showed consistency across all 3 hospitals. Associate degree nurses reported more missed care than baccalaureate-prepared and diploma-educated nurses. The results of this study lead to the conclusion that a large proportion of all hospitalized patients are being placed in jeopardy because of missed nursing care or errors of omission. Furthermore, changes in Center for Medicare and Medicaid Services (CMS) regulations which will eliminate payment for acute care services when any one of a common set of complications occurs, such as pressure ulcers and patient falls, point to serious cost implications for hospitals.
Atyeo, J; Sanderson, P M
The melodic alarm sound set for medical electrical equipment that was recommended in the International Electrotechnical Commission's IEC 60601-1-8 standard has proven difficult for clinicians to learn and remember, especially clinicians with little prior formal music training. An alarm sound set proposed by Patterson and Edworthy in 1986 might improve performance for such participants. In this study, 31 critical and acute care nurses with less than one year of formal music training identified alarm sounds while they calculated drug dosages. Sixteen nurses used the IEC and 15 used the Patterson-Edworthy alarm sound set. The mean (SD) percentage of alarms correctly identified by nurses was 51.3 (25.6)% for the IEC alarm set and 72.1 (18.8)% for the Patterson-Edworthy alarms (p = 0.016). Nurses using the Patterson-Edworthy alarm sound set reported that it was easier to distinguish between alarm sounds than did nurses using the IEC alarm sound set (p = 0.015). Principles used to construct the Patterson-Edworthy alarm sounds should be adopted for future alarm sound sets.
Ryan, Catherine; Powlesland, Jean; Phillips, Cynthia; Raszewski, Rebecca; Johnson, Alexia; Banks-Enorense, Kelly; Agoo, Victor C; Nacorda-Beltran, Rosalind; Halloway, Shannon; Martin, Kathleen; Smith, Lenore D; Walczak, Debra; Warda, Jane; Washington, Barbara J; Welsh, Julie
Limited research has been conducted on how nurses define or perceive "quality nursing care." We conducted focus groups to identify nurses' perceptions of quality care at a Midwestern academic medical center. Transcripts of the focus group sessions were analyzed using thematic analysis techniques, and 11 themes emerged: Leadership, Staffing, Resources, Timeliness, Effective Communication/Collaboration, Professionalism, Relationship-Based Care, Environment/Culture, Simplicity, Outcomes, and Patient Experience.
Costello, Joanne F; Sliney, Anne; MacLeod, Cindy; Carpentier, Michelle; Garofalo, Rebecca; Flanigan, Timothy
The Centers for Disease Control and Prevention (CDC) expanded HIV screening of adults ages 13-64 years in 2006 from risk based to routine. Early detection and treatment improve patient outcomes and prevent disease transmission. This article describes a pilot program in which nurses in an adult inpatient unit at an acute care hospital offer HIV testing to all patients ages 18-64 upon admission through standing orders. The pilot, Standing Orders for Routine Testing (SORT), is a response to changes in state law and regulations in the majority of states including Rhode Island, which have occurred following the CDC policy change. The SORT pilot involves collaboration with interdisciplinary partners and education of unit nurses.
Welton, John M; Zone-Smith, Laurie; Fischer, Mary H
The Centers for Medicare and Medicaid Services has begun an ambitious recalibration of the inpatient prospective payment system, the first since its introduction in 1983. Unfortunately, inpatient nursing care has been overlooked in the new payment system and continues to be treated as a fixed cost and billed at a set per-diem "room and board" fee despite the known variability of nursing intensity across different care settings and diagnoses. This article outlines the historical influences regarding costing, billing, and reimbursement of inpatient nursing care and provides contemporary evidence about the variability of nursing intensity and costs at acute care hospitals in the United States. A remedy is proposed to overcome the existing limitations of the Inpatient Prospective Payment System by creating a new nursing cost center and nursing intensity adjustment by DRG for each routine-and intensive-care day of stay to allow independent costing, billing, and reimbursement of inpatient nursing care.
Dikken, Jeroen; Hoogerduijn, Jita G; Lagerwey, Mary D; Shortridge-Baggett, Lillie; Klaassen, Sharon; Schuurmans, Marieke J
In clinical practice, identifying positive and negative attitudes toward older patients is very important to improve quality of care provided to them. The Older People in Acute Care Survey - United States (OPACS-US) is an instrument measuring hospital nurses attitudes regarding older patients. However, psychometrics have never been assessed. Furthermore, knowledge being related to attitude and behavior should also be measured complementing the OPACS-US. The purpose of this study was to assess structural validity and reliability of the OPACS-US and assess whether the OPACS-US can be complemented with the Knowledge about Older Patients-Quiz (KOP-Q). A multicenter cross sectional design was conducted. Registered nurses (n = 130, mean age 39,9 years; working experience 14,6 years) working in four general hospitals were included in the study. Nurses completed the OPACS-US section A: practice experiences, B: general opinion and the KOP-Q online. Findings demonstrated that the OPACS-US is a valid and reliable survey instrument that measures practice experiences and general opinion. Furthermore, the OPACS-US can be combined with the KOP-Q adding a knowledge construct, and is ready for use within education and/or quality improvement programs in the USA.
Hessels, Amanda J.; Flynn, Linda; Cimiotti, Jeannie P.; Cadmus, Edna; Gershon, Robyn R.M.
Objectives Missed nursing care is an emerging problem negatively impacting patient outcomes. There are gaps in our knowledge of factors associated with missed nursing care. The aim of this study was to determine the relationship between the nursing practice environment and missed nursing care in acute care hospitals. Methods This is a secondary analysis of cross sectional data from a survey of over 7.000 nurses from 70 hospitals on workplace and process of care. Ordinary least squares and multiple regression models were constructed to examine the relationship between the nursing practice environment and missed nursing care while controlling for characteristics of nurses and hospitals. Results Nurses missed delivering a significant amount of necessary patient care (10–27%). Inadequate staffing and inadequate resources were the practice environment factors most strongly associated with missed nursing care events. Conclusions This multi-site study examined the risk and risk factors associated with missed nursing care. Improvements targeting modifiable risk factors may reduce the risk of missed nursing care. PMID:27547768
Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an “ideal” nursing professional practice
Sherman, Deborah Witt
Describes the role and responsibilities of advanced-practice nurses in palliative care and nursing's initiative in promoting high-quality care through the educational preparation of these nurses. (JOW)
Johnson, C. Frances; Hales, Loyde W.
A study examined the effectiveness of the current inservice training process used to teach newly employed nurses at Bess Kaiser Medical Center to transfer nursing process theory to practice. Eighty-two of 102 recently hired registered nurses were included in the audit sample. The newly hired nurses, whose previous experience varied from less than…
... 42 Public Health 2 2014-10-01 2014-10-01 false Nursing care. 409.21 Section 409.21 Public Health... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.21 Nursing care. (a) Basic rule. Medicare pays for nursing care as posthospital SNF care when provided by or under the supervision of a...
... 42 Public Health 2 2011-10-01 2011-10-01 false Nursing care. 409.21 Section 409.21 Public Health... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.21 Nursing care. (a) Basic rule. Medicare pays for nursing care as posthospital SNF care when provided by or under the supervision of a...
... 42 Public Health 2 2012-10-01 2012-10-01 false Nursing care. 409.21 Section 409.21 Public Health... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.21 Nursing care. (a) Basic rule. Medicare pays for nursing care as posthospital SNF care when provided by or under the supervision of a...
... 42 Public Health 2 2013-10-01 2013-10-01 false Nursing care. 409.21 Section 409.21 Public Health... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.21 Nursing care. (a) Basic rule. Medicare pays for nursing care as posthospital SNF care when provided by or under the supervision of a...
Rochon, Andrea; Heale, Roberta; Hunt, Elena; Parent, Michele
The literature suggests that effective teamwork among patient care teams can positively impact work environment, job satisfaction and quality of patient care. The purpose of this study was to determine the perceived level of nursing teamwork by registered nurses, registered practical nurses, personal support workers and unit clerks working on patient care teams in one acute care hospital in northern Ontario, Canada, and to determine if a relationship exists between the staff scores on the Nursing Teamwork Survey (NTS) and participant perception of adequate staffing. Using a descriptive cross-sectional research design, 600 staff members were invited to complete the NTS and a 33% response rate was achieved (N=200). The participants from the critical care unit reported the highest scores on the NTS, whereas participants from the inpatient surgical (IPS) unit reported the lowest scores. Participants from the IPS unit also reported having less experience, being younger, having less satisfaction in their current position and having a higher intention to leave. A high rate of intention to leave in the next year was found among all participants. No statistically significant correlation was found between overall scores on the NTS and the perception of adequate staffing. Strategies to increase teamwork, such as staff education, among patient care teams may positively influence job satisfaction and patient care on patient care units.
López Díaz, Cristina
Handling a neurologically critical patient requires some necessary knowledge and aptitudes in order to avoid risks and complications which could worsen a patient's prognosis. To that end, in this article the author deals with two important points nursing personnel need to bear in mind: the distinct methods and catheters which can be used to monitor intracranial pressure, obtaining an important parameter for evaluation purposes and therapeutic follow-up on these patients, placing special emphasis on ventricular drainage and nursing care, and the operations nurses take when dealing with patients who present a risk of intracranial hypertension, setting up a protocol based on seven necessities in the Virginia Henderson model: breathing, elimination, temperature, hygiene and skin, feeding and hydration, mobility and safety. In each of these necessities, the author studies the problems these patients present, identifying them with a series of diagnoses according to NANDA (North American Nursing Diagnosis Association), and defining the care or nursing activities for each of them, which will prove essential to prevent cerebral ischemia after suffering a primary cerebral injury due to a "TCE"(Cranial Encephalic Trauma) hemorrhage, etc. Nurses' role in caring for neurologically critical patients proves to be of vital importance since these professionals must be capable of evaluating, preventing, controlling and identifying those risk situations which neurologically critical patients could present, avoiding possible complications, aiding their recuperation, and providing quality health care.
Steyer, Nathalia Helene; Oliveira, Magáli Costa; Gouvêa, Mara Regina Ferreira; Echer, Isabel Cristina; Lucena, Amália de Fátima
Objective To analyze the clinical profile, nursing diagnoses, and nursing care established for postoperative bariatric surgery patients. Method Cross-sectional study carried out in a hospital in southern Brazil with a sample of 143 patients. Data were collected retrospectively from electronic medical records between 2011 and 2012 and analyzed statistically. Results We found a predominance of adult female patients (84%) with class III obesity (59.4%) and hypertension (72%). Thirty-five nursing diagnoses were reported, among which the most frequent were: Acute Pain (99.3%), Risk for perioperative positioning injury (98.6%), and Impaired tissue integrity (93%). The most frequently prescribed nursing care were: to use protection mechanisms in the surgical patient positioning, to record pain as 5th vital sign, and to take vital signs. There was an association between age and comorbidities. Conclusion The nursing diagnoses supported the nursing care prescription, which enables the qualification of nursing assistance.
Daly, Donnelle; Matzel, Stephen Chavez
A transdisciplinary team is an essential component of palliative and end-of-life care. This article will demonstrate how to develop a transdisciplinary approach to palliative care, incorporating nursing, social work, spiritual care, and pharmacy in an acute care setting. Objectives included: identifying transdisciplinary roles contributing to care in the acute care setting; defining the palliative care model and mission; identifying patient/family and institutional needs; and developing palliative care tools. Methods included a needs assessment and the development of assessment tools, an education program, community resources, and a patient satisfaction survey. After 1 year of implementation, the transdisciplinary palliative care team consisted of seven palliative care physicians, two social workers, two chaplains, a pharmacist, and End-of-Life Nursing Consortium (ELNEC) trained nurses. Palomar Health now has a palliative care service with a consistent process for transdisciplinary communication and intervention for adult critical care patients with advanced, chronic illness.
Nurses are practising in a work environment which is sometimes difficult and which can affect their capacity to supervise students. They may sometimes find themselves taking out their frustration on these students. By being better trained in the specificities of adult learning, frontline professionals and tutors could find it easier to adopt a compassionate care attitude towards nursing students, an essential condition for the development of their skills.
Warelow, Philip; Edward, Karen-Leigh; Vinek, Jeanette
Caring is neither simply a set of attitudes or theories, nor does it comprise all that nurses do. Nursing care is determined by the way nurses use knowledge and skills to appreciate the uniqueness of the person they are caring for (changing the care noun into a caring verb). The purpose of this article is to present a range of contemporary nurse theorists' ideas on caring and to examine these ideas using the backdrop of nursing as practiced in both Australia and Canada to demonstrate a range of national and international similarities and theoretical beliefs. Caring relationships set up the conditions of trust that enable the one receiving the care to accept the help offered, underpinning the nurse-patient relationship or the therapeutic relationship. Caring is always specific and relational such as that found in the nurse-patient relationship. We believe that caring theory has much to offer nursing practice worldwide. Caring must be considered in the caring context because the nature of the caring relationship is central to most nursing interventions. Nurses need to be able to actually practice caring rather than just theorize about it-using caring theories to inform their practice.
Davis, Kimberly A; Rozycki, Grace S
At the center of the development of acute care surgery is the growing difficulty in caring for patients with acute surgical conditions. Care demands continue to grow in the face of an escalating crisis in emergency care access and the decreasing availability of surgeons to cover emergency calls. To compound this problem, there is an ever-growing shortage of general surgeons as technological advances have encouraged subspecialization. Developed by the leadership of the American Association for the Surgery of Trauma, the specialty of acute care surgery offers a training model that would produce a new breed of specialist with expertise in trauma surgery, surgical critical care, and elective and emergency general surgery. This article highlights the evolution of the specialty in hope that these acute care surgeons, along with practicing general surgeons, will bring us closer to providing superb and timely care for patients with acute surgical conditions.
Jeffs, Lianne; Nincic, Vera; White, Peggy; Hayes, Laureen; Lo, Joyce
A study was undertaken to gain insight into how nurse leaders are influencing the use of performance data to improve nursing care in hospitals. Two themes emerged: getting relevant, reliable, and timely data into the hands of nurses, and the leaders' ability to "connect the dots" in working with different stakeholders. Study findings may inform nurse leaders in their efforts to leverage data to transform nursing care.
Kalisch, Beatrice J; Doumit, Myrna; Lee, Kyung Hee; Zein, Joanna El
Missed nursing care refers to omission of standard required nursing care of patients in acute care hospitals. The objective of this study was to compare the amounts and reasons of missed nursing care, the level of nurse staffing, and job satisfaction between the United States and Lebanon. Several studies in the United States have shown that a significant amount of care is being missed. This study is designed to determine if Lebanon is experiencing a similar phenomenon and what reasons are given for missing nursing care. Findings support that a substantial amount of nursing care is missed in Lebanon, although less than that in the United States (t = 11.53, P < .001), that nurses in Lebanon were less satisfied with being a nurse than are nurses in the United States, and there was no difference in the identification of staffing resources as a reason for missed care in the 2 countries.
Woods, Landace W; Snow, Susan W
This article describes the design and results of a study to demonstrate the impact of telemonitoring on acute care hospitalization (ACH) and emergency department (ED) visit rates for a Medicare-certified home health agency (HHA). Sociodemographic characteristics did not significantly differ between patients in the baseline, control, and intervention groups. Patients in the telemonitoring group had a statistically lower rate of ACH and ED visit rates. Telemonitoring may be an effective strategy for HHAs to reduce hospitalization and ED visits for patients with cardiac and/or respiratory conditions.
Rask, Mikael; Aberg, Jonas
Nurses (registered nurses, RN, and licensed mental nurses, LMN) working in five Swedish forensic psychiatric units filled in a questionnaire designed for general psychiatric nursing, but modified for forensic use. In this report, data regarding how nursing care could contribute to improved care and the organizational changes needed and what knowledge the nurses need, in order to be able to meet the demands in the future, were analysed by means of content analysis. The salient findings were: (i) an interpersonal patient-nurse relationship based on trust, empathy, respect and responsibility for the patients' personal resources and knowledge seems to be the essence of nursing care and a way to improve care; and (ii) the nurses' educational needs emanate from different treatment modalities, how to perform different treatments, how to establish developing relationships and in-service training adapted to the ward-specific problems.
Peloquin, Susan; Carley, Annette; Bonifacio, Sonia L; Glass, Hannah C
Neonatal neurocritical care is an emerging subspecialty that combines the expertise of critical care medicine and neurology with that of nursing and other providers in an interprofessional team approach to care. Neurocritical care of the neonate has roots in adult and pediatric practice. It has been demonstrated that adults with acute neurologic conditions who are treated in a specialized neurocritical care unit have reduced morbidity and mortality, as well as decreased length of stay, lower costs, and reduced need for neurosurgical procedures. In pediatrics, neurocritical care has focused on various primary and secondary neurologic conditions complicating critical care that also contribute to mortality, morbidity, and duration of hospitalization. However, the concept of neurocritical care as a subspecialty in pediatric practice is still evolving, and evidence demonstrating improved outcomes is lacking. In the neonatal intensive care nursery, neurocritical care is also evolving as a subspecialty concept to address both supportive and preventive care and optimize neurologic outcomes for an at-risk neonatal patient population. To enhance effectiveness of this care approach, nurses must be prepared to appropriately recognize acute changes in neurologic status, implement protocols that specifically address neurologic conditions, and carefully monitor neurologic status to help prevent secondary injury. The complexity of this team approach to brain-focused care has led to the development of a specialized role: the neurocritical care nurse (neonatal intensive care nursery [NICN] nurse). This article will review key concepts related to neonatal neurocritical care and the essential role of nursing. It will also explore the emerging role of the NICN nurse in supporting early recognition and management of at-risk infants in this neonatal subspecialty practice.
Kowalski, Dorcas S.; And Others
Text, illustrations, and exercises are provided in this set of learning modules to teach nurses and nursing students various patient care skills. The first module, "How to Write a Nursing Care Plan" by Dorcas S. Kowalski, discusses three tasks in developing patient care plans: identifying and prioritizing a patient's needs, gathering…
Jackson, Susan E
The transformation of health care into managed care has raised many issues and concerns for nurse educators. The milieu in which nurses currently practice reflects the restructuring shaped by managed care principles. The shift from acute care to expanded community services has changed the way health care is provided within hospital settings. The organization of nursing programs has been affected by this shift, and the ramifications of these external forces on curriculum structure have altered the way nursing students are educated. This article presents research demonstrating the changes in the structure of the curricula for baccalaureate nursing education in 2001, which were caused by health care reform in effect since 1994.
Lehto, Rebecca H
A new diagnosis of lung cancer is a highly threatening experience that raises personally relevant existential issues and brings death-related thoughts and concerns to mind. Those issues can be very disturbing to patients, leading to distress and potentially to a lowered quality of life. The purpose of this article is to present to the practicing oncology nurse the types of existential and death-related concerns that patients with a new diagnosis of lung cancer may have. In addition, the article identifies practical strategies and resources for oncology nurses who can help patients accept and manage the normal but often distressing responses to a life-threatening diagnosis.
Castro, Emily; Click, Elizabeth; Douglas, Sara; Friedman, Isabel
Professionalism is paramount to the formation and functioning of new graduate critical care nurses. In this project, a sample of 110 new graduate nurses used a descriptive self-report electronic survey with Hall's Professionalism Inventory Scale. A great percentage of these new graduate critical care nurse fellows with high professionalism scores may be related to their participation in the Critical Care Nurse Fellowship orientation program. Perhaps, Nursing Professional Development specialists should incorporate classes on professional advancement planning for new graduate nurses.
This document consists of an instructor's manual and student manual for a nurse assistant curriculum. The instructor's manual provides answers to activity sheets and unit evaluations along with individual unit overviews. Suggested teaching strategies and audiovisual supplements are included for each lesson. The student manual contains eight units:…
Ball, Jane E; Murrells, Trevor; Rafferty, Anne Marie; Morrow, Elizabeth; Griffiths, Peter
Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’. Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p <0. 001). Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing. PMID:23898215
Piexak, Diéssica Roggia; Backes, Dirce Stein; Santos, Silvana Sidney Costa
The complex nursing care is essential for understanding the human being as unique and multidimensional. This study aimed at knowing what nursing care means to nurse-teachers in the perspective of complexity. It is a qualitative research, carried out with seven nurse-teachers of a nursing school from central Rio Grande do Sul, Brazil. Data were collected in November 2011, through focus group,from three meetings, systematized with themes which considered the objective of this study. Discursive text analysis was used for data analysis. Results evinced nursing care as unique construction that goes beyond a technical-prescriptive, punctual and linear care. It is concluded that nursing care cannot be conceived as a reductionist action, but as a unique construction, which involves interactions, reflections and self-knowledge.
Drennan, Vari; Andrews, Sarah; Sidhu, Rajinder; Peacock, Richard
There is increasing demand for nurses to work in primary care. This is driven in part by the need to retain current levels but also by the modernisation plans for primary care services, which require new roles for nurses, new ways of working and more nurses in primary care settings. While campaigns for increased recruitment of hospital nurses and doctors has been largely successful in recent years, primary care has still to see the impact. This article reports on a Department of Health (England) funded project that aimed to identify strategies and exemplars to assist primary care trusts (PCTs) and the workforce development confederations (WDCs) in strategic health authorities in attracting and retaining nurses to primary care at registered nurse level. It reports on the range of initiatives identified, the perceived benefits and challenges. It concludes by proposing a strategic model for planning for the recruitment and retention of primary care nurses.
Arling, Greg; Kane, Robert L.; Mueller, Christine; Bershadsky, Julie; Degenholtz, Howard B.
Purpose: The purpose of this study was to determine the relationship between nursing home staffing level, care received by individual residents, and resident quality-related care processes and functional outcomes. Design and Methods: Nurses recorded resident care time for 5,314 residents on 156 units in 105 facilities in four states (Colorado,…
Part of the FY 83 Army Study Program and intended to augment the FY 81 completed study titled ’ Nursing Care Hours Standards’ by providing valid and...reliable percentages for hospital patient nursing care unit requirements (i.e., direct care, indirect care, and non-productive time). These data
Coetzee, Minette; Britton, Margretta; Clow, Sheila E
The voice of clinical nurses is important to find and hear in the design of curricula. A participative action research project proposed to add this voice to the design of a new Critical Care Child Nursing programme at the University of Cape Town (UCT). Nurses' experiences of nursing critically ill children and their perceived learning needs in this context, were the central focus of the study. Participants were registered nurses working in the paediatric intensive care unit at the Red Cross Children's Hospital (a specialist hospital), which offers secondary and tertiary care in the Cape Town region and beyond. Data were gathered in five focussed group discussions. Findings indicate that the Critical Care Child Nurse needs not only a specialised knowledge base and acutely developed assessment skills, but also astute interpersonal skills. The nurse's professional identity and integration into the multidisciplinary team need exploring. Together with the development of interpersonal skills, the nurse needs to engage the child and family.
McHugh, Matthew D.; Stimpfel, Amy Witkoski
As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses’ reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses’ responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance. PMID:22911102
Van Bogaert, Peter; van Heusden, Danny; Timmermans, Olaf; Franck, Erik
Aim: To explore the mechanisms through which nurse practice environment dimensions, such as nurse–physician relationship, nurse management at the unit level and hospital management and organizational support, are associated with job outcomes and nurse-assessed quality of care. Mediating variables included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption. Background: Understanding how to support and guide nurse practice communities in their daily effort to answer complex care most accurate, alongside with the demand of a stable and healthy nurse workforce, is challenging. Design: Cross-sectional survey. Method: Based on earlier empirical findings, a structural equation model, designed with valid measurement instruments, was tested. The study population included registered acute care hospital nurses (N = 1201) in eight hospitals across Belgium. Results: Nurse practice environment dimensions predicted nurses’ ratings of job outcome variables as well as quality of care. Features of nurses’ work characteristics, e.g., perceived workload, decision latitude, social capital, and the three dimension of work engagement, played mediating roles between nurse practice environment and outcomes. A revised model, using various fit measures, explained 60% of job outcomes and 47% of nurse-assessed quality of care. Conclusion: The findings in this study show that nurse work characteristics as workload, decision latitude, and social capital, alongside with nurse work engagement (e.g., vigor, dedication, and absorption) influence nurses’ perspective of their nurse practice environment, job outcomes, and quality of care. The results underline aspects to considerate for various stakeholders, such as executives, nurse managers, physicians, and staff nurses, in setting up and organizing health care services. PMID:25431563
Mensik, Jennifer S
Nurse staffing in a world of health care reform and accountable care is uncertain and creates fear not only for the nurse leaders, but all RNs. As health care reform transforms the environment, so must the role and staffing of nurses. There is still not one right answer or agreed upon manner to nurse staffing of inpatient units. This leaves nurses free to imagine roles and staffing possibilities for the future across the continuum. Including all RNs in conversations, visioning, and problem solving for the future will best prepare the profession for our role in caring for our patients.
Lecordier, Didier; Jovic, Ljiljana
As a continuation of its work and of the seminar on nursing sciences education in 2014, the “Association de recherche en soins infirmiers” (Arsi) organized a seminar on the 3rd and-4th of June 2016 in Nantes entitled : “nursing : perspectives and foresights”. More than fifty participants from the francophone area representing various sectors of practice : clinical, teaching, management and students gathered to debate and produce benchmarks to support the development of nursing sciences in France and to draw future directions for clinical practice and training. The successive sessions made it possible to reflect, to confront opinions, to make proposals and to identify the terms of the problematic of care and nursing knowledge today and the methodological elements relating to foresight. At the end of this very creative seminar, new avenues of reflection emerged shifting our usual look at the nurse profession. Orientations for training and practice have been defined with different stakes depending on the level of training and professional commitment. The strong links between professional, scientific and academic discipline have also been clarified, highlighting the importance to hold a high theoretical and scientific requirement, rigorous clinical practice, strong professional commitment and effective leadership.
Gates, Michael G; Mark, Barbara A
Nursing scholars and healthcare administrators often assume that a more diverse nursing workforce will lead to better patient and nurse outcomes, but this assumption has not been subject to rigorous empirical testing. In a study of nursing units in acute care hospitals, the influence of age, gender, education, race/ethnicity, and perceived value diversity on nurse job satisfaction, nurse intent to stay, and patient satisfaction were examined. Support was found for a negative relationship between perceived value diversity and all outcomes and for a negative relationship between education diversity and intent to stay. Additionally, positive relationships were found between race/ethnicity diversity and nurse job satisfaction as well as between age diversity and intent to stay. From a practice perspective, the findings suggest that implementing retention, recruitment, and management practices that foster a strong shared value system among nurses may lead to better workplace outcomes.
Espinosa, Laura; Young, Anne; Symes, Lene; Haile, Brenda; Walsh, Teresa
At least 1 in 5 Americans die while using intensive care service-a number that is expected to increase as society ages. Many of these deaths involve withholding or withdrawing life-sustaining therapies. In these situations, the role of intensive care nurses shifts from providing aggressive care to end-of-life care. While hospice and palliative care nurses typically receive specialized support to cope with death and dying, intensive care nurses usually do not receive this support. Understanding the experiences of intensive care nurses in providing care at the end of life is an important first step to improving terminal care in the intensive care unit (ICU). This phenomenological research study explores the experiences of intensive care nurses who provide terminal care in the ICU. The sample consisted of 18 registered nurses delivering terminal care in an ICU that participated in individual interviews and focus groups. Colaizzi's steps for data analysis were used to identify themes within the context of nursing. Three major themes consisted of (1) barriers to optimal care, (2) internal conflict, and (3) coping. Providing terminal care creates significant personal and professional struggles among ICU nurses.
The increasing number of ethical issues highlighted in everyday nursing care demonstrates the connectedness between nursing ethics and nursing practice. However, what is the role of ethical theories in this context? This question will be examined in this article by analysing the contribution made by the ethics of care, in particular in understandings of gender roles, asymmetries of power, professional knowledge and experience. The adoption and criticism of an emergent nursing ethics is discussed and stated from different viewpoints. The actuality of the caring approach is affirmed by a new reading of the given situation. This article first describes the traditional perception of nurses as marginalised actors in the health sector. By making reference to the current and growing global scarcity of nursing care, it contends that nursing will no longer be marginalised, but instead at the centre of public health attention and reputation. Nevertheless, marginalisation will persist by increasingly affecting the care receivers, especially those groups that are pushed to the fringes by the consequences of the healthcare market, such as persons of extreme old age, suffering from multiple morbidities, or with poor health literacy. Whereas the "classical" understanding of the ethics of care focuses on the nurse-patient relationship and on individual care and understanding of ethics, the new understanding confirms the classical, but adds an understanding of social ethics: caring for the access to care is seen as a main ethical goal of social justice within a nursing ethic.
Anderson, Jane A; Willson, Pamela
Almost everything we do in nursing is based on our knowledge. In 1984, Benner (From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984) described nursing knowledge as the culmination of practical experience and evidence from research, which over time becomes the "know-how" of clinical experience. This "know-how" knowledge asset is dynamic and initially develops in the novice critical care nurse, expands within competent and proficient nurses, and is actualized in the expert intensive care nurse. Collectively, practical "know-how" and investigational (evidence-based) knowledge culminate into the "knowledge of caring" that defines the profession of nursing. The purpose of this article is to examine the concept of knowledge management as a framework for identifying, organizing, analyzing, and translating nursing knowledge into daily practice. Knowledge management is described in a model case and implemented in a nursing research project.
The definition of a pressure ulcer remains very academic. It results from tissue necrosis following ischemia through prolonged arteriolar constriction between two hard surfaces progressing in stages. The nursing care and the use of dressings are therefore adapted to each stage. Today, the treatment of pressure ulcers is complex due to the large number of categories of dressings available. Moreover, the choice of the dressing must take into account the specificities of elderly patients. However, certain basic principles remain essential.
Cook, Patricia R.; Cullen, Janice A.
An associate nursing degree program threads caring across the curriculum using Watson's framework of interpersonal/transpersonal processes for caring and a taxonomy of affective competencies. Ways of caring are integrated into classroom and clinical experiences. (Contains 20 references.) (SK)
Labrague, Leodoro J; McEnroe-Petitte, Denise M; Achaso, Romeo H; Cachero, Geifsonne S; Mohammad, Mary Rose A
This study was to explore the perceptions of Filipino nurses' spirituality and the provision of spiritual nursing care. A descriptive, cross-sectional, and quantitative study was adopted for this study. The study was conducted in the Philippines utilizing a convenience sample of 245 nurses. Nurses' Spirituality and Delivery of Spiritual Care (NSDSC) was used as the main instrument. The items on NSDSC with higher mean scores related to nurses' perception of spirituality were Item 7, "I believe that God loves me and cares for me," and Item 8, "Prayer is an important part of my life," with mean scores of 4.87 (SD = 1.36) and 4.88 (SD = 1.34), respectively. Items on NSDSC with higher mean scores related to the practice of spiritual care were Item 26, "I usually comfort clients spiritually (e.g., reading books, prayers, music, etc.)," and Item 25, "I refer the client to his/her spiritual counselor (e.g., hospital chaplain) if needed," with mean scores of 3.16 (SD = 1.54) and 2.92 (SD = 1.59). Nurse's spirituality correlated significantly with their understanding of spiritual nursing care (r = .3376, p ≤ .05) and delivery of spiritual nursing care (r = .3980, p ≤ .05). Positive significant correlations were found between understanding of spiritual nursing care and delivery of spiritual nursing care (r = .3289, p ≤ .05). For nurses to better provide spiritual nursing care, they must care for themselves through self-awareness, self-reflection, and developing a sense of satisfaction and contentment.
Carroll, M; Maichele, J
Since the inception of the Social Security Amendments of 1983, nurses have assumed expanded roles in ensuring the monitoring of the quality of care received by Medicare beneficiaries. This unique area of nursing practice offers new challenges and employment opportunities for the nurse as a patient advocate. Nurses who are interested in this role may contact state PRO directors or watch for specific recruitment advertisements in nursing magazines.
Gustafsson, Christine; Fagerberg, Ingegerd; Asp, Margareta
Few research studies have focused on nurses' working conditions for caring provided at night, and these studies have mainly described nurses' work in hospital settings, not in a municipal, social-care context. In Swedish municipal care, nurses have responsibility for hundreds of older people in need of care. This working condition compromises caring encounters; instead the nurses' caring is mainly mediated through care staff (or relatives). In considering that caring based on caring encounters is fundamental to ethical nursing practice questions leads to the aim: to explore Swedish municipal night nurses' experiences of their working conditions for caring in nursing. All municipal night-duty nurses (n = 7) in a medium-sized community in Sweden participated in interviews, while six of them also wrote diaries. Thematic content analysis has been used in analysing the data. The findings revealed that the nurses experienced their working conditions for caring in nursing in the themes of Dependency in the Organisation and Other Staff, Vocational Responsibility, Deficiency in Conditions for Caring and Autonomous Caring. The findings illustrate privileged, as well as, poor working conditions for caring in nursing. The nurses' role as consultants emerge as their main function. The consultant function implies that nurses do not participate in ordinary bed-side caring, which makes it easier for them to find time for caring in situations that arise when nurses' skills, expertise and authority are called upon. Conversely the consultancy function entails short-term solution of complex caring problems, which can signify deficient caring due to prevailing working conditions. The findings also point to nurses' possible problems in fulfilling their own and vocational demands for ethics in the practice of caring in nursing related to existing working conditions.
Leonard, Barbara J; Fulkerson, Jayne A; Rose, Diane; Christy, Andrea
Maternal and child health (MCH) nurses are vital to caring for the nation's infants, children, and adolescents. A shortage of pediatric nursing educators has important consequences for the preparation of the next generation of MCH nurses. A Web-based survey of administrators and pediatric nursing faculty from U.S. schools of nursing with baccalaureate and advanced degree programs was conducted to assess perceptions of a pediatric nursing faculty shortage, and implications and solutions to such a shortage. Deans (n = 191) and pediatric faculty (n = 237) from schools of nursing responded to the survey. Institutions are representative of the 660 schools of nursing across the United States. Fifty percent of deans and 70% of pediatric nursing faculty members reported a shortage of pediatric nursing faculty. Large, public institutions (total school student enrollment over 15,000) expressed the most concern. The educational impact of the reported shortage included increased faculty workload, difficulty getting appropriate clinical practice settings, elimination of acute care clinical experiences, and reduction in pediatric content in curricula. Expected retirements of the current workforce (76% were over 45 years of age) without an increase in replacements will deepen the shortage in the coming decade. Pediatric faculty members focused on the need for competitive salaries (particularly compared to clinical salaries) and active mentoring programs as important factors in recruitment and retention of new faculty. Recommendations for stemming the decline in availability of pediatric nursing faculty are provided.
Welton, John M; Harper, Ellen M
Nursing care makes up one of the largest expenditures in the health care system, yet patient-level nursing intensity and costs are essentially unknown. Prior efforts to define nursing care value have been stymied by a lack of available data; however, emerging information from electronic health records provide an opportunity to measure nursing care in ways that have not been possible. New metrics using these data will allow improved measurement of cost, quality, and intensity at the level of each nurse and patient across many different settings which can be used to inform operational and clinical decision making. In this article, the initial results and recommendations of an expert panel tasked with defining and measuring nursing care value as part of a larger effort to address evolving issues related to big data and nursing knowledge development are described.
Caring outcomes in practice depend on a caring teaching-learning process. A transformation in thinking and practice in nursing education, that is congruent with the values of caring is essential to develop the kind of nurses that are needed in today's health care system. A project to implement caring as a nursing therapeutic with associate degree nursing students was initiated in a community college of Western New York in the fall of 1993. Watson's carative factors (1988) and Carper's ways of knowing (1978) were utilized as a framework to develop caring strategies to awaken a caring-consciousness among the students. The goals of the project were to provide a caring space for students to dialogue and share their stories and to experience themselves as caring and cared for; and to value and practice caring by implementing creative, knowledgeable, intentional actions for the ultimate good of the patient.
Brown, Kathleen; Iqbal, Sabah; Sun, Su-Lin; Fritzeen, Jennifer; Chamberlain, James; C. Mullan, Paul
Asthma is the most common chronic paediatric disease treated in the emergency department (ED). Rapid corticosteroid administration is associated with improved outcomes, but our busy ED setting has made it challenging to achieve this goal. Our primary aim was to decrease the time to corticosteroid administration in a large, academic paediatric ED. We conducted an interrupted time series analysis for moderate to severe asthma exacerbations of one to 18 year old patients. A multidisciplinary team designed the intervention of a bedside nurse initiated administration of oral dexamethasone, to replace the prior system of a physician initiated order for oral prednisone. Our baseline and intervention periods were 12 month intervals. Our primary process measure was the time to corticosteroid administration. Other process measures included ED length of stay, admission rate, and rate of emesis. The balance measures included rate of return visits to the ED or clinic within five days, as well as the proportion of discharged patients who were admitted within five days. No special cause variation occurred in the baseline period. The mean time to corticosteroid administration decreased significantly, from 98 minutes in the baseline period to 59 minutes in the intervention period (p < 0.01), and showed special cause variation improvement within two months after the intervention using statistical process control methodology. We sustained the improvement and demonstrated a stable process. The intervention period had a significantly lower admission rate (p<0.01) and emesis rate (p<0.01), with no unforeseen harm to patients found with any of our balance measures. In summary, the introduction of a nurse initiated, standardized protocol for corticosteroid therapy for asthma exacerbations in a paediatric ED was associated with decreased time to corticosteroid administration, admission rates, and post-corticosteroid emesis. PMID:28090325
Haloburdo, Esther P.; Thompson, Mary Ann
In the opinions of 11 Dutch nursing students on a study tour of the United States, the U.S. emphasizes technical aspects of nursing and medical over nursing care, lacks team nursing and collegiality, and has a litigious environment. These negative images have implications for the use of U.S. nursing as a benchmark for global education and…
In June 2008 the UK government, supported by the Royal College of Nursing, stated that nursing care would be measured for compassion. This paper considers the implications of this statement by critically examining the relationship of compassion to care from a variety of perspectives. It is argued that the current market-driven approaches to healthcare involve redefining care as a pale imitation, even parody, of the traditional approach of the nurse as "my brother's keeper". Attempts to measure such parody can only measure artificial techniques and give rise to a McDonald's-type nursing care rather than heartfelt care. The arguments of this paper, although applied to nursing, also apply to medicine and healthcare generally.
Living in an increasingly multicultural society, nurses are regularly required to care for employees from a variety of cultural backgrounds. An awareness of cultural differences focuses occupational health nurses on those differences and results in better employee care. This article explores the concept of culturally competent employee care, some of the non-verbal communication cues among cultural groups, models associated with completing a cultural assessment, and how health disparities in the workplace can affect delivery of employee care. Self-evaluation of the occupational health nurse for personal preferences and biases is also discussed. Development of cultural competency is a process, and occupational health nurses must develop these skills. By developing cultural competence, occupational health nurses can conduct complete cultural assessments, facilitate better communication with employees from a variety of cultural backgrounds, and improve employee health and compliance with care regimens. Tips and guidelines for facilitating communication between occupational health nurses and employees are also provided.
Monareng, Lydia V
Although the concept 'spiritual nursing care' has its roots in the history of the nursing profession, many nurses in practice have difficulty integrating the concept into practice. There is an ongoing debate in the empirical literature about its definition, clarity and application in nursing practice. The study aimed to develop an operational definition of the concept and its application in clinical practice. A qualitative study was conducted to explore and describe how professional nurses render spiritual nursing care. A purposive sampling method was used to recruit the sample. Individual and focus group interviews were audio-taped and transcribed verbatim. Trustworthiness was ensured through strategies of truth value, applicability, consistency and neutrality. Data were analysed using the NUD*IST power version 4 software, constant comparison, open, axial and selective coding. Tech's eight steps of analysis were also used, which led to the emergence of themes, categories and sub-categories. Concept analysis was conducted through a comprehensive literature review and as a result 'caring presence' was identified as the core variable from which all the other characteristics of spiritual nursing care arise. An operational definition of spiritual nursing care based on the findings was that humane care is demonstrated by showing caring presence, respect and concern for meeting the needs not only of the body and mind of patients, but also their spiritual needs of hope and meaning in the midst of health crisis, which demand equal attention for optimal care from both religious and nonreligious nurses.
Fukuda, Risa; Shimizu, Yasuko
Objective Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods This was a qualitative study using focus group interviews (FGIs). The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1–1.5 h. The qualitative synthesis method was used for data analysis. Results In total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital. Conclusions The two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a) the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b) nurses do their best to adapt to these conditions despite feeling conflicted. PMID:25716983
Lima, Ana Paula Souza; Chianca, Tânia Couto Machado; Tannure, Meire Chucre
OBJECTIVE: to analyze the efficacy of the Nursing Process in an Intensive Care Unit using indicators generated by software. METHOD: cross-sectional study using data collected for four months. RNs and students daily registered patients, took history (at admission), performed physical assessments, and established nursing diagnoses, nursing plans/prescriptions, and assessed care delivered to 17 patients using software. Indicators concerning the incidence and prevalence of nursing diagnoses, rate of effectiveness, risk diagnoses, and rate of effective prevention of complications were computed. RESULTS: the Risk for imbalanced body temperature was the most frequent diagnosis (23.53%), while the least frequent was Risk for constipation (0%). The Risk for Impaired skin integrity was prevalent in 100% of the patients, while Risk for acute confusion was the least prevalent (11.76%). Risk for constipation and Risk for impaired skin integrity obtained a rate of risk diagnostic effectiveness of 100%. The rate of effective prevention of acute confusion and falls was 100%. CONCLUSION: the efficacy of the Nursing Process using indicators was analyzed because these indicators reveal how nurses have identified patients' risks and conditions, and planned care in a systematized manner. PMID:26039293
Bakir, Ercan; Samancioglu, Sevgin; Kilic, Serap Parlar
The purpose of this study was to determine the experiences and perceptions of intensive care nurses (ICNs) about spirituality and spiritual care, as well as the effective factors, and increase the sensitivity to the subject. In this study, we examined spiritual experiences, using McSherry et al. (Int J Nurs Stud 39:723-734, 2002) Spirituality and spiritual care rating scale (SSCRS), among 145 ICNs. 44.8% of the nurses stated that they received spiritual care training and 64.1% provided spiritual care to their patients. ICNs had a total score average of 57.62 ± 12.00 in SSCRS. As a consequence, it was determined that intensive care nurses participating in the study had insufficient knowledge about spirituality and spiritual care, but only the nurses with sufficient knowledge provided the spiritual care to their patients.
Faeda, Marília Silveira; Perroca, Márcia Galan
ABSTRACT Objectives: analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions. Method: descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed. Results: 75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found. Conclusion: the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended. PMID:27508902
Providing spiritual care is an important foundation of nursing and is a requirement mandated by accreditation organizations. Spiritual care is essential in all clinical areas but particularly in home care and hospice. Clinicians may be unable to respond to spiritual needs because of inadequate education or the assumption that spiritual needs should be addressed by clergy, chaplains, or other "spiritual" care providers. In reality, clinicians in the home may be in the best position to offer spiritual support when caring for patients at home at end of life. The purpose of this pilot study was to examine relationships between spirituality and nurses' providing spiritual care. Professional nurses (n = 69) working in 2 large healthcare organizations completed the Perceptions of Spiritual Care Questionnaire. Approximately, 33% of the nurses worked in home care. Significant correlations were found among those nurses whose reported nursing education programs adequately prepared them to meet spiritual needs and taught ways to incorporate spiritual care into practice and those who did not.
Eliason, Michele J.
Argues that nursing practice and theory cannot be ethical unless cultural factors are taken into consideration and that ethical/transcultural nursing is central to the philosophy and practice of nursing. (Author)
In the extremely aged society, rehabilitation staff will be required to provide ample rehabilitation training for more stroke patients and more aged people with disabilities despite limitations in human resources. A nursing-care robot is one potential solution from the standpoint of rehabilitation. The nursing-care robot is defined as a robot which assists aged people and persons with disabilities in daily life and social life activities. The nursing-care robot consists of an independent support robot, caregiver support robot, and life support robot. Although many nursing-care robots have been developed, the most appropriate robot must be selected according to its features and the needs of patients and caregivers in the field of nursing-care.
Corbett, Lisa Q.
As the field of wound care advances and seeks validity as a distinctive healthcare specialty, it becomes imperative to define practice competencies for all related professionals in the arena. As such, the myriad nurses practicing wound care in settings across the continuum should be understood for their unique contribution to the wound care team. Furthermore, the hierarchy of wound care nursing with varying levels of licensure, certification, and scope of practice can be clarified to delineate leadership and reimbursement issues to meet current health care challenges. A review of the role of nursing in wound care from a historical and evolutionary perspective helps to characterize the trend towards advanced practice nursing in the wound care specialty. PMID:24527304
Califf, R.M.; Wagner, G.S.
This book contains 22 chapters. Some of the titles are: The measurement of acute myocardial infarct size by CT; Magnetic resonance imaging for evaluation of myocardial ischemia and infarction; Poistron imaging in the evaluation of ischemia and myocardial infarction; and New inotropic agents.
Schoenman, Julie A.; Mueller, Curt D.
Under the Medicare post-acute-care (PAC) transfer policy, acute-care hospitals are reimbursed under a per-diem formula whenever beneficiaries are discharged from selected diagnosis-related groups (DRGs) to a skilled nursing facility, home health care, or a prospective payment system (PPS)-excluded facility. Total per-diem payments are below the…
Nursing is widely considered as an art and a science, wherein caring forms the theoretical framework of nursing. Nursing and caring are grounded in a relational understanding, unity, and connection between the professional nurse and the patient. Task-oriented approaches challenge nurses in keeping care in nursing. This challenge is ongoing as professional nurses strive to maintain the concept, art, and act of caring as the moral center of the nursing profession. Keeping the care in nursing involves the application of art and science through theoretical concepts, scientific research, conscious commitment to the art of caring as an identity of nursing, and purposeful efforts to include caring behaviors during each nurse-patient interaction. This article discusses the profession of nursing as an art and a science, and it explores the challenges associated with keeping the care in nursing.
Varton, Deborah M.
A description is provided of a course, "Nursing in the Pediatric Intensive Care Unit," offered for senior-level baccalaureate degree nursing students. The first section provides information on the place of the course within the curriculum, the allotment of class time, and target student populations. The next section looks at course content in…
Trinier, Ruth; Liske, Lori; Nenadovic, Vera
Variability in parameters such as heart rate, respiratory rate and blood pressure defines healthy physiology and the ability of the person to adequately respond to stressors. Critically ill patients have lost this variability and require highly specialized nursing care to support life and monitor changes in condition. The critical care environment is a dynamic system through which information flows. The critical care unit is typically designed as a tree structure with generally one attending physician and multiple nurses and allied health care professionals. Information flow through the system allows for identification of deteriorating patient status and timely interventionfor rescue from further deleterious effects. Nurses provide the majority of direct patient care in the critical care setting in 2:1, 1:1 or 1:2 nurse-to-patient ratios. The bedside nurse-critically ill patient relationship represents the primary, real-time feedback loop of information exchange, monitoring and treatment. Variables that enhance information flow through this loop and support timely nursing intervention can improve patient outcomes, while barriers can lead to errors and adverse events. Examining patient information flow in the critical care environment from a dynamic systems perspective provides insights into how nurses deliver effective patient care and prevent adverse events.
Cleary, Michelle; Horsfall, Jan; O'Hara-Aarons, Maureen; Hunt, Glenn E
How the principles of a recovery-oriented mental health service are incorporated in the day-to-day nursing practice of mental health nurses in inpatient settings is unclear. In this study, we interviewed 21 mental health nurses working in acute inpatient mental health units about a range of recovery-focused topics. Three overlapping themes were identified: (i) the perception of recovery; (ii) congruent humanistic approaches; and (iii) practical realities. Only four interviewees had some formal training about recovery. Most respondents recognize that positive attitudes, person-centred care, hope, education about mental illness, medication and side-effects, and the acknowledgement of individual recovery pathways are necessary to prevent readmission, and are central to a better life for people who live with a mental illness. This research supports the view that ideas and practices associated with the recovery movement have been adopted to some degree by nurses working at the acute end of the services continuum. However, most saw the recovery orientation as rhetoric rather than as an appropriately resourced, coordinated, and integrated program. These nurses, however, speak of much more detailed aspects of working with patients and being required to prepare them for the exigencies of living in the community post-discharge.
Grant, Marcia; Economou, Denice; Ferrell, Betty
Oncology nurses are playing an important role in the provision of survivorship care. Their involvement includes educating and coordinating multidiscipline teams to initiate and provide care to patients and families. Oncology nurses participate in this evolving model of care in a variety of ways. Using the IOM report recommendations for the provision of quality cancer care nurses provide care based on the specific characteristics of individual health care settings and the populations they serve. Evaluating the settings resources and goals for desired survivorship activities as part of the planning process can be the difference between success and failure. Collaborating with local and national resources for cancer survivors can help expand services for a setting in an efficient and cost effective manner. Models of care vary and resources and communication differs among cancer care settings. Survivorship care differs as a result, across different models. Nurses are key to the dissemination and coordination of survivorship activities and are critical in facilitating communication between health care providers, the patients and caregivers. Nurses have a significant role in the dissemination and coordination of information between the patient and other health care providers. Oncology care does not end when treatment ends. PMID:21112849
Sullivan, Debra Henline
Technology is rapidly changing the way nurses deliver patient care. The Health Information Technology for Economic and Clinical Health Act of 2009 encourages health care providers to implement electronic health records for meaningful use of patient information. This development has opened the door to many technologies that use this information to streamline patient care. This article explores current and new technologies that nurses will be working with either now or in the near future.
Carl, David L.; And Others
The attitudes and perceptions of practicing nurses, student nurses, and nurse educators toward computerization of health care were assessed using questionnaires sent to two general hospitals and five nursing education programs. The sample consisted of 83 first-year nursing students, 84 second-year nursing students, 52 practicing nurses, and 26…
Ritmala-Castren, Marita; Virtanen, Irina; Leivo, Sanna; Kaukonen, Kirsi-Maija; Leino-Kilpi, Helena
This study aimed to describe the quality of sleep of non-intubated patients and the night-time nursing care activities in an intensive care unit. The study also aimed to evaluate the effect of nursing care activities on the quality of sleep. An overnight polysomnography was performed in 21 alert, non-intubated, non-sedated adult patients, and all nursing care activities that involved touching the patient were documented by the bedside nurse. The median (interquartile range) amount of sleep was 387 (170, 486) minutes. The portion of deep non-rapid-eye-movement (non-REM) sleep varied from 0% to 42% and REM sleep from 0% to 65%. The frequency of arousals and awakenings varied from two to 73 per hour. The median amount of nursing care activities was 0.6/h. Every tenth activity presumably awakened the patient. Patients who had more care activities had more light N1 sleep, less light N2 sleep, and less deep sleep. Nursing care was often performed while patients were awake. However, only 31% of the intervals between nursing care activities were over 90 min. More attention should be paid to better clustering of care activities.
Siela, Debra; Twibell, K Renee; Keller, Vicki
Nurses are needed more than ever to support the healthcare needs of every American. Nurses make up the greatest single component of hospital staff. In 2004, of the almost 3 million nurses in the United States, 83% were employed in nursing, and 58% of those were employed full-time. However, a severe shortage of nurses exists nationwide, putting the safe, effective healthcare of Americans in jeopardy. The concurrent shortage of nursing faculty has significant impact on the potential for admitting and graduating sufficient numbers of nursing students to address the shortage of prepared nurses. A close examination of the demographics of the 3 million nurses provides a context for an in-depth discussion of strategies that critical care nurses can employ to help alleviate the nursing and nurse faculty shortages.
Grindel, Mary E; Grindel, Cecelia Gatson
The increasing incidence of morbid obesity suggests that the quantity of bariatric surgical procedures will continue to multiply each year. Bariatric surgery has become an accepted approach to weight management with the additional benefit of resolution of several co-morbidities. However, quality nursing care and effective patient teaching are essential to achieve positive patient outcomes. Nursing care along the continuum of the bariatric surgical experience is key to positive outcomes for these patients. Throughout the process from selection for surgery to follow-up visits in the physician's office, the nurse can have a significant impact on the response of the patient and family to the surgical procedure. During the selection process, the nurse can explain the required diagnostic tests and their rationale and conduct a thorough medical history, informing the physician of pertinent information that might affect the patient's outcomes. Patient and family teaching begins at this stage with information about the peri-operative experience. Bariatric surgery results in a major lifestyle change for the patient. This change will evolve over time as weight is lost, and the patient adjusts to changes in eating patterns, body image, and the perceptions of others. The nurse should see that the patient has appropriate referral information for support services and should follow up to see that the patient and family availed themselves of these services. The patient's stay in acute care is usually very short. Clearly the patient and family need to go home with specific information about drinking/eating, caring for drainage tubes, skin and wound care, ambulation, self-care, and signs and symptoms that require medical attention. Nursing care should include written information and demonstrations of such activities as care of the wounds and drains. The nurse should assure that the patient leaves the hospital with a call number if questions arise at home. Ideally the nurse, patient
Pryor, Claire; Clarke, Amanda
Nursing and healthcare is changing in response to an ageing population. There is a renewed need for holistic nursing to provide clinically competent, appropriate and timely care for patients who may present with inextricably linked mental and physical health requirements. This article explores the dichotomy in healthcare provision for 'physical' and 'mental' health, and the unique role nurses have when caring for people with delirium superimposed on dementia (DSD). Delirium is prevalent in older people and recognised as 'acute brain failure'. As an acute change in cognition, it presents a unique challenge when occurring in a person with dementia and poses a significant risk of mortality. In this article, dementia is contrasted with delirium and subtypes of delirium presentation are discussed. Nurses can recognise DSD through history gathering, implementation of appropriate care and effective communication with families and the multidisciplinary team. A simple mnemonic called PINCH ME (Pain, INfection, Constipation, deHydration, Medication, Environment) can help identify potential underlying causes of DSD and considerations for care planning. The mnemonic can easily be adapted to different clinical settings and a fictitious scenario is presented to show its application in practice.
Tirgari, Batool; Iranmanesh, Sedigheh; Ali Cheraghi, Mohammad; Arefi, Ali
Spiritual care is an essential component in nursing practice and strongly influenced by the sociocultural context. This article aimed to elucidate the meaning of nurses' experiences of giving spiritual care in southeast of Iran. A phenomenological hermeneutic approach influenced by Ricoeur was used. Eleven staff nurses who were currently working in the 3 major hospitals under the umbrella of the Kerman University of Medical Sciences were interviewed. The meaning of spiritual care was comprehensively understood as meeting patient as a unique being. This can be divided into 3 themes: meeting patient as a being in relationship, meeting patient as a cultural being, and meeting patient as a religious being. The results in this study suggest that education about spirituality and spiritual care should be included in the continuous and in-service education of registered nurses. Spiritual and cultural assessment criteria should be included in this education to improve the provision of holistic care.
Puplampu, Gideon L; Olson, Karin; Ogilvie, Linda; Mayan, Maria
Attracting and retaining nurses in HIV care is essential to treatment success, preventing the spread of HIV, slowing its progression, and improving the quality of life of people living with HIV. Despite the wealth of studies examining HIV care, few have focused on the factors that influenced nurses' choices to specialize in HIV care. We examined the factors that attracted and retained eight nurses currently working in HIV care in two large Canadian cities. Participants were primarily women between the ages of 20 and 60 years. Interviews were conducted between November 2010 and September 2011 using interpretive description, a qualitative design. Factors that influenced participants to focus their careers in HIV care included both attracting factors and retaining factors. Although more research is needed, this exploration of attracting and retaining factors may motivate others to specialize in HIV nursing, and thus help to promote adequate support for individuals suffering from the disease.
The task of designing a new critical care unit is best accomplished with the input of people representing multiple disciplines including architects, engineers, physicians, nurses, and equipment manufacturers. It is imperative that the critical care nursing staff and management take an active role in planning the layout of the unit and patient rooms, as the nurses will be the bedside providers 24 hours a day. The new unit should be designed to offer efficient patient care as well as a healing, comfortable environment for both the patients and their families.
Namasivayam, Pathmavathy; Orb, Angélica; O'Connor, Margaret
Caring for families of the terminally ill is an important aspect of nursing care as nurses are considered the main health care professionals who are closest to families. This paper describes the experience of seven registered nurses caring for families of the terminally ill in Western Australia. Five of the nurses worked in an acute area at a public hospital; the other two nurses worked at long-term care settings at a private hospital. Descriptive phenomenology as described by Husserl (1970) was used to describe and explore nurses' lived experience. Data were collected through in depth interviews and analysed using the Colaizzi method. Four major themes are reported in this paper: 1) walking a journey together; 2) dealing with intense emotions; 3) working as a team; and 4) balancing the dimension of care. Nurses' lived experiences of caring for families of terminally ill patients revealed that nurses are confronted by families' emotions and at the same time needed to manage their own emotions. The findings further indicated that nurses play a significant role in caring for families of the terminally ill. The family's fear of losing their loved ones often resulted in conflicts, which required extra time from nurses. Moreover, some of the major barriers identified were time constraints and excessive workloads. Finally, some implications of the findings for registered nurses are discussed.
Sibbald, Bonnie; Laurant, Miranda G; Reeves, David
Nurses increasingly work as substitutes for, or to complement, general practitioners in the care of minor illness and the management of chronic diseases. Available research suggests that nurses can provide as high quality care as GPs in the provision of first contact and ongoing care for unselected patients. Reductions in cost are context dependent and rarely achieved. This is because savings on nurses' salaries are often offset by their lower productivity (due to longer consultations, higher patient recall rates, and increased use of tests and investigations). Gains in efficiency are not achieved when GPs continue to provide the services that have been delegated to nurses, instead of focusing on the services that only doctors can provide. Unintended consequences of extending nursing roles include loss of personal continuity of care for patients and increased difficulties with coordination of care as the multidisciplinary team size increases. Rapid access to care is, however, improved. There is a high capital cost involved in moving to multidisciplinary teams because of the need to train staff in new ways of working; revise legislation governing scope of practice; address concerns about legal liability; and manage professional resistance to change. Despite the unintended consequences and the high costs, extending nursing roles in primary care is a plausible strategy for improving service capacity without compromising quality of care or health outcomes for patients.
Can, Gulbeyaz; Erol, Ozgul
This descriptive study was planned in order to assess self-perceived sufficiency levels of nursing students at preparing nursing care plans and also determine the effect of these plans on students' occupational development. Sample of the study was consisted of 55 nursing students who were taking oncological training. Data were collected by using Personal Information Form and Student Care Plan Evaluation Form. Non-parametric tests were used in data analysis. Students perceived themselves 'insufficient' although assessing reproductive neurological and cardiovascular systems, respectively, and also interpreting results of hemogram and urine tests. No significant difference was found between the initial and last nursing care plans prepared by the students during clinical training. Sixty % of students reported that preparing and implementing nursing care plans had favourable effects on their occupational development. Results suggest that students should be well prepared before clinical training programmes and also nursing care plans should be revised and used in more proper and practical ways in order to enhance students' occupational development.
Eigsti, Janice E
Graduate nurse internship programs (NIPs) have existed for a number of years as tools for recruiting and retaining nurses. A recent literature review uncovers the rare NIP dedicated to orienting the graduate nurse to a critical care environment. Few have addressed the nurse interns' perceptions of these programs. Ongoing evaluation is vital to improving existing programs and giving credence to other hospitals with similar initiatives. A retrospective descriptive design study with the purpose of disclosing the critical care graduate nurse interns' perceptions of the critical care NIP at Elkhart General Hospital, a 330-bed community hospital in Elkhart, Indiana, provided information for this study. Patricia Benner's novice-to-expert model served as the theoretical framework. The critical care NIP questionnaire provided satisfaction scores for program components. Mean scores between groups were explored using the t test. Mean satisfaction score for the overall program was 5.62 (SD = 0.371), with a retention rate of 76.9% (20 of 26). Statistically significant differences in satisfaction scores were not found in this pilot study between nurse interns currently working in critical care and those who are not.
Wittenberg, Elaine; Ferrell, Betty; Goldsmith, Joy; Buller, Haley; Neiman, Tammy
Conversations about goals of care with the patient and family are a critical component of advanced practice in oncology. However, there are often inadequate team structures, training, or resources available to assist advanced practitioners in initiating these conversations. We conducted a study to assess nurses' perceived role and communication tasks in such conversations about goals of care. In a cross-sectional survey of 109 nurses attending a comprehensive 2-day end-of-life nursing education course, nurses were asked to describe how they would participate in a "goals of care" meeting in three different scenarios. They were also asked what changes they desired in their clinical settings. Nurses overwhelmingly described that their primary task and communication role was to assess patient/family understanding. Nurses referenced their team members and team support with the least frequency across scenarios. Team roles, structure, and process were reported as areas in greatest need of change in patient/family goals of care meetings. These findings demonstrate that lack of preparation to function as a team is a barrier for nurses in communicating about goals of care, and there is a demand to move such conversations upstream in oncology care.
Russell, J S
In the last few years, much medical-facility construction has been driven by what insurers want. Hospitals have built facilities for well-reimbursed procedures and closed money-losing ones. Health-maintenance organizations increasingly expect to hold down costs by making prepayment arrangements with doctors and their hospitals. President Clinton has pledged early action on health-care reform, which will likely change planners' priorities. Whether the nation goes to Clintonian "managed competition" or a Canadian-style nationwide single-payer system (the two most likely options), the projects on these pages reflect two large-scale trends that are likely to continue: the movement of more procedures from inpatient to outpatient facilities and the separation of treatment functions from ordinary office and administrative tasks so that the latter are not performed in the same high-cost buildings as technology-intensive procedures. Various schemes that make care more "patient-centered" have been tried and been shown to speed healing, even for outpatients, but such hard-to-quantify issues get short shrift in an era of knee-jerk cost containment. The challenge in tomorrow's healthcare universe--whatever it becomes--will be to keep these issues on the table.
VanFosson, Christopher A; Jones, Terry L; Yoder, Linda H
Performance measurement is a core administrative function and an essential component of organizational quality programs. The prevalence of performance measurement initiatives increased significantly after the release of the Institute of Medicine series on quality. Nursing performance measures are limited in their scope, resulting in an underrepresentation of process measures. Development of performance indicators that reflect how effectively organizational units actually transform nursing resources into nursing services should be a high priority. Unfinished nursing care is a nursing process performance measure that reflects the complexity of the nursing care environment and can be useful in comparing process performance across systems and organizations. Unfinished nursing care is congruent with many of the National Quality Forum requirements for endorsement and warrants further refinement as an important nurse-sensitive performance measure.
Serio-Melvin, Maria; Yoder, Linda H; Gaylord, Kathryn M
Nursing plays a critical role in the comprehensive burn care delivered at the US Army Institute of Surgical Research, otherwise known as the US Army's Burn Center serving the Department of Defense. This center serves as a model for burn units nationally and internationally. It also provides a challenging and innovative work environment for military and civilian nurses. Nurses in the Burn Center contribute to innovations in acute, rehabilitative, and psychological care for patients with burns. This article provides an overview of the complex nursing care provided to burn patients treated at the Burn Center.
Recommends choosing appropriate health care providers for camp, and referring to them by the title their credentials warrant. Explains distinctions among nursing titles and that they vary by state. Discusses developing a health care plan suited to camp's population, program, and location. Presents guidelines required of a health care plan by…
The question of secularism, long-time confined to schools and the relationships between the Church and State, is today being raised in the field of public health. Nurses are directly affected and are integrating this dimension of secularism into their care practices. A private practice nurse describes the effect these changes are having on her practice in patients' homes.
A patient's refusal of nursing care concerns the caregivers. Future professionals must be prepared for it and student nurses are trained to deal with such situations. It is also important to empower patients and support them in their choice. This article presents the example of the Haute École Robert Schuman in Libramont, Belgium.
Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.
Barra, Daniela Couto Carvalho; Waterkemper, Roberta; Kempfer, Silvana Silveira; Carraro, Telma Elisa; Radünz, Vera
Qualitative research whose purpose was to reflect and argue about the relationship between hospitality, care and nursing according to experiences of PhD students. The research was developed from theoretic and practical meeting carried through by disciplines "the care in Nursing and Health" of PhD nursing Program at Santa Catarina Federal University. Its chosen theoretical frame of Hospitality perspective while nursing care. Data were collected applying a semi-structured questionnaire at ten doctoral students. The analysis of the data was carried through under the perspective of the content analysis according to Bardin. Hospitality it is imperative for the individuals adaptation in the hospital context or any area where it is looking for health care.
Tønnessen, Siri; Nortvedt, Per; Førde, Reidun
The purpose of this study was to investigate nurses' decisions about priorities in home-based nursing care. Qualitative research interviews were conducted with 17 nurses in home-based care. The interviews were analyzed and interpreted according to a hermeneutic methodology. Nurses describe clinical priorities in home-based care as rationing care to mind the gap between an extensive workload and staff shortages. By organizing home-based care according to tight time schedules, the nurses' are able to provide care for as many patients as possible. Furthermore, legal norms set boundaries for clinical priority decisions, resulting in marginalized care. Hence, rationing care jeopardizes important values in the nurse-patient relationship, in particular the value of individualized and inclusive nursing care. The findings are highly relevant for clinical practice, since they have major implications for provision of nursing care. They revive debates about the protection of values and standards of care, and nurses' role and responsibility when resources are limited.
Wittenberg, Elaine; Ferrell, Betty; Goldsmith, Joy; Buller, Haley; Neiman, Tammy
Conversations about goals of care with the patient and family are a critical component of advanced practice in oncology. However, there are often inadequate team structures, training, or resources available to assist advanced practitioners in initiating these conversations. We conducted a study to assess nurses’ perceived role and communication tasks in such conversations about goals of care. In a cross-sectional survey of 109 nurses attending a comprehensive 2-day end-of-life nursing education course, nurses were asked to describe how they would participate in a "goals of care" meeting in three different scenarios. They were also asked what changes they desired in their clinical settings. Nurses overwhelmingly described that their primary task and communication role was to assess patient/family understanding. Nurses referenced their team members and team support with the least frequency across scenarios. Team roles, structure, and process were reported as areas in greatest need of change in patient/family goals of care meetings. These findings demonstrate that lack of preparation to function as a team is a barrier for nurses in communicating about goals of care, and there is a demand to move such conversations upstream in oncology care. PMID:28090365
This paper examines the aids and barriers to implementing the psychosocial interventions (PSI) which trainees learned on two teaching modules. The main purpose of the modules is to teach trainees PSI to help them be more effective in their care of patients with severe mental illness. The trainees were qualified nurses working in acute mental health wards in various London hospitals. PSI has been found to be helpful for patients with psychotic symptoms in community contexts. In this study, the implementation of PSI specific to acute inpatient mental health settings is explored. This was achieved by conducting semi-structured audiotaped interviews with all 20 trainees from a single cohort. The data were analysed by categories and themes to elicit not only the problems but also helpful strategies which can be used when working with PSI in acute inpatient mental health settings. The paper concludes by offering recommendations for future good practice for this area of mental health service.
Silva, Irene de Jesus; de Oliveira, Marilia Fátima Vieira; da Silva, Sílvio Eder Dias; Polaro, Sandra Helena Isse; Radünz, Vera; dos Santos, Evanguelia Kotzias Atherino; de Santana, Mary Elizabeth
This article presents a reflection about care, self-care and caring for oneself and establishes these issues' relations with the paradigms of totality and simultaneity. On the first part of the text, care and its general aspects are contextualized; the second part discusses about care in Martin Heidegger's philosophical perspective; the third part explores self-care on Dorothea Orem's conception; the fourth part considers Michel Foucault's care of oneself. And finally, the fifth part aims to establish the relationship between the concepts of self-care and care of oneself, and the totality and simultaneity paradigms. Self-care and care of oneself are connected to the objectivism of the totality, and to the subjectivism of the simultaneity. These subjects lead nursing to comprehend such paradigmatic inheritance and its implications on the nursing care.
Cheung, Robyn B.; Aiken, Linda H.; Clarke, Sean P.; Sloane, Douglas M.
Countries across the globe are experiencing nursing shortages. In hospitals, supportive practice environments have positive effects on both nurse and patient outcomes. However, these relationships have been established primarily in the US. International studies of the effects of nurse staffing levels and the practice environment on nurse outcomes and the quality of care mirror the findings from the US, thus raising these issues to the international level. The solutions that have been successful in the US for improving practice environment and patient outcomes are solutions that should be successful in any country, thus putting them on a global scale. The Magnet hospital program is one model that has been shown to improve nurse and patient outcomes and is one solution to the shortage of hospital nurses. PMID:18218265
Palese, Alvisa; Ambrosi, Elisa; Prosperi, Letizia; Guarnier, Annamaria; Barelli, Paolo; Zambiasi, Paola; Allegrini, Elisabetta; Bazoli, Letizia; Casson, Paola; Marin, Meri; Padovan, Marisa; Picogna, Michele; Taddia, Patrizia; Salmaso, Daniele; Chiari, Paolo; Marognolli, Oliva; Canzan, Federica; Gonella, Silvia; Saiani, Luisa
Missed nursing care (MNC), such as nursing care omitted or delayed, has not been measured in the Italian context where several cost containment interventions affect the care offered in medical units. The aim of the study is to identify the amount, type, and reasons for MNC in the Italian medical care setting and to explore the factors that affect the occurrence of MNC. A 3-month longitudinal survey was carried out followed by a cross-sectional study design in 12 north eastern acute medical units. A total of 314 nursing staff members were involved. Multivariate logistic regression was performed to identify the predictors of MNC. Patient ambulation (91.4 %), turning the patient every 2 h (74.2 %), and right timing in administering medications (64.6 %) were the most perceived MNC. Among the most frequent reasons were the unexpected rise in patient volume or critical conditions (95.2 %), inadequate numbers of staff (94.9 %), and large numbers of admissions/discharges (93.3 %). The R (2) 33.2 % of the variance in MNC were explained by a full-time position (OR 4.743, 95 % CI 1.146-19.629), communication tensions between Registered Nurses and Nurses' Aides (OR 1.601, 95 % CI 1.020-2.515), the amount of experience in medical unit (OR 1.564, 95 % CI 1.021-2.397), and the amount of daily care offered by Nurses' Aides (1.039, 95 % CI 1.011-1.067). A substantial amount of basic and clinically relevant nursing interventions was perceived to be missed, and this may lead to an increase in negative outcomes for patients admitted to a medical unit. Appropriate standards of nursing care should be adopted urgently in medical units aiming to protect frail patients.
Kutzen, H S
Nurses in AIDS care need to support patients and promote patient autonomy throughout the continuum of HIV/AIDS. Nurses are essential for assisting patients and family members in making difficult treatment decisions, including choices regarding death. Discussions of end of life issues should be postponed until the patient demonstrates active signs and symptoms of approaching death. These discussions require expert knowledge of subtle cues and knowledge of advancing disease, as well as options for improved symptom management without focusing on curative aspects of care. Through these discussions, the nurse empowers the family in decision making while realizing patients and loved ones are still faced with existential or spiritual crises, psychological pain, and grief associated with terminal illness. Towards the end of life, nursing contacts should increase and be armed with an understanding of palliative care planning with patients with advanced HIV disease.
Care means taking care, paying extreme attention to others in vulnerable situations, "helping and not hurting". Admitting that ethical care exists would require recognizing that there are also treatments which are not ethical. However, care can only be ethical.
Grøndahl, Vigdis Abrahamsen; Fagerli, Liv Berit
Purpose The purpose of this paper is to explore potential differences in how nursing home residents rate care quality and to explore cluster characteristics. Design/methodology/approach A cross-sectional design was used, with one questionnaire including questions from quality from patients' perspective and Big Five personality traits, together with questions related to socio-demographic aspects and health condition. Residents ( n=103) from four Norwegian nursing homes participated (74.1 per cent response rate). Hierarchical cluster analysis identified clusters with respect to care quality perceptions. χ(2) tests and one-way between-groups ANOVA were performed to characterise the clusters ( p<0.05). Findings Two clusters were identified; Cluster 1 residents (28.2 per cent) had the best care quality perceptions and Cluster 2 (67.0 per cent) had the worst perceptions. The clusters were statistically significant and characterised by personal-related conditions: gender, psychological well-being, preferences, admission, satisfaction with staying in the nursing home, emotional stability and agreeableness, and by external objective care conditions: healthcare personnel and registered nurses. Research limitations/implications Residents assessed as having no cognitive impairments were included, thus excluding the largest group. By choosing questionnaire design and structured interviews, the number able to participate may increase. Practical implications Findings may provide healthcare personnel and managers with increased knowledge on which to develop strategies to improve specific care quality perceptions. Originality/value Cluster analysis can be an effective tool for differentiating between nursing homes residents' care quality perceptions.
Gurfolino, V; Dumas, L
In this article, some differences are presented between hospice and home care nurses. Issues related to pain control, symptom management, and dehydration are highlighted. Emphasis is placed on the spiritual dimensions of hospice care and the holism implicit in its concept.
Team work is required in the treatment of the thermally injured patient--nursing staff being part of the team. The nurses are with the patient for 24 hours a day and they have to understand the objectives of all other members of the team involved in the treatment as well as thoroughly mastering their own work. For the nursing staff the care of the thermally injured patient is a challenge. The work demands strong motivation and interest--it includes at times painful treatment, isolation and also constant alertness. It is important that the nursing staff is given continuous training so that they are able to give the required care efficiently and to keep up active interest. Practical work is the best way of getting aquainted with the complex forms of treatment of the thermally injured patient. It also lessens the fear of a badly burned patient. Nursing care of the thermally injured patient consists of good basic care, local attention and active observation. The basic care consists of basic hygiene, diet, observation of the patient's psychological condition, giving emotional support, encouraging initiative physiotherapy and postural treatment.
Wako, Fumiko; Tsuru, Satoko; Omori, Miho; Watanabe, Chitose; Uchiyama, Makiko; Asada, Miwa; Inoue, Kikumi
A common language in nursing facilitates better communication among nurses and healthcare team, assuring better nursing care, hence better patient outcomes. As we developed and disseminated the standardized terminology of nursing which provided nurses with a set of terms to describe nursing observations and nursing actions, we developed a certain number of nursing care plans using the terms in it. The nursing care plans included those for the patients requiring medical (pharmaceutical)/surgical procedures or the patients showing some signs and symptoms. Generally, nurses found that the nursing care plans were useful and flexible enough to allow for the modification according to the needs of each individual patient. In conclusion, the nursing care plans based on the standardized terminology showed its relevance to the clinical settings.
Maintaining continence lies at the heart of a sense of adulthood and is essential to preserving dignity, a core and universal nursing value. This article explores the reasons why poor continence care was found at Mid Staffordshire Foundation Trust, the changes to the culture of the health service that led to it, and why it is so important for nurses to maintain patients' dignity. Recommendations for changing this culture in the future are discussed.
Georges, C Alicia; Bolton, Linda Burnes; Bennett, Crystal
The National Black Nurses Foundation commissioned a research project to determine the effect of the nursing shortage on African-American communities. The W.K. Kellogg Foundation funded the project as part of a multiphase project aimed at identifying issues related to the nursing shortage among ethnic people of color communities and developing policy recommendations around the supply of nurses to serve those communities. The study was conducted over a six-month period by the nursing research investigative team at Cedars-Sinai Medical Center and Burns and Allen Research Institute in Los Angeles, California. One hundred (N=100) nurse leaders from communities across the United States participated in the research. Each leader completed a questionnaire regarding the existence of the nursing shortage in their community and the effect of the shortage on access to services, clinical quality and the retention and recruitment of nurses. Leaders were queried on nurse vacancy and turnover within their communities, incidence of adverse events and the ability of institutions to meet the demands for nursing and health services in their communities. Forty-five percent of the organizations in the study were reported to be single facilities and 55% consisted of integrated health systems. Respondents identified five major issues resulting from nurse vacancies in their communities: closure of acute care beds or clinical services, delays in providing treatment to patients, inability to retain nurses due to increased workload and decreased nurse satisfaction, diminished capacity to address chronic health problems in their communities and increased incidence of adverse patient events. African-American nurse leaders reported higher rates of nurse vacancy and turnover; higher incidence of adverse events and greater difficulty providing access to health care than was reported in the literature. Nurse vacancy and turnover rates are higher than reported national averages. The study suggests
Negrisolo, Adriana; Brugnaro, Luca
In nursing practice, the ability to make decisions regarding patients and to act on them is considered to be an expression of the professional nursing role. Problems may arise when a nurses would like to perform an action they believe morally correct but which are conflictual with the habits, organization or politics of the health structure in which they work. This inevitably produces moral distress in nurses who feel impotent to act as they feel they should. Although a certain amount of moral distress is part and parcel of the nursing profession , when it is excessive or prolonged it may become unacceptable and culminate in burn-out and the relative consequences. The aim of the study was to compare the level of moral stress in 111 Italian nurses working in different Operative Units to identify those clinical situations significantly associated with moral stress using the MDS scale. Similarly to studies performed in the USA, the level of moral stress in the 3 different work contexts was moderate, although some clinical situations were related to significant stress levels.
French, Kempa S
Limited patient literacy contributes to poorer health status, increased emergency room and hospital use, higher morbidity and mortality rates, and less use of preventive health services. All patients, however, need health information that is accurate, accessible, and actionable to make informed decisions about their health. A universal health literacy precautions approach is recommended to empower patients through shared decision-making interactions. Consistent use of evidence-based health literacy practices by front-line nurses offers the potential for transformations in nursing care through stronger patient-nurse interactions and health system partnerships.
Maeve, M K; Vaughn, M S
The number of incarcerated persons in the United States has been increasing dramatically over the last two decades. Incarcerated men and women have increased rates of serious and chronic physical and mental illnesses and therefore require substantial health care efforts. Caring for prisoners is a difficult and often unrewarding experience for health care providers, particularly within a social climate that encourages noncaring behaviors. This article critically analyzes three philosophic stances toward nursing care with prisoners and suggests their philosophic commensurability within traditional nursing practice. Implications for nursing practice, research, and education are discussed.
McRee, Laura; Reed, Pamela G
An impending policy change in Medicare will provide reimbursement for the end-of-life conversation. The rise in numbers of older adults who face serious illness coupled with advances in healthcare technology are increasing the need for providers to address end of life issues in the acute care setting. Doctoral-level nurse practitioners who specialize in acute care of older adults are poised to be leaders and facilitators of this conversation in a particularly challenging context-the intensive care unit. The focus of this article is the new end-of-life policy in relation to the particular contributions that adult gerontology acute care nurse practitioners offer in the acute care setting.
Sousa, Josueida de Carvalho; Mallmann, Danielli Gavibo; Galindo Neto, Nelson Miguel; de Freitas, Natália Oliveira; de Vasconcelos, Eliane Maria Ribeiro; de Araújo, Ednaldo Cavalcante
The aim of this study was to analyze national and international scientific literature on nursing care for lesbian women. An integrative approach was adopted to review studies from MEDLINE, LILACS, BDENF and SCOPUS databases and SciELO and Cochrane libraries using the keywords: female homosexuality, nursing care, health promotion and women's health. Studies published between 1990 and 2013 in English, Portuguese or Spanish were considered for analysis. After analyzing data, four international studies were selected, being that three were from the United States and one was from Canada. This study revealed a scarcity of Brazilian and international studies and the importance of increasing scientific literature on this topic. Descriptors: Homosexuality, female. Nursing care. Health promotion. Women's health.
Hall, Mary Barbera
When a unit's staff changed from a team nursing to a primary nursing approach to care, the role of students gaining experience there changed to that of associate nurse, who is accountable for providing continuity of care to the primary nurses' patients. (Editor/TA)
Ihlenfeld, Janet T
Nurses in critical care units are often asked to precept a student nurse. To make this a valuable learning experience, careful planning should be done. The preceptor and the nursing faculty member need to collaborate to plan and carry out the nursing experience.
Lin, Li-Chun; Chi, Shu-Ching; Pan, Kuei-Ching; Huang, Chin-Kun
The sedentary lifestyle, common to most modern societies, has turned obesity into an increasingly prevalent and universal problem. Obesity correlates positively with many diseases and health risk factors. Medical therapies currently used to treat obesity are generally limited in terms of long-term effectiveness. Bariatric surgery has been demonstrated an effective treatment for morbid obesity. Special nursing care considerations for bariatric surgery include providing wider cuffs for blood pressure checks, preventing deep venous thrombosis and post operation dietary education in order to accommodate changes in the gastrointestinal system. The purposes of this article were to introduce obesity therapy trends as well as to share nursing care principles for those undergoing bariatric surgery.
Bowen, M; Lyons, K J; Young, B E
The health care system is undergoing profound changes. Cost containment efforts and restructuring have resulted in cutbacks in registered nurse (RN) positions. These changes are often related to the increased market penetration by managed care companies. To determine how RN graduates perceive these changes and their impact on the delivery of patient care, Healthcare Environment Surveys were mailed to graduates of the classes of 1986 and 1991. Using the Survey's 5-point Likert Scale, we measured the graduates' satisfaction with their salary, quality of supervision they received, opportunities for advancement, recognition for their job, working conditions, the overall job and the changes in their careers over the previous five year period. Our study suggests that the changes in the health care system are having an impact on how health care is being delivered and the way nurses view their jobs. Respondents reported that insurance companies are exerting increased control over patient care and perceive that the quality of patient care is declining. Increased workloads and an increase in the amount of paperwork were reported. Participants perceived that there were fewer jobs available and that job security was decreasing. The percentage of nurses who see job satisfaction as remaining the same or increasing are a majority. However, the relatively high percent of nurses who see job satisfaction as declining should provide a note of warning. The major implications of this study are that the professional nursing curriculum must be modified to include content on communication, organization, legislative/policy skills, and leadership. The nation's health care system is undergoing profound changes. There are numerous forces at work that are effecting the delivery of care and, consequently, the work of health professionals. These forces include significant efforts at cost containment, restructuring and downsizing of hospitals, and the movement of health care delivery out of acute
Lee, Eun Joo; Lee, Mikyoung; Moorhead, Sue
Increased accountability requirements for the cost and quality of healthcare force nurses to clearly define and verify nursing's contributions to patient outcomes. This demand necessitates documentation of nursing care in a precise manner. An electronic nursing record system is considered a key element that enhances nurses' ability not only to record nursing care provided to patients but also to measure, report, and monitor quality and effectiveness. Home care is a growing field as nurses attempt to meet the demand for long-term care. The development of an electronic record system for home care nursing was the immediate focus of this study. We identified the nursing content required for home care nursing using standardized nursing languages and designed linkages among medical diagnoses, nursing diagnoses, nursing interventions, and nursing-sensitive outcomes within the system. Equipping an electronic nursing record system with nursing standards is particularly critical for enhancing nursing practice and for creating refined data to verify nursing effectiveness.
It has been clearly acknowledged and well-documented that physical, emotional, and psychological violence is a central theme and an expected workplace hazard for registered nurses working in acute inpatient mental health care facilities. Limited research, however, has focused on how registered nurses have been able to cope within this environment and adequately protect themselves from harm. A critical feminist research project recently explored the lived experience of 13 Australian, female, registered nurses working in a busy metropolitan acute inpatient mental health care facility. "Fear" was exposed as the precursor to violence and aggression, both "fear as experienced by the nurse" and "fear as experienced by the patient." The participants reported experiencing a sense of fear when they could not accurately or confidently anticipate a patient response or reaction. They identified this relationship with fear as being "part of the job" and part of the unpredictable nature of caring for people experiencing complex distortions in thinking and behavior. The participants believed, however, that additional workplace pressures complicated the therapeutic environment, resulting in a distraction from patient care and observation. This distraction could lead to nurse-patient miscommunication and the potential for violence. This article discusses a major theme to emerge from this study, "Better the devil you know!" The theme highlights how mental health nurses cope with violence and why they choose to continue working in this complex care environment.
Dean, Marleah; Oetzel, John; Sklar, David P
Effective communication has been linked to better health outcomes, higher patient satisfaction, and treatment adherence. Communication in ambulatory care contexts is even more crucial, as providers typically do not know patients' medical histories or have established relationships, conversations are time constrained, interruptions are frequent, and the seriousness of patients' medical conditions may create additional tension during interactions. Yet, health communication often unduly emphasizes information exchange-the transmission and receipt of messages leading to a mutual understanding of a patient's condition, needs, and treatments. This approach does not take into account the importance of rapport building and contextual issues, and may ultimately limit the amount of information exchanged.The authors share the perspective of communication scientists to enrich the current approach to medical communication in ambulatory health care contexts, broadening the under standing of medical communication beyond information exchange to a more holistic, multilayered viewpoint, which includes rapport and contextual issues. The authors propose a socio-ecological model for understanding communication in acute ambulatory care. This model recognizes the relationship of individuals to their environment and emphasizes the importance of individual and contextual factors that influence patient-provider interactions. Its key elements include message exchange and individual, organizational, societal, and cultural factors. Using this model, and following the authors' recommendations, providers and medical educators can treat communication as a holistic process shaped by multiple layers. This is a step toward being able to negotiate conflicting demands, resolve tensions, and create encounters that lead to positive health outcomes.
Dhamani, Khairunnisa Aziz
This article seeks to describe a professional, personal, and cultural understanding of spirituality in nursing care. It revisits and refines the many concept clarifications of spirituality in our practice discipline, while reflecting on the potential meanings and learnings from Ismaili tenets and principles within a personal nursing practice. Through a review of mainstream literature in conjunction with nontraditional literature, the implicit is made explicit in terms of similarities and differences, as well as opportunities for further exploration. The summary brings forward the persistent gaps and questions on critical areas such as creating the "place" and "operationalizing" of spirituality. These continue to challenge and intrigue nurses seeking spiritual comfort for both themselves and their clients.
Feo, Rebecca; Kitson, Alison
Meeting patients' fundamental care needs is essential for optimal safety and recovery and positive experiences within any healthcare setting. There is growing international evidence, however, that these fundamentals are often poorly executed in acute care settings, resulting in patient safety threats, poorer and costly care outcomes, and dehumanising experiences for patients and families. Whilst care standards and policy initiatives are attempting to address these issues, their impact has been limited. This discussion paper explores, through a series of propositions, why fundamental care can be overlooked in sophisticated, high technology acute care settings. We argue that the central problem lies in the invisibility and subsequent devaluing of fundamental care. Such care is perceived to involve simple tasks that require little skill to execute and have minimal impact on patient outcomes. The propositions explore the potential origins of this prevailing perception, focusing upon the impact of the biomedical model, the consequences of managerial approaches that drive healthcare cultures, and the devaluing of fundamental care by nurses themselves. These multiple sources of invisibility and devaluing surrounding fundamental care have rendered the concept underdeveloped and misunderstood both conceptually and theoretically. Likewise, there remains minimal role clarification around who should be responsible for and deliver such care, and a dearth of empirical evidence and evidence-based metrics. In explicating these propositions, we argue that key to transforming the delivery of acute healthcare is a substantial shift in the conceptualisation of fundamental care. The propositions present a cogent argument that counters the prevailing perception that fundamental care is basic and does not require systematic investigation. We conclude by calling for the explicit valuing and embedding of fundamental care in healthcare education, research, practice and policy. Without this
Jepson, Cheri A.
This course guide describes an elective speciality course on critical/intensive care nursing. A rationale for the course is followed by general information, including a description of the theoretical and clinical course components, an enumeration of major goals and objectives, a detailed outline of the units of instruction, a calendar of…
Nurses in neurosurgical departments play a critical role as they are involved in the first stages of the care pathway of patients with glioblastoma. Indeed, surgery enables a definitive histopathological diagnosis to be established and the size of the tumour to be significantly reduced, thereby improving the prognosis.
North Carolina State Dept. of Community Colleges, Raleigh. Occupational Information Center.
Designed for use in community colleges, technical colleges, and technical institutes, this manual contains a course for teaching emergency care skills to both licensed practical and registered nurses employed in occupational health. The manual consists of three sections. In section 1 the need for the course, its content, objectives, length,…
Chronic diarrhoea is a distressing symptom of a number of conditions. This article explains the assessment of patients at the initial outpatient visit through the various investigations and finally medical and surgical treatment. Emphasis is placed on the nursing management of chronic diarrhoea, particularly the treatment of physical effects such as dehydration and perianal skin soreness, and the psychological aspects of care.
Vallejo-Torres, Laura; Morris, Stephen
Rising demand for and costs of health care have led to an increasing role of practice nurses in primary care in many countries, including the United Kingdom. Previous research has explored how practice nurse care differs from that provided by general practitioners (GPs) in terms of costs and health outcomes, and has highlighted the importance of matching skills and experience with roles and responsibilities. However, there has been little research to compare the characteristics of patients seen by GPs and practice nurses in primary care. We aim to investigate the factors associated with the use of practice nurse visits, and to compare these with the factors associated with GP use. We jointly model the use of practice nurse and GP visits using a bivariate probit regression model with a large set of covariates taken from two rounds of the Health Survey for England (2001, 2002). We find that practice nurse use is associated with age and gender, health, socioeconomic and supply variables. There are differences in the factors associated with practice nurse and GP use. Chronically ill patients are more likely to see a practice nurse, while acute ill health has a stronger association with the probability of seeing the GP. Practice nurse use is also correlated with a narrower range of health conditions compared with GP use. We also found differences between practice nurse and GP visits with respect to the association with economic activity, ethnic group, number of children, degree of urbanisation, and distance to practice.
Wong, Ka Fai; Yau, Sui Yu
Nurses emphasize spiritual care in maintaining patients' holistic health; however, the provision for spiritual care is found to be inadequate. The limited study in exploring the nurses' perception on applying spiritual care in Hong Kong has been noted. This descriptive phenomenological study investigated the experiences of spirituality and spiritual care in Hong Kong from the nurses' perspective. Ten nurses were purposively invited for an unstructured interview. Thematic analysis was used for data analysis, and three themes emerged: the meaning of spirituality, benefits of applying spiritual care, and difficulties in applying spiritual care. This study provided preliminary insights into the development of spiritual care in Hong Kong.
Scott, P A
Even a brief consideration of the nature of nursing will indicate that an ethical dimension underlies much, if not all, of nursing practice. It is therefore important that students and practitioners are facilitated in developing an ethical awareness and sensitivity from early in their professional development. This paper argues that Aristotelian virtue theory provides a practice-based focus for health care ethics for a number of reasons. Also, because of his emphasis on the character of the moral agent, and on the importance of perception and emotion in moral decision-making, Aristotelian virtue theory provides a useful supplement to the traditional duty-based approaches to health care ethics analysis, which are increasingly being identified in the literature as having limits to their application within the health care context.
Hurley, Ann C; Bane, Anne; Fotakis, Sofronia; Duffy, Mary E; Sevigny, Amanda; Poon, Eric G; Gandhi, Tejal K
Efforts to promote safe care prompted the development point-of-care technology, but successful adoption requires acceptance by nursing staff. To assess the satisfaction of nurses who use point-of-care technology that integrates nurse scanning of bar-coded medications with the patient's electronic medication administration record, the authors examined nurses' satisfaction with barcode/electronic medication administration record before and after introduction in an academic medical center.
Aims. To critically examine the nursing care offered to older people who have been delirious. Background. Delirium occurs as a result of physiological imbalances resulting in an alteration in consciousness and cognitive impairment. Delirium is a prevalent and serious cognitive disorder experienced by older people. While there is a vast number of studies published utilizing quantitative methods, there remains a dearth of research relating to delirium in older people from a qualitative perspective. Design. A qualitative research design that utilized a critical gerontological framework underpinned this study. This framework drew on aspects of postmodernism and Foucault's understanding of discourse. Methods. Data sources included published documents on delirium, semi-structured taped interviews with people over the age of 65 years who had been delirious (as well as their clinical notes), family members, Registered Nurses and a hospital doctor. A postmodern discourse analytic approach was used to interrogate the 20 sets of data collected. Findings. Textual analysis revealed the presence of two major discourses impacting on being an older person with delirium. These were identified as a nursing discourse of delirium and a personal discourse of delirium. A nursing discourse of delirium was largely focussed on the biomedical processes that resulted in a delirious episode. Conversely, a personal discourse of delirium highlights that there are other ways of 'knowing' about delirium through considering the narratives of older adults, and their families, when offering a nursing service to this group of people. Relevance to clinical practice. Nursing needs to critically examine all aspects of nursing care as it applies to older people who have delirium to ensure the rhetorical claims of the profession become the reality for consumers of health services. The use of critical gerontology provides nurses with the tools to challenge the status quo and uncover the
Roth, Sean M; Keyser, Gabrielle; Winfield, Michelle; McNeil, Julie; Simko, Leslie; Price, Karen; Moffa, Donald; Hussain, Muhammad Shazam; Peacock, W Frank; Katzan, Irene L
The Acute Care Team Educational Initiative (ACTEI) was developed as a quality improvement initiative for the recognition and initial management of time-sensitive medical conditions. For our first time-sensitive disease process, we focused on acute stroke [acute stroke initiative (ASI)]. As part of the larger ACTEI, the ASI included creating an ACT that responds to all suspected emergency department stroke patients. In this article, we describe the planning, process, and development of the ACTEI/ASI as well as how we created an acute response team for the diagnosis and management of suspected acute stroke.
Cohen, Lynne; O'Connor, Moira; Blackmore, Amanda Marie
Nursing homes are one of the care settings in Western Australia where older people may spend their final years. Residents should be able to receive palliative care where appropriate, but this type of care is not always available at some nursing homes in the state. This study investigated nurses' attitudes to palliative care in nursing homes by examining their cognitive, affective and behavioural information. A sample of 228 nurses working in nursing homes completed a questionnaire, using a free response methodology. Results showed that participants had either a positive or negative attitude to palliative care. Cognitive and affective information significantly and independently predicted the attitudes of nurse, whereas knowledge of palliative care did not contribute significantly to these attitudes. Nurses currently working in palliative care were more positively disposed towards such care, but this disappeared when they ceased working in the area. There is an emphasis on education in the literature which does not take into account the beliefs and emotions of the nurse. Therefore, there is a need to consider these in undergraduate and postgraduate training for nurses. Current experience is also important in palliative care education. The results obtained from nurses in this study should be incorporated into policy for introducing palliative care into nursing homes and used to provide support and assistance to nurses working in this field.
Deacon, M; Warne, T; McAndrew, S
This paper makes a case for the attractiveness of acute mental health inpatient nursing (acute nursing) and argues that an altered perception of this work is essential if we are to provide the most acutely mentally ill and vulnerable people with a stable and expert nursing workforce. The discussion draws on an ethnographic study conducted in an inner-city psychiatric unit in England and the advantages of this method for understanding nursing work are described. Within our findings, we set out two overarching themes: the contextual realities of the contemporary acute ward and features of attraction that encourage nurses to work in the acute care setting. The former includes nurses' responsibility for the total ward environment and the latter the 'comfort of closeness' and 'surviving and thriving in chaos and crisis'. In conclusion, we argue that despite the unpopularity of the acute inpatient mental health environment, the highly sophisticated skills employed by acute nurses actually ensure the promotion of health for the majority of service users.
Moye, Janet P; Swan, Beth Ann
Ambulatory care faces challenges in sustaining a nursing workforce in the future as newly licensed nurses are heavily recruited to inpatient settings and retirements will impact ambulatory care sooner than other areas. Building a diverse team by recruiting nurses of different ages (generations) and skills may result in a more successful and robust organization. Knowledge about generational characteristics and preferences will aid nurse leaders and recruiters in attracting high-quality, talented nurses. Nurses of Generations X and Y can increase their likelihood of success in ambulatory care by better understanding intergenerational issues.
Manley, Kim; Hills, Val; Marriot, Sheila
This is the fifth article in a nine-part series describing the Principles of Nursing Practice developed by the Royal College of Nursing (RCN) in collaboration with patient and service organisations, the Department of Health, the Nursing and Midwifery Council, nurses and other healthcare professionals. This article discusses Principle D, the provision of person-centred care.
Arkansas State Dept. of Human Services, Little Rock.
This curriculum is designed for use in developing training programs for nursing assistants who provide nursing or nursing-related services to residents in long-term care (LTC) facilities. Implementation provisions provide a general overview of the basic requirements found in Arkansas' Nursing Assistant Training Program "Rules and Regulations." The…
Nursing has always regarded caring as its core business. The historical record about caring in nursing is non-specific, and little direct evidence exists about caring as part of nursing. Caring is not restricted to nursing, is possibly influenced by public perceptions of nursing, and can be subverted for maleficent ends. This paper discusses these points, and then moves to explain how caring fares in the Australian health care system. Australia has been blighted by a "cultural cringe" which sees anything from overseas as more valuable than anything Australian. This is as true for nursing, and caring within that, as for any other aspect of Australian life. However, Australia has one of the best health care systems in the world, and nursing as a profession is a world leader. The argument of this paper is that the core business of caring could be under threat in Australia unless nurses recognize their particularly good contribution to the profession and subsequent patient/client care, and celebrate that. Examples are taken from the United Kingdom where there is a crisis of caring within nursing and health. These are used to explain how Australian nursing can avoid the pitfalls and retain caring as its core business.
Garcia, Paulo Carlos; Fugulin, Fernanda Maria Togeiro
The objective of this quantitative, correlational and descriptive study was to analyze the time the nursing staff spends to assist patients in Adult Intensive Care Units, as well as to verify its correlation with quality care indicators. The average length of time spent on care and the quality care indicators were identified by consulting management instruments the nursing head of the Unit employs. The average hours of nursing care delivered to patients remained stable, but lower than official Brazilian agencies' indications. The correlation between time of nursing care and the incidence of accidental extubation indicator indicated that it decreases with increasing nursing care delivered by nurses. The results of this investigation showed the influence of nursing care time, provided by nurses, in the outcome of care delivery.
de Guzman, Allan B.; Cruz, Andrei Angelo R.; Cruz, Angela Laurice G.; Cruz, Robert Edward D.; Cuarto, Jose Mari Nino L.
The continually rising percentage of the elderly population and the demand for geriatric nursing care are dramatically related. While it is true that most undergraduate programs prepare nurses for the care of geriatric patients, most receive limited academic preparation in the nursing curriculum (Williams & Mezey, 2000). This is particularly…
... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2013-07-01 2013-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2012-07-01 2012-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2011-07-01 2011-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
... 38 Pensions, Bonuses, and Veterans' Relief 2 2014-07-01 2014-07-01 false Nursing home care... (CONTINUED) GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES § 59.140 Nursing home care requirements. As a condition for receiving a grant and grant funds for a nursing home facility under this...
Marten, Marie Lucille
Proposes a series of university nursing education programs developed to increase knowledge and skills relevant to nursing care of elderly and chronically ill persons who reside in nursing homes. Briefly describes five programs intended for persons engaged in long-term care or in preparation for such roles. (EM)
Wu, Shiao-Chi; Tsai, Yin-Yin; Yeh, Shin-Ting
The government must reform and enhance current medical and long-term care services in order to respond effectively to societal ageing and labor shortage trends and to ensure sustainable operations. The post-acute care system should be reoriented on the home and community instead of the hospital. The Long Term Care Service Act integrates long-term care services that were previously dispersed amongst different departments, sets up a long-term care development fund, and improves the quality and allocation of long-term care services. Moreover, the Long Term Care Insurance Act will implement a bundle payment system to assist disabled families. The integration of automation and information technology will make long-term care more efficient. Although nurses are more skilled at elderly care and counseling than other community care professionals, nurses generally lack training in business management. Home and community-based services thus require better-trained manpower, opportunities to set care agents, and opportunities to offer flexible caring jobs. Therefore, nurses should strengthen their capabilities in post-acute care, business management, cooperation, and coordination.
Vahedian-Azimi, Amir; Ebadi, Abbas; Saadat, Soheil; Ahmadi, Fazlollah
Background: Working in respiratory intensive care unit (RICU) is multidimensional that requires nurses with special attributes to involve with the accountability of the critically ill patients. Objectives: The aim of this study was to explore the appropriate nursing care strategy in the RICU in order to unify and coordinate the nursing care in special atmosphere of the RICU. Materials and Methods: This conventional content analysis study was conducted on 23 health care providers working in the RICU of Sina and Shariati hospitals affiliated to Tehran university of medical sciences and the RICU of Baqiyatallah university of medical sciences from August 2012 to the end of July 2013. In addition to in-depth semistructured interviews, uninterrupted observations, field notes, logs, patient’s reports and documents were used. Information saturation was determined as an interview termination criterion. Results: Intelligence care emerged as a main theme, has a broad spectrum of categories and subcategories with bridges and barriers, including equality of bridges and barriers (contingency care, forced oriented task); bridges are more than barriers (human-center care, innovative care, cultural care, participatory care, feedback of nursing services, therapeutic-professional communication, specialized and independent care, and independent nurse practice), and barriers are higher than bridges (personalized care, neglecting to provide proper care, ineffectiveness of supportive caring wards, futility care, nurse burnout, and nonethical-nonprofessional communications). Conclusions: Intelligence care is a comprehensive strategy that in addition to recognizing barriers and bridges of nursing care, with predisposing and precipitating forces it can convert barriers to bridges. PMID:26734480
Konick-McMahan, Joanne; Bixby, Brian; McKenna, Catherine
Heart failure continues to be a challenge for older patients and their health care providers. This article is based on work by advanced practice nurses in a nursing study funded by the National Institute of Nursing Research of the National Institute of Health. Mary Naylor, RN, PhD at the University of Pennsylvania School of Nursing through grant #1RO1-NR04315 is using a transitional care model to provide advance practice nurse intervention for older adults with heart failure in a randomized controlled trial. Effects of the intervention being addressed include quality of life, functional status, rehospitalizations, and costs of care. Working with the patient in the acute hospital setting and following patients to the home care setting for 3 months, the advance practice nurse develops a visit pattern and intervention plan individual to the patient's needs. Key to a successful intervention plan is the right treatment for systolic versus diastolic failure. Although the patient's symptoms and some physical findings may be similar, the drugs used to treat systolic versus diastolic heart failure are different. Thus the nursing interventions to promote symptom management and avoid rehospitalizations have a different approach. In this article, care of elderly individuals with systolic versus diastolic heart failure is compared and contrasted using physical examination and diagnostic techniques, medication management, and nursing intervention. Case studies of a typical patient with systolic and diastolic heart failure will be used to illustrate the differences in approach to this common group of patients with complex needs.
The purpose of this qualitative study, using a modified grounded theory approach, was to investigate how palliative care nurses care for people from cultural backgrounds other than their own. Ten palliative care nurses were interviewed. The semi-structured interviews were tape-recorded and transcribed verbatim. Analysis commenced as soon as data began to emerge. The findings show that palliative nursing across cultural boundaries is paradoxical. In endeavouring to treat everyone equally, nurses treated everyone as individuals. They made intense efforts to transcend both cultural and language barriers. The nurses gave of themselves when caring for the patients, but their endeavours were impeded by limited resources and a lack of education. The theory of cross-cultural endeavour in palliative nursing was developed to explain how palliative care nurses care for patients from cultures other than their own.
Noel, Dianne L
Many health care and academic centers have adopted Watson's Theory of Human Caring as their guiding principle; the theory is also used in other disciplines, such as library science. Human caring theory offers occupational health nurses as structure that not only defines a focus for practice, but also provides a basis for moral and philosophical practice analyses. In particular, nurses may find this theory useful in confirming the definition of "caring" and reconsidering what nursing is all about. More importantly, consideration and application of this theory may lead to research on its applicability to the field of occupational health nursing. This article presents the science and philosophy of human caring, specifically Watson's Theory of Human Caring. Two case studies are presented that demonstrate how the theory could be used to evaluate occupational health nursing practice. To demonstrate its possible relevance as an occupational health nursing framework, an analysis of and comparison to existing occupational health nursing guidelines are detailed and discussed.
Brown, Loraine P
It is widely accepted that a caring curriculum is integral to nursing education. Caring as a concept is extensively cited in the literature as a core value in nursing education and nursing practice. What is not evident is the curricular designs used by nurse educators to enable students to internalize caring behaviors. The literature supports the internalization of affective learning through hierarchically structured learning objectives, and the movement from emotional to reflexive responses through critical reflection. Krathwohl, Bloom, and Masia's (1964) taxonomy of affective objectives and concepts from Mezirow's (2000) transformational learning theory were used to synthesize the integration of caring affective objectives into the design of the nursing curricula. The expected outcome of such integration is a nursing curriculum that progressively supports the development of nursing students' caring behaviors that are consistent with the ideals of the profession. Examples of hierarchically leveled caring objectives are provided.
Tan, Yung-Ming; Hii, Joshua; Chan, Katherine; Sardual, Robert; Mah, Benjamin
With the introduction of CPOE systems, nurses in a Singapore hospital were facing difficulties monitoring key patient information such as critical tasks and alerts. Issues include unfriendly user interfaces of clinical systems, information overload, and the loss of visual cues for action due to paperless workflows. The hospital decided to implement an interactive electronic dashboard on top of their CPOE system to improve visibility of vital patient data. A post-implementation survey was performed to gather end-user feedback and evaluate factors that influence user satisfaction of the dashboard. Questionnaires were sent to all nurses of five pilot wards. 106 valid responses were received. User adoption was good with 86% of nurses using the dashboard every shift. Mean satisfaction score was 3.6 out of 5. User satisfaction was strongly and positively correlated to the system's perceived impact on work efficiency and care quality. From qualitative feedback, nurses generally agreed that the dashboard had improved their awareness of critical patient issues without the hassle of navigating a CPOE system. This study shows that an interactive clinical dashboard when properly integrated with a CPOE system could be a useful tool to improve daily patient care.
Collins, Sarah A; Gazarian, Priscilla; Stade, Diana; McNally, Kelly; Morrison, Conny; Ohashi, Kumiko; Lehmann, Lisa; Dalal, Anuj; Bates, David W; Dykes, Patricia C
Patient- and Family-Centered Care (PFCC) is essential for high quality care in the critical and acute-specialty care hospital setting. Effective PFCC requires clinicians to form an integrated interprofessional team to collaboratively engage with the patient/family and contribute to a shared patient-centered plan of care. We conducted observations on a critical care and specialty unit to understand the plan of care activities and workflow documentation requirements for nurses and physicians to inform the development of a shared patient-centered plan of care to support patient engagement. We identified siloed plan of care documentation, with workflow opportunities to converge the nurses plan of care with the physician planned To-do lists and quality and safety checklists. Integration of nurses and physicians plan of care activities into a shared plan of care is a feasible and valuable step toward interprofessional teams that effectively engage patients in plan of care activities.
Thomas, L H; McColl, E; Priest, J; Bond, S; Boys, R J
OBJECTIVES--To test the validity and reliability of scales for measuring patients' experiences of and satisfaction with nursing care; to test the ability of the scales to detect differences between hospitals and wards; and to investigate whether place of completion, hospital, or home influences response. DESIGN--Sample survey. SETTING--20 wards in five hospitals in the north east of England. PATIENTS--2078 patients in general medical and surgical wards. MAIN MEASURES-- Experiences of and satisfaction with nursing care. RESULTS--75% of patients approached to complete the questionnaires did so. Construct validity and internal consistency were both satisfactory. Both the experience and satisfaction scales were found to detect differences between randomly selected wards and hospitals. A sample of patients (102) were sent a further questionnaire to complete at home. 73% returned this; no significant differences were found in either experience or satisfaction scores between questionnaires given in hospital or at home. CONCLUSION--Scales to measure patients' experiences of and satisfaction with nursing in acute care have been developed and found to be valid, reliable, and able to detect differences between hospitals and wards. Questionnaires can be given before patients leave hospital or at home without affecting scores, but those given at home have a lower response rate. PMID:10158594
Chan, Roxane Raffin; Schaffrath, Michelle
Nurses, nursing educators and students support the inclusion of integrative health care (IHC) into nursing core curriculum as a way to create nurses who deliver nursing care to the full extent of their scope of practice and advance evidenced based IHC. Because of the holistic nature of IHC modalities, research to investigate appropriate teaching strategies and potential efficacy of learning IHC in the baccalaureate core curriculum requires a holistic approach. Therefore a phenomenological exploration using participatory action inquiry was conducted at a large Midwestern university. Eighteen first year nursing students were selected as co-researchers. Their experiences in learning and delivering three 15 min IHC interventions (foot reflexology, lavender aromatherapy and mindful breathing) in an acute care setting were captured using reflexive journaling and participation in structured and organic communicative spaces. Of the patients approached, 67% accepted to receive one or more IHC modalities (147/219). Using van Manen's model for holistic data reduction three themes emerged: The experience of presence, competency and unexpected results. Learning IHC modalities is best supported by a self-reflective process that is constructed and modeled by a nurse faculty member with experience in delivering IHC modalities.
Parenteral nutrition is a recognised method of feeding patients with specific clinical conditions, most notably those with various forms of intestinal failure who cannot be fed enterally. However, it has several associated risks including sepsis, and metabolic and electrolyte imbalances. The aim of this article is to enhance nurses' understanding of parenteral nutrition and how this differs from oral or enteral nutrition, indications for use and the potential risks involved. Appropriate vascular access is discussed as well as the clinical monitoring that is required to ensure complications of therapy are detected quickly. A greater understanding of the issues associated with parenteral nutrition allows nurses caring for patients receiving parenteral nutrition to ensure safe and effective care.
Shih, Chia-Wen; Lo, Hui-Min
Few discussions have been published on appropriate surgery positioning. Ensuring the patient is in an appropriate pendulum position allows for optimal surgery scope exposition, puts the anesthetist in the closest proximity to the patient to monitor respiratory ventilation, helps maintain patient physiology security, and prevents surgical injury. A poor surgery pendulum position can result in patient injury. In the short-term, such injuries may cause neurotrosis, while over the long-term they may induce deep tissue pressure sores. This article discusses pendulum position injuries during surgery and provides suggestions for proper nursing care of patients undergoing surgical procedures. Clinical nursing staffs may reference this article to enhance patient care during and after surgery.
Creating an environment in which patient's responsibility for self is fostered and nurses can practice professional and autonomous nursing practice is a challenge in today's hospitals. Innovative systems and structures need to be developed to assure quality of patient care and a high quality work environment. Newark Beth Israel Medical Center responded to the many demands of the mid-1980s, including increasing acuity of patients hospitalized, personnel shortages in nursing, physical therapy and other disciplines, and diminishing dollars available to the health care institution, through the creation of Self-Care Units. This article reviews how they came about, the way in which Self-Care Units function within the acute care setting and the management philosophy and structure which make them work. The experience at Newark Beth Israel Medical Center demonstrates that the potential exists to put control back at the bedside with the patient and the health care team working with the patient to achieve mutual goals. The focus of care has shifted from a "doing for" to a "working with" patients to identify interventions which promote active participation in hospitalization and a sense of self responsibility.
Mattsson, Janet; Forsner, Maria; Castrén, Maaret; Arman, Maria
Children in the pediatric intensive care unit are indisputably in a vulnerable position, dependent on nurses to acknowledge their needs. It is assumed that children should be approached from a holistic perspective in the caring situation to meet their caring needs. The aim of the study was to unfold the meaning of nursing care through nurses' concerns when caring for children in the pediatric intensive care unit. To investigate the qualitative aspects of practice embedded in the caring situation, the interpretive phenomenological approach was adopted for the study. The findings revealed three patterns: medically oriented nursing--here, the nurses attend to just the medical needs, and nursing care is at its minimum, leaving the children's needs unmet; parent-oriented nursing care--here, the nursing care emphasizes the parents' needs in the situation, and the children are viewed as a part of the parent and not as an individual child with specific caring needs; and smooth operating nursing care orientation--here, the nursing care is focused on the child as a whole human being, adding value to the nursing care. The conclusion drawn suggests that nursing care does not always respond to the needs of the child, jeopardizing the well-being of the child and leaving them at risk for experiencing pain and suffering. The concerns present in nursing care has been shown to be the divider of the meaning of nursing care and need to become elucidated in order to improve the cultural influence of what can be seen as good nursing care within the pediatric intensive care unit.
The four basic techniques of medical imaging are X-ray, ultrasound, magnetic resonance and radionuclide. This article describes imaging techniques that display anatomical structure and those that are better at showing the physiological function of organs and tissues. Safety and preparation relating to nursing practice are discussed. Understanding the purpose and limitations of the different imaging techniques is important for providing best patient care.
Internal radiation therapy has been used in treating gynecological cancers for over 100 years. A variety of radioactive sources are currently used alone and in combination with other cancer treatments. Nurses need to be able to provide safe, comprehensive care to patients receiving internal radiation therapy while using precautions to keep the risks of exposure to a minimum. This article discusses current trends and issues related to such treatment for gynecological cancers.20 references.
Bladder cancer is the second most common urological cancer after prostate cancer in the UK. This article aims to update nurses knowledge about the disease, focusing on diagnosis, treatment and nursing care.
Kim, Hongsoo; Harrington, Charlene; Greene, William H.
Purpose: To examine the relationship between registered nurse (RN) staffing mix and quality of nursing home care measured by regulatory violations. Design and Methods: A retrospective panel data study (1999-2003) of 2 groups of California freestanding nursing homes. One group was 201 nursing homes that consistently met the state's minimum standard…
Randall, Carla E; Tate, Betty; Lougheed, Mary
Much has been written in the nursing literature about the intentions and desires of a transformatory movement in nursing education. However, dialogue and critique related to actual implementation of a curriculum revolution begun in the late 1980s are lacking. The acute care context of nursing practice holds particular challenges for faculty teaching in an emancipatory curriculum. How do faculty implement a philosophy of teaching-learning congruent with the curriculum revolution, in the context of an acute care setting that privileges empirical knowledge and values a behaviorist paradigm? In this article, we provide an example of one teaching approach grounded in an emancipatory ideology: critical questioning. We also discuss some of the tensions we associate with teaching-learning in an acute care context and our experiences of navigating these tensions.
Noureddine, Samar; Dumit, Nuhad Y; Saab, Mohammad
The purpose of this qualitative descriptive study was to explore how patients who experience acute myocardial infarction (AMI) decide to seek emergency care. Fifty patients with AMI were interviewed at two hospitals in Lebanon. The perspective of 22 witnesses of the attack was also sought about the cardiac event. The themes that transpired from the data were as follows: making sense of the symptoms, waiting to see what happens, deciding to come to the hospital, and the family influenced the decision to seek care. The witnesses of the cardiac event, mostly family members, supported the decision to seek emergency care. Deciding to seek emergency care for AMI is complex. Nurses must solicit their patients' perception of the cardiac event to provide them with tailored education and counseling about heart attack symptoms and how to respond to them in case they recur. Family members must be included in the education process.
Elaine, Hardy; DeBasio, Nancy; Warmbrodt, Lynn; Gartland, Myles; Bassett, William; Tansey, Michael
Research College of Nursing and the Rockhurst University Helzberg School of Management Health Care Initiative collaborated to offer the Executive Nurse Practice: Health Care Leadership track to Research College of Nursing graduate students. This effort was not only cost effective, but also offered expert faculty in both the fields of nursing and business. The curriculum is an integration of both fields and faculties from both institutions as they communicate and collaborate each semester to successfully coordinate the track.
Sheldon, Lisa Kennedy
Comprehensive cancer care continues to improve in the United States, but many developing countries carry a high cancer burden. With limited resources, nurses in such countries often are unable to improve cancer detection and treatment or relieve patient suffering. The Oncology Nursing Society has developed collaborative relationships with many international organizations to educate nurses around the world. Global partnerships have the potential to improve cancer care internationally and encourage more oncology nurses to use their expertise and become "citizens of the world."
Vardell, Emily; Paulaitis, Gediminas Geddy
Nursing Reference Center is a point-of-care resource designed for the practicing nurse, as well as nursing administrators, nursing faculty, and librarians. Users can search across multiple resources, including topical Quick Lessons, evidence-based care sheets, patient education materials, practice guidelines, and more. Additional features include continuing education modules, e-books, and a new iPhone application. A sample search and comparison with similar databases were conducted.
Merrill, Alison S; Hayes, Janice S; Clukey, Lory; Curtis, Denise
Applying the theory of Nursing as Caring can help the nurse provide care that is perceived as caring by moderately to severely injured trauma patients. The Caring Behaviors Inventory was administered in a 1-to-1 interview format to hospitalized trauma patients in a level 2 trauma center. Nurses were positively perceived in their caring behaviors with some variation based on gender and ethnicity. The modified Caring Behaviors Inventory is quick to use and is reliable and valid.
Holistic care has long been a defining attribute of nursing practice. From the earliest years of its formal history, nursing has favored a holistic approach in the care of patients, and such an approach has become more important over time. The expansion of nursing's responsibility in delivering comprehensive primary care, the recognition of the importance of relationship-centered care, and the need for evidence-based legitimation of holistic nursing care and practices to insurance companies, policy-makers, health care providers, and patients highlight the need to examine the holistic properties of nursing care. The Holistic Caring Inventory is a theoretically sound, valid, and reliable tool; however, it does not comprehensively address attributes that have come to define holistic nursing care, necessitating the development of a more current instrument to measure the elements of a holistic perspective in nursing care. The development of a current and more comprehensive measure of holistic nursing care may be critical in demonstrating the importance of a holistic approach to patient care that reflects the principles of relationship-based care, shared decision-making, authentic presence, and pattern recognition.
Passarella, P M; Lewis, N
The nursing approach in the care of stroke patients has a direct impact on functional outcome. Nursing application of Bobath principles in stroke care offers a nursing focus on involvement of the affected side; facilitation of normal tone, posture, and movement; and development of more normal function. A research study evaluating the functional gains of stroke patients demonstrated a significant level of functional improvement in those treated with Bobath principles over stroke patients treated with the traditional nursing approach. Practical methods for applying Bobath principles in patient care activities are described. These therapeutic methods provide nurses with the means to maximize stroke patients' potential and further influence their functional recovery.
Schoenhofer, Savina O
Drawing on a story of a nursing situation for practical context, this article explores the meaning of intentionality within the theoretical context of Nursing as Caring. May's definition of intentionality as the structure that gives meaning to experience is interwoven with the concepts of the theory of Nursing as Caring to explore the topic. Mayeroff's concepts of hope and commitment contribute to an understanding of intentionality in relation to Nursing as Caring. The major thesis of this article, that intentionality is consistently choosing personhood as a way of life and the aim of nursing, is demonstrated in the practice situation.
Sawatzky, Jo-Ann V; Enns, Carol L; Ashcroft, Terri J; Davis, Penny L; Harder, B Nicole
Nursing education plays a central role in the ability to practice effectively. It follows that an optimally educated nursing workforce begets optimal patient care. A framework for excellence in nursing education could guide the development of novice educators, establish the basis for evaluating teaching excellence, and provide the impetus for research in this area. However, a review of the social sciences and nursing literature as well as a search for existing models for teaching excellence revealed an apparent dearth of evidence specific to excellence in nursing education. Therefore, we developed the Caring Framework for Excellence in Nursing Education. This framework evolved from a review of the generic constructs that exemplify teaching excellence: excellence in teaching practice, teaching scholarship, and teaching leadership. Nursing is grounded in the ethic of caring. Hence, caring establishes the foundation for this uniquely nursing framework. Because a teaching philosophy is intimately intertwined with one's nursing philosophy and the ethic of caring, it is also fundamental to the caring framework. Ideally, this framework will contribute to excellence in nursing education and as a consequence excellence in nursing practice and optimal patient care.
Hui, Jiang; Chen, Li; Yan, Gu; Haiyan, Lu; Wenqin, Ye
Abstract Aim To evaluate nurse staffing levels and nursing care delivery in adult general medical or surgical wards of hospitals in the Pudong district of Shanghai, China. Background Rapid economic development and improved Chinese living standards have spurred increased demands for high quality health care. Thus, the quality of nursing services has become a focus of attention. Design A cross-sectional, descriptive design was used for the study. Methods We used an anonymous survey to collect data from 1614 nurses from 98 wards in seven general hospitals in Pudong, Shanghai. Results During day shifts, the nurse-to-patient ratios were >1:10. However, these ratios were much higher during evening and night shifts. The clinical front-line nursing workforce primarily consisted of nurses with junior college degrees that had limited working experience. Junior nurses with different educational backgrounds, professional levels, and work experiences were assigned almost similar nursing care work as senior nurses. Conclusions In the surveyed hospitals in the Pudong district, nurse staffing levels and skill mix may be inadequate to meet the increasing demands of patient care. The clinical nursing workforce needs to be strengthened and used effectively to enhance the quality and safety of patient care. Relevance to clinical practice We should focus on the quantity and quality of the nursing workforce, as well as nursing skill utilization.
Dhaliwal, Kirnvir; Hirst, Sandra
Registered nurses are the primary healthcare providers for offenders in correctional facilities. The way in which correctional nurses care for offenders can be difficult in this context. Following a systematic review and narrative synthesis of literature regarding how correctional nurses show caring for offenders three themes emerged: the struggle of custody and caring (conflicting ethical and philosophical ideologies, correctional priorities that override nursing priorities, safety and security), the need to be nonjudgmental (judgmental attitudes can impact care; focus on health not the crime), and the importance of boundaries. Implications for practice focus on recommendations to promote caring in correctional nursing; the outcome of which will potentially enhance quality of care for offenders and improve working environments for nurses.
Broom, Alex; Kirby, Emma; Good, Phillip; Wootton, Julia; Yates, Patsy; Hardy, Janet
Nurses play a pivotal role in caring for patients during the transition from life-prolonging care to palliative care. This is an area of nursing prone to emotional difficulty, interpersonal complexity, and interprofessional conflict. It is situated within complex social dynamics, including those related to establishing and accepting futility and reconciling the desire to maintain hope. Here, drawing on interviews with 20 Australian nurses, we unpack their accounts of nursing the transition to palliative care, focusing on the purpose of nursing at the point of transition; accounts of communication and strategies for representing palliative care; emotional engagement and burden; and key interprofessional challenges. We argue that in caring for patients approaching the end of life, nurses occupy precarious interpersonal and interprofessional spaces that involve a negotiated order around sentimental work, providing them with both capital (privileged access) and burden (emotional suffering) within their day-to-day work.
Ferrell, Betty R.; Virani, Rose; Grant, Marcia
As the members of the health care team who spend the most time with patients who are facing death, nurses are aware of the need for improved end-of-life (EOL) care and have identified resources to achieve that goal by improving education. A survey of 725 nursing faculty and state boards indicates an awareness of the need for improved EOL care and…
Although the nursing profession has traditionally been associated with compassionate, patient, and caring behaviors, living in this advanced technological environment where patient related skills and tasks are often rushed caring behaviors are sometimes not seen. In order to improve high school nursing assistant student caring behaviors as well…
Robinson, C A
History repeats itself despite the best intentions of those in the nursing profession. Once again there is an emerging shortage of nurses, and critical care units are particularly affected. The work environment in critical care and medical/surgical units is demanding and stressful, but little effort has been made to mitigate the working conditions that cause nurses to leave. It is possible to apply lessons from magnet hospital research spanning the past 18 years to alter the pattern of repeated nursing shortages. The process of receiving the magnet nursing services designation has transformed the work environment for all nurses at the University of California Davis Medical Center. This broadly focused article describes the transformation process and the culture of an institution that values and consequently retains the best nurses to provide outstanding patient care despite the nursing shortage.
Vázquez-Calatayud, Mónica; Oroviogoicoechea, Cristina; Saracibar, Maribel; Pumar-Méndez, María J
Although the concept of 'Transforming care' is promising for improving health care, there is no consensus in the field as to its definition. The aim of this concept analysis is to develop a deeper understanding of the term 'Transforming care' within the nursing discipline, in order to facilitate its comprehension, implementation, and evaluation. We performed a comprehensive literature review on electronic databases such as Medline (PubMed), Cinahl (Ebsco), Cochrane Library, PsycINFO (Ovid), Web of Science, Wiley-Blackwell, ScienceDirect, and SpringerLink and used Walker and Avant's approach to analyse the concept. From the 20 studies selected for this analysis, 3 main attributes of 'Transforming care' were identified: patient-centredness, evidence-based change, and transformational leadership driven. We suggest an operational definition to facilitate the implementation of the concept in practice. Furthermore, we propose that implementation is guided by the following key ideas: (1) fostering a culture of continuous improvement; (2) encouraging bottom-up initiatives; (3) promoting patient-centred care; and (4) using transformational leadership. Lastly, the evaluation of 'Transforming care' initiatives should assess care processes and professionals' and patients' outcomes.
Nursing interventions for each of the symptoms of Parkinson's disease, muscle rigidity, bradykinesia, tremors at rest and postural reflex abnormalities, are designed to increase the patient's quality of life by minimizing symptoms. Nurses are responsible for planning patient medication schedules to maximize drug effectiveness. Dietary implications include a low-protein regimen for the patient during the day, eliminating foods high in Vitamin B6, high caloric foods, and soft-solid foods offered at frequent feedings. Constipation is addressed by increasing the patient's fiber and fluid intake and by increasing the patient's mobility. Patient mobility is increased when the patient is taught purposeful activities and to concentrate on the way he walks. Communication is facilitated if the patient takes deep breaths before speaking and uses diaphragmatic speech. A telephone receiver which amplifies the patient's voice is also available. Interventions are good only if the patient chooses to implement them; he is the head of the health team planning his care.
Fan, Ya-Fen; Chien, Chen-Yen; Yang, Hui-Yuan; Tsai, Jung-Mei
The treatment of aortic disease previously used conventional open surgery to replace the aorta with artificial vascular prosthesis after resecting the lesioned segment. The recently developed technique of endovascular aneurysm repair (EVAR) uses a stent graft to reinforce the diseased aortic wall while allowing blood flow continuity and preventing further aortic expansion, dissection and aortic rupture. Taiwan's National Health Insurance now covers payment for authorized EVAR procedures, making treatments safer for patients who are elderly, have congestive heart failure, have multiple comorbidities, or have other high-risk factors. EVAR is gradually replacing previous methods to become the primary treatment approach for aortic disease. This article discusses the development of EVAR, indications, operative procedures, complications, postoperative risk factors, and clinical nursing problems. We hope that this article provides new information on nursing care for patients undergoing endovascular aneurysm repair surgery.
Nashrath, Mariyam; Akkadechanunt, Thitinut; Chontawan, Ratanawadee
The present study explored nurses' and patients' expectations of nursing service quality, their perception of performance of nursing service quality performed by nurses, and compared nursing service quality, as perceived by nurses and patients. The sample consisted of 162 nurses and 383 patients from 11 inpatient wards/units in a tertiary care hospital in the Maldives. Data were collected using the Service Quality scale, and analyzed using descriptive statistics and the Mann-Whitney U-test. The results indicated that the highest expected dimension and perceived dimension for nursing service quality was Reliability. The Responsiveness dimension was the least expected dimension and the lowest performing dimension for nursing service quality as perceived by nurses and patients. There was a statistically significant difference between nursing service quality perceived by nurses and patients. The study results could be used by nurse administrators to develop strategies for improving nursing service quality so that nursing service delivery process can be formulated in such a way as to reduce differences of perception between nurses and patients regarding nursing service quality.
Mueller, A; Johnston, M; Bligh, D
Nursing care plans have helped students learn problem solving for nursing practice, but creativity and the interrelationship of patient problems are not stimulated by their linear nature. Joining mind mapping with care planning forces connections, engages whole brain thinking, and stimulates creativity. The authors describe mind mapping, infusion of mind-mapped care plans into the curriculum, the teaching/learning process of mapped care plans, and the positive outcomes of mind mapping nursing care plans.
Radmehr, Maryam; Ashktorab, Tahereh; Abedsaeedi, Zhila
Background: Despite the emphasis of contemporary nursing theories on the belief that nursing is a science and an art in care, published studies show that only the nursing science has developed. Many experts believe that by recognizing and perceiving this concept, the clinical field can develop aesthetic knowledge in nursing and education of students. Objectives: The purpose of this study was to explain clients and nurses perspective of nursing care aesthetics. Patients and Methods: Using an interpretive phenomenology, 12 clients and 14 nurses were interviewed. Participants in this study were purposefully selected and their experiences were analyzed using Van Manen’s hermeneutic phenomenological framework. Results: Emerged themes were as follows: subjective description, overt spirituality, opening desperate impasse, sense of unity, continue to shine, and painful pass and pleasing. According the participants experiences, nursing care aesthetics includes subjective description of spiritual and desirable caring behaviors combined with sense of unity and sympathy between the nurse and the patients, which leads to opening in desperate impasse with creating the feeling of satisfaction and peace in the patient. It is a shining of clinical capabilities and an action beyond what should be combined with a decorating care that leads to a pleasant ending against the pain and suffering of the others for the nurse. Conclusions: Many caring behaviors associate with aesthetic experience for both patients and nurses and despite two different views, findings of this study showed that these experiences were similar in most cases. The aesthetics of nursing care was defined as what reflects the holistic nature of nursing with an emphasis on spirituality and skill. Results of this study are effective in identification of the values existed in nurse caring behaviors and developing of profession by instruction, implementation, and evaluation them. PMID:26339668
Dill, Janette; Erickson, Rebecca J; Diefendorff, James M
For nurses and other caregivers there is a strong emphasis on prosocial forms of motivation, or doing the job because you want to help others, even in formal, institutionalized care settings. This emphasis is based in gendered assumptions that altruistic motivations are the "right" reasons for being a nurse and lead to the best outcomes for workers and patients. Other motivations for pursuing care work, particularly extrinsic motivation, depart from the prosocial model of care and may be indicative of substandard outcomes, but little research has examined variation in care workers' motivations for doing their jobs. In this study, we use survey data collected from 730 acute care hospital nurses working within one health care system in the Midwestern United States to examine whether different sources of motivation for being a nurse are related to nurse job burnout, negative physical symptoms, and turnover intentions. Our findings suggest that nurses who have high intrinsic and extrinsic motivation actually have better perceived health and employment outcomes (i.e., less likely to say that they will leave, lower burnout, fewer negative physical symptoms) than those with high prosocial motivation, who are more likely to report job burnout.
Corrales-Nevado, Dolores; Palomo-Cobos, Luis
Home care is essential for dependent persons, in order to support the high levels of morbidity, for the elderly as well as their caregivers, as it enables patients to remain in their familiar environment as long as possible, fulfilling the wish expressed by most of the population. Home care is the activity that best represents the essential attributes (longitudinality, comprehensiveness, continuity, coordination) of the primary, and that suffers most when these attributes are not included in the activities undertaken by primary care teams, or due to cuts in health-care. Home care requires highly skilled, versatile and committed nursing staff, with whom the population identifies as a source of care, and where they are assessed for their relevance and effectiveness. Nurses with wide clinical care skills, with a balanced content of treatment and prevention, and the freedom to develop their work, are needed in order to continuously monitor the health problems of their acute and chronic patients, in the family and community.
Terry, Allison J
Many states, including Alabama, allow registered nurses (RNs) in school settings to delegate procedures such as assistance with medication to unlicensed assistive personnel. In Alabama, the Board of Nursing(the Board) is accountable for enforcing the regulations that allow for this action. The Alabama Board of Nursing Administrative Code addresses delegation by school nurses and lists specific tasks that cannot be delegated because they require nursing judgment. As a result of this reporting requirement, Alabama's Center for Nursing, a division of the Board of Nursing, implemented an annual survey of school nurses to determine how nursing care is delivered to students in Alabama public schools. This study investigates the results of this survey and its implications for school nursing both in Alabama and in other states.
Santa Maria, Diane; Guilamo-Ramos, Vincent; Jemmott, Loretta Sweet; Derouin, Anne; Villarruel, Antonia
: Nurses care for adolescents in a variety of settings, including communities, schools, and public health and acute care clinics, which affords them many opportunities to improve adolescents' sexual and reproductive health and reduce the rates of unplanned pregnancy and sexually transmitted infections. To ensure that adolescents have access to sexual and reproductive health care (which includes both preventive counseling and treatment) in all nursing practice sites, nurses need to gain the knowledge and hone the skills required to deliver evidence-based counseling and services to adolescents and parents. Collectively, nurses can use their unique combination of knowledge and skills to make a positive impact on adolescent sexual and reproductive outcomes. Nurses have the capacity and opportunity to disseminate information about sexual and reproductive health to adolescents and their parents in communities, schools, public health clinics, and acute care settings. This article discusses the Society for Adolescent Health and Medicine's goals and recommendations, which address adolescent sexual and reproductive health as both a health care and a human rights issue.
Isaksen, Lise Widding
This article argues that international nurse recruitment from Latvia to Norway is not a win–win situation. The gains and losses of nurse migration are unevenly distributed between sender and receiver countries. On the basis of empirical research and interviews with Latvian nurses and families they left behind, this article argues that nurse migration transforms families and communities and that national health services now become global workplaces. Some decades ago feminist research pointed to the fact that the welfare state was based on a male breadwinner family and women’s unpaid production of care work at home. Today this production of unpaid care is “outsourced” from richer to poorer countries and is related to an emergence of transnational spaces of care. International nurse recruitment and global nurse care chains in Norway increasingly provide the labor that prevents the new adult worker model and gender equality politics from being disrupted in times where families are overloaded with elder care loads.
Porter, Eileen J
In this phenomenological study, I aimed to describe the personal impact of home-care nursing and to compare the findings to domains of the construct of home-care satisfaction (HCS). I report data from interviews with 11 women (ages 82 to 96) who had home-care nurses during a 3-year period. None of the women mentioned satisfaction, but when asked about their nurses, they shared memorable incidents exemplifying how home-care nursing was relevant to their personal goals. Using a previously developed descriptive phenomenological method, I discerned this feature of personal-social context (or life-world) as the main finding: Being Aware of What Stands Out for Me About Having a Nurse at Home. This main finding had six descriptors, including Sensing that the Nurse Knows How to Do What Nurses Do and Linking the Nurse's Help to Sustaining Myself Here. I compared the findings to domains of HCS on three parameters, including evaluation of satisfaction versus relevance of nursing activities. I concluded that compared with satisfaction with home care, the personal impact of home-care nursing was a more basic interest to the women and that the perceived relevance of nursing activities is an important standard for appraising that impact. I recommend that researchers use phenomenological methods to discern life-world descriptors of the personal impact of home-care nursing and use those descriptors to develop indicators to measure the personal impact of home-care nursing.
Carney, Hazel C; Little, Susan; Brownlee-Tomasso, Dawn; Harvey, Andrea M; Mattox, Erica; Robertson, Sheilah; Rucinsky, Renee; Manley, Donna Stephens
NURSING CARE: The term nursing care means different things to different people. The authors of these AAFP and ISFM Feline-Friendly Nursing Care Guidelines define nursing care as any interaction between the cat and the veterinary team (veterinarian, technician or nurse, receptionist or other support staff) in the clinic, or between the cat and its owner at home, that promotes wellness or recovery from illness or injury and addresses the patient's physical and emotional wellbeing. Nursing care also helps the sick or convalescing cat engage in activities that it would be unable to perform without help. GUIDELINES RATIONALE: The purpose of the Guidelines is to help all members of the veterinary team understand the basic concepts of nursing care, both in the clinic and at home. This includes methods for keeping the patient warm, comfortable, well nourished, clean and groomed. The Guidelines provide numerous practical tips gleaned from the authors' many years of clinical experience and encourage veterinary team members to look at feline nursing care in ways they previously may not have considered. OVERARCHING GOAL: The primary goal of feline-friendly nursing care is to make the cat feel safe and secure throughout its medical experience.
Elliot, R; Adams, J
Older people form the largest group occupying acute hospital beds and many of them will have undiagnosed mental health problems. The creation of a Dementia Nurse Specialist role in a district general hospital provided the opportunity to assess the extent of the previously unmet need among patients, carers and nursing staff. Over 30 patients were seen each month, while around 6 to 12 were diagnosed as having dementia. Other activities undertaken as part of the role included providing information and support for carers, and advice on management of behaviours and support for ward staff. The role also involved policy writing, pathway and local strategy planning, care plan development, and formal and informal teaching on dementia. It is argued that this fixed-term post demonstrated that a Dementia Nurse Specialist could provide significant input in an acute hospital setting, by improving the experience of hospitalization for vulnerable older people and their carers.
Papastavrou, Evridiki; Andreou, Panayiota; Efstathiou, Georgios
Bedside rationing in nursing care refers to withholding or failure to carry out certain aspects of care because of limited resources such as time, staffing or skill mix. The absence of previous systematic reviews on nursing care rationing leads to a gap of synthesized knowledge on the factors and processes related to rationing and the potential negative consequences on both patients and nurses. The aim of this study was to gain an in-depth understanding of the factors and processes related to nursing care rationing. Selected papers were methodologically assessed based on their design, sampling, measurement and statistical analysis. Seventeen quantitative studies were reviewed, and findings were categorized into four themes: elements of nursing care being rationed, causes of rationing, nurse outcomes and patient outcomes. Results revealed that communication with patients and families, patient ambulation, and mouth care were common elements of rationed care. Nurse-patient workload and communication barriers were reported as potential causes of rationing. Patient-related outcomes included patient falls, nosocomial infections and low patient satisfaction levels. Nurse-related outcomes included low job and occupational satisfaction. In addition, rationing appears to be an important organizational variable linked with patient safety and quality of care. This review increases understanding of what is actually occurring at the point of care delivery so that managers will be able to improve processes that lead to high quality of care and better patient and nurse outcomes.
Temkin-Greener, Helena; Zheng, Nan; Norton, Sally A.; Quill, Timothy; Ladwig, Susan; Veazie, Peter
Purpose: The objectives of this study were to develop measures of end-of-life (EOL) care processes in nursing homes and to validate the instrument for measuring them. Design and Methods: A survey of directors of nursing was conducted in 608 eligible nursing homes in New York State. Responses were obtained from 313 (51.5% response rate) facilities.…
Castle, Bryan W; Shapiro, Susan E
Accountable Care Units are a disruptive innovation that has moved care on acute care units from a traditional silo model, in which each discipline works separately from all others, to one in which multiple disciplines work together with patients and their families to move patients safely through their hospital stay. This article describes the "what," "how," and "why" of the Accountable Care Units model as it has evolved in different locations across a single health system and includes the lessons learned as different units and hospitals continue working to implement the model in their complex care environments.
da Silva, Laura Johanson; Leite, Josete Luzia; Scochi, Carmen Gracinda Silvan; da Silva, Leila Rangel; da Silva, Thiago Privado
OBJECTIVE: construct an explanatory theoretical model about nurses' adherence to the Kangaroo Care Method at the Neonatal Intensive Care Unit, based on the meanings and interactions for care management. METHOD: qualitative research, based on the reference framework of the Grounded Theory. Eight nurses were interviewed at a Neonatal Intensive Care Unit in the city of Rio de Janeiro. The comparative analysis of the data comprised the phases of open, axial and selective coding. A theoretical conditional-causal model was constructed. RESULTS: four main categories emerged that composed the analytic paradigm: Giving one's best to the Kangaroo Method; Working with the complexity of the Kangaroo Method; Finding (de)motivation to apply the Kangaroo Method; and Facing the challenges for the adherence to and application of the Kangaroo Method. CONCLUSIONS: the central phenomenon revealed that each nurse and team professional has a role of multiplying values and practices that may or may not be constructive, potentially influencing the (dis)continuity of the Kangaroo Method at the Neonatal Intensive Care Unit. The findings can be used to outline management strategies that go beyond the courses and training and guarantee the strengthening of the care model. PMID:26155013
Allard, Melissa E; Katseres, Julie
With the growing popularity of integrative medicine, essential oils have found their way back into health care. Essential oils provide a simple way to alleviate certain physical symptoms, promote emotional well-being, and provide comfort. This article, the last in a five-part series on holistic nursing, discusses the administration and common uses of essential oils; their reported benefits, potential risks, and contraindications; and the current state of associated research. The authors focus specifically on the inhalation, both direct and by diffusion, as well as the topical application of essential oils, providing guidance for their use in acute care, self-care, community nursing, and long-term care that will enable readers to incorporate this modality into nursing practice.
Willey, Jeffrey Allan
Published research suggests that the future of health care will be dependent on new technologies that serve to decrease the need for increased numbers of critical-care nurses while also increasing the quality of patient care delivery. The eCare technology is one technology that provides this service in the intensive care unit (ICU) setting. The…
Johnson, K A; Valdez, R S; Casper, G R; Kossman, S P; Carayon, P; Or, C K L; Burke, L J; Brennan, P F
The infusion of health care technologies into the home leads to substantial changes in the nature of work for home care nurses and their patients. Nurses and nursing practice must change to capitalize on these innovations. As part of a randomized field experiment evaluating web-based support for home care of patients with chronic heart disease, we engaged nine nurses in a dialogue about their experience integrating this modification of care delivery into their practice. They shared their perceptions of the work they needed to do and their perceptions and expectations for patients and themselves in using technologies to promote and manage self-care. We document three overarching themes that identify preexisting factors that influenced integration or represent the consequences of technology integration into home care: doing tasks differently, making accommodations in the home for devices and computers, and being mindful of existing expectations and skills of both nurses and patients.
Mitty, Ethel; Mezey, Mathy
A telephone survey of home care agencies and providers revealed a need for the following: evidence of the effectiveness of nurse practitioners in home care, regulatory and financial support for nurse practitioner home care, and development of home care agencies as clinical sites for training. (SK)
Chan Carusone, Soo; Loeb, Mark; Lohfeld, Lynne
Background Nursing home residents are frequently sent to hospital for diagnostic tests or to receive acute health care services. These transfers are both costly and for some, associated with increased risks. Although improved technology allows long-term care facilities to deliver more complex health care on site, if this is to become a trend then residents and family members must see the value of such care. This qualitative study examined resident and family member perspectives on in situ care for pneumonia. Methods A qualitative descriptive study design was used. Participants were residents and family members of residents treated for pneumonia drawn from a larger randomized controlled trial of a clinical pathway to manage nursing home-acquired pneumonia on-site. A total of 14 in-depth interviews were conducted. Interview data were analyzed using the editing style, described by Miller and Crabtree, to identify key themes. Results Both residents and family members preferred that pneumonia be treated in the nursing home, where possible. They both felt that caring and attention are key aspects of care which are more easily accessible in the nursing home setting. However, residents felt that staff or doctors should make the decision whether to hospitalize them, whereas family members wanted to be consulted or involved in the decision-making process. Conclusion These findings suggest that interventions to reduce hospitalization of nursing home residents with pneumonia are consistent with resident and family member preferences. PMID:16430782
Nagington, Maurice; Luker, Karen; Walshe, Catherine
Ethical care is beginning to be recognised as care that accounts for the views of those at the receiving end of care. However, in the context of palliative and supportive district nursing care, the patients' and their carers' views are seldom heard. This qualitative research study explores these views. Data were collected through semi-structured interviews with 26 patients with palliative and supportive care needs receiving district nursing care, and 13 of their carers. Participants were recruited via community nurses and hospices between September 2010 and October 2011. Post-structural discourse analysis is used to examine how discourses operate on a moral level. One discourse, 'busyness', is argued to preclude a moral form of nursing care. The discourse of friendship is presented to contrast this. Discussion explores Gallagher's 'slow ethics' and challenges the currently accepted ways of measuring to improve quality of care concluding that quality cannot be measured.
Talon-Chrétien, Marie-Claire; Prigent, Alexane; Thirion, Lucille
The private practice nurse may be required to supervise a student during their provision of care to patients in their home. These situations can be mutually rewarding and open the way for discussion around the quality of care.
Kwekkeboom, Kristine L; Vahl, Cheryl; Eland, Joann
Currently, major deficiencies exist in undergraduate nursing education for end-of-life care. Nursing students report feeling anxious and unprepared to be with patients who are dying. A Palliative Care Companion program that allows undergraduate nursing students to volunteer to spend time with patients at the end of life provides a unique educational opportunity to enhance students' knowledge and attitudes toward palliative care. In addition, the program offers a service to patients and families by providing a nonmedical, caring human presence to patients who may be alone, lonely, or bored. In accordance with tenets of Experiential Learning Theory, a Palliative Care Companion program was developed and revised using feedback from initial participants and facilitators. Data collected during the first two semesters indicated increased knowledge of palliative care, improved attitudes about care at the end of life, and fewer concerns about providing nursing care to dying patients, when participating students were compared to their undergraduate peers.
de Oliveira, Marília de Fátima Vieira; Carraro, Telma Elisa
Given the dimensions involving human care, this study aimed at providing a reflection on nursing care as an ontological possibility. In Heidegger we consider the concepts that underlie the foundation of his thought. These reflections offer theoretical resource that allows the recognition that live in the everyday actions of nursing is a challenge that leads us to a new look at the magnitude of care. However, the actions of care should not target only the perspective of a philosopher, but live with that thought in search of reflection, and find, scrutinizing everything you contribute to a nursing care committed to the right, with ethics, and with respect for others.
Fairchild, Roseanne Moody
In the context of health care system complexity, nurses need responsive leadership and organizational support to maintain intrinsic motivation, moral sensitivity and a caring stance in the delivery of patient care. The current complexity of nurses' work environment promotes decreases in work motivation and moral satisfaction, thus creating motivational and ethical dissonance in practice. These and other work-related factors increase emotional stress and burnout for nurses, prompting both new and seasoned nurse professionals to leave their current position, or even the profession. This article presents a theoretical conceptual model for professional nurses to review and make sense of the ethical reasoning skills needed to maintain a caring stance in relation to the competing values that must coexist among nurses, health care administrators, patients and families in the context of the complex health care work environments in which nurses are expected to practice. A model, Nurses' Ethical Reasoning Skills, is presented as a framework for nurses' thinking through and problem solving ethical issues in clinical practice in the context of complexity in health care.
Cooper, Katherine L; Chang, Esther; Sheehan, Athena; Johnson, Amanda
Spiritual care is an important component of holistic care. In Australia competency statements relating to nursing practice emphasise the need to provide care that addresses the spiritual as well as other aspects of being. However, many nurses feel they are poorly prepared to provide spiritual care. This is attributed largely to lack a of spiritual care education provided in undergraduate nursing programmes. A few higher education providers have responded to this lack of spiritual care education by incorporating specific content related to this area into their undergraduate nursing programme. Minimal international studies have investigated the impact of spiritual care education on undergraduate nursing students and no Australian studies were identified. This review explores spiritual care education in undergraduate nursing programmes and identifies the need for an Australian study.
For many years student nurses were trained in a more disciplined approach with considerable time allocated to working in the hospital environment and specified times allowed for gaining theoretical knowledge throughout their formal training. Nurses therefore gained a tremendous amount of experience and competency in their practical skills. With the introduction of more specialized equipment and technology it was now desirable to improve the professional status of nurses and nursing education. The introduction of university trained nurses has been met with much criticism. Student nurses are now being empowered and informed with theoretical knowledge from many health disciplines that allows them to use a holistic approach to patient care. The changes to nurse education were hoped to improve the professional status of nurses although this transition has not been without problems. Experienced nurses who are already working in stressful conditions with continuous staff shortages and poor recognition of service see the student nurse sometimes as an extra hindrance to their already increasing workload. Student nurses are theoretically competent but lack the clinical expertise and experience to complement this knowledge which can also add to the professional pressure that experience nurses encounter. Most nurses would like to see themselves, as promoters of nursing but are frustrated and disillusioned with their profession. It would seem then that student nurses as a result of this dissatisfaction are often devoured by some nurses instead of being encouraged and nurtured in their enthusiasm for nursing.
Jarrin, Olga F.
Much emphasis has been placed on the importance of the environment as a determinant of health; however, little theoretical work in nursing has specifically articulated the importance of the nursing practice environment as a factor in patient outcomes. This work advances the unitary-transformative-caring paradigm by focusing on the concept of integrality and exploring the nursing meta-paradigm concepts (nursing, environment, human being, and health) through integral philosophical inquiry. PMID:22222236
dos Santos, José Luís Guedes; Lima, Maria Alice Dias da Silva
This study aimed to analyze care management actions performed by nurses in a hospital emergency service. This is a qualiative research of the case study type, carried out with nurses from the Emergency Service of a University Hospital in southern Brazil. The data were collected through participant observation and semi-structured interviews, and analyzed using thematic analysis. The results show nurses' actions in care planning, forecasting and provisioning of resources, supervision, leadership and training of the nursing team. In care planning, there is the execution of the nursing process and the control of the realization of laboratory and radiological tests. The actions of forecasting and provisioning of resources were: elaboration of the monthly schedule of employees, daily distribution of the staff and the management of material resources. Leadership encourages the planning of care, the coordination of the nursing staff and the delegation of activities.
Zust, Barbara Lois; Busiahn, Lydia; Janisch, Kelly
Studies indicate that psychological support of a mother during labor greatly increases the well-being of the mother and the infant. Nurses caring for incarcerated women in birthing centers, provide the only caring support these women have a possibility of receiving. However, there is a dearth of studies that explore nurses' perception of their role in caring for female offenders. The purpose of this article is to present a study that explored nurses' perception of caring for incarcerated women in a perinatal setting. Findings of the study indicated that nurses have difficulty working around the shackles that tied a laboring offender to the bed, and found the guards in the room to be intrusive. Some nurses advocated for the patients; others felt that the women were getting what they deserved. Most nurses struggled with the emotions of the incarcerated mom leaving behind her newborn upon return to prison.
Unruh, Lynn Y; Hassmiller, Susan B; Reinhard, Susan C
Historically, the economic value that nursing brings to the patient care process has not been recognized or quantified. Improving the quality of nursing care through work environment changes or increases in staffing is viewed by many as an added cost, but the benefits in terms of money saved through improved nursing satisfaction and patient outcomes are not considered. This article introduces nine articles that were originally presented at the Economics of Nursing Invitational Conference: Paying for Quality Nursing Care held at the Robert Wood Johnson Foundation in Princeton, New Jersey, June 13 and 14, 2007. Recommendations are to conduct research on the impact of policy and payment changes on the nursing workforce and quality of care and to correct the misalignment of socioeconomic and business case incentives for quality by payment systems and other changes.
Horwitz, Rany J.; And Others
The University of Illinois' medical school has a third-year program of weekly role-playing exercises focusing on management of acute medical problems. Students are responsible for creating the cases, complete with scenarios and treatment teams, simulating them, and successfully treating or reaching an impasse. Little teacher preparation time is…
Sousa, Cleber Ricardo de; Gonçalves, Leilane Andrade; Toffoleto, Maria Cecília; Leão, Karine; Padilha, Kátia Grillo
The age of patients is a controversial issue in admission to intensive care unit (ICU). The aim of this study was to compare severity and nursing workload of elderly patients with 60-69, 70-79, and e"80 years of age and to identify predictors of nursing workload in elderly patients. A cross sectional study was performed with a sample of 71 elderly patients admitted to three ICU in the city of Sao Paulo, Brazil from October to November 2004. Data were prospectively collected using Nursing Activities Score (NAS) and Simplified Acute Physiology Score II (SAPS II). There was no significant difference in nursing workload among the elderly patients age subgroups (p=0.84). Multiple regression analysis indicated that the independent risk factors of high nursing workload were severity, age e"70 years, and to be a surgical ICU patient. Age as an isolated factor should not be discriminative for elderly patients admission to ICU.
Last month, Aysha Mendes discussed the impact on care of personal beliefs held by both nurses and patients. This month, she delves into the aspects of culture and religion, which form important pieces of this puzzle, as well as the importance of culturally appropriate care provision in nursing practice.
Pladec, Boris Martin le; Menoret, Romuald; Rodes, Raphaël
In collaboration with the ambulance driver and the emergency doctor, the prehospital nurse provides care in a universe which is often difficult and sometimes hostile. Whether they are a nurse from the Samu (urgent medical aid service) or from the Paris fire service, how are they recruited and what training do these emergency care professionals receive?
Rojas, P; Stark, R; Tembo, P
Progress in bringing health care to the workplace lags considerably behind progress in bringing health care to where people live. Experience in Botswana shows that the family nurse practitioner--a registered nurse midwife with one year of post-basic training--can provide useful preventive and curative services to people in their places of work.
Using spiritual and religious resources gives patients and families strength to cope during a crisis, but nurses often do not offer spiritual care (Kloosterhouse & Ames, 2002). The purpose of this phenomenological study was to explore nurses" lived experience of giving spiritual care. A descriptive phenomenological approach was used to…
In the wake of health care reform, a large health system developed a new model of medical-surgical nursing care delivery. To facilitate the subsequent culture change, a non-traditional educational approach was used to provide a dynamic experiential venue that included real-time feedback to facilitate nurses' behavioral transformation.
Mujallad, Alaa; Taylor, Elizabeth Johnston
Modesty is central to Islamic life. Modesty is exemplified in dress and behavior with persons of the opposite sex. Because ethical nursing care requires respecting patient culture and religiosity, nurses should be able to provide care that respects Muslim interpretations of modesty.
Purpose: The purpose of this study is to explore home care nurses' experience of learning in a multicultural environment. Design/methodology/approach: The study was based on qualitative research design. Data were collected through repeated interviews with registered home care nurses working in a multicultural area. The data were analyzed through a…
Nogueira, Lilia de Souza; Koike, Karina Mitie; Sardinha, Débora Souza; Padilha, Katia Grillo; de Sousa, Regina Marcia Cardoso
Objective This study sought to compare patients at public and private intensive care units according to the nursing workload and interventions provided. Methods This retrospective, comparative cohort study included 600 patients admitted to 4 intensive care units in São Paulo. The nursing workload and interventions were assessed using the Nursing Activities Score during the first and last 24 hours of the patient's stay at the intensive care unit. Pearson's chi-square test, Fisher's exact test, the Mann-Whitney test, and Student's t test were used to compare the patient groups. Results The average Nursing Activities Score upon admission to the intensive care unit was 61.9, with a score of 52.8 upon discharge. Significant differences were found among the patients at public and private intensive care units relative to the average Nursing Activities Score upon admission, as well as for 12 out of 23 nursing interventions performed during the first 24 hours of stay at the intensive care units. The patients at the public intensive care units exhibited a higher average score and overall more frequent nursing interventions, with the exception of those involved in the "care of drains", "mobilization and positioning", and "intravenous hyperalimentation". The groups also differed with regard to the evolution of the Nursing Activities Score among the total case series as well as the groups of survivors from the time of admission to discharge from the intensive care unit. Conclusion Patients admitted to public and private intensive care units exhibit differences in their nursing care demands, which may help managers with nursing manpower planning. PMID:24213086
Loke, Jennifer C F; Lee, Kah Wai; Lee, Bryant K; Mohd Noor, Asmah
In an increasing technologised and cost-constrained healthcare environment, the role of pre-registration nursing education in nurturing and developing the professional caring disposition of students is becoming far more critical than before. In view of this growing demand, the aim of this study was to evaluate the impact of Singapore's pre-registration nursing programmes on students' concept of caring. A descriptive quantitative cross-sectional survey collected data using the Caring Behaviour Inventory from first and final year student nurses, nurse lecturers and nurses in practice. The findings based on student surveys indicated a statistically significant reduction in the overall level of caring behaviour in first to final year students. When compared with the findings of lecturers and nurses, less variance to lecturers than to nurses was found amongst the first years' score, and the lowest variance to nurses was demonstrated amongst the final year. A greater reduction was evidenced amongst Singaporean students, which was exaggerated with exposure to pre-enrolled nursing education and magnified with caring job experience. This study indicates more effort is necessary to harness student caring attributes in students' entire educational journey so that expressive caring is not subsumed in the teaching of students to meet demands of complicated contemporary care.
Eggenberger, Sandra K; Sanders, Marita
The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses' attitudes towards and confidence in providing family care, as well as families' perceptions of support from nurses in an adult critical care setting. An academic-clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members' experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic-clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in
Maryland State Board of Nursing, Baltimore.
This set of guidelines by the Maryland Board of Nursing presents the role and responsibilities of the school nurse in relation to the child with special health care needs. The introduction identifies four basic issues including necessary level of preparation, who determines what nursing care can be delegated, under what conditions nursing care can…
Davis, R Scott; Connelly, Linda K
The mission of the en route caregiver is to provide critical care in military helicopters for wounded Warriors. This care minimizes the effects of the wounds and injuries, and improves morbidity and mortality. This article will focus on the history of Army Nursing en route care. From World War II through Vietnam, and continuing through the War on Terrorism in Iraq and Afghanistan, Army nurses served in providing en route care in military airplanes and helicopters for patients being transported to higher echelons of care. From aid stations on the battlefield to forward surgical teams which provide life, limb, and eyesight saving care, to the next higher level of care in combat support hospitals, these missions require specialized nursing skills to safely care for the high acuity patients. Before the en route care concept existed, there was not a program to train nurses in these critical skills. There was also a void of information about patient outcomes associated with the nursing assessment and care provided during helicopter medical evacuation (MEDEVAC) of such unstable patients, and the consequent impact on the patient's condition after transport. The role of critical care nurses has proven to be essential and irreplaceable in providing full-spectrum care to casualties of war, in particular, the postsurgical patients transferred from one surgical facility to another in theatre. However, we have only recently developed the concepts over the required skill set, training, equipment, functionality, evidenced-based care, and sustainability of nursing in the en route care role. Much of the work to quantify and qualify nursing care has been done by individuals and individual units whose lessons-learned have only recently been captured.
... professional nurse. (b) Exception. Medicare does not pay for the services of a private duty nurse or attendant. An individual is not considered to be a private duty nurse or attendant if he or she is an...
Mitchell, Beverly; Petrovskaya, Olga; McIntyre, Marjorie; Frisch, Noreen
The authors explore the possibilities for documenting professional nursing practice in an electronic health record. Recognizing that there are a variety of approaches to electronic documentation, the intent of this discussion is to generate a general rather than a particular approach to this issue. Nurses themselves must determine the ways in which professional nursing care will be captured in the electronic systems used in their facilities. Questions that arise from nursing include: How can nurses balance generalized care and protocol management with the need for documentation of each individual's nursing needs and particular experiences? How can the goals of nursing care be incorporated into the record? How can nursing actions/interventions be clearly communicated to all members of the health care team? In what ways can an electronic record document collaboration with the client to determine individualized outcomes of care and treatment? In considering these questions a number of issues arise: the selection of standardized languages to be used in the records, the title of the record, the tension between coding and text, the accessibility and transferability of the record, the ability to retrieve data on nursing outcomes through data mining techniques, ownership of the record, and privacy/security of the information stored. Although the paper will make no attempt to answer these questions it will draw on relevant journal articles to provide a context for this pivotal change in that way we account for health care practice.
Tubbs-Cooley, Heather L; Pickler, Rita H; Mara, Constance A; Othman, Mohammad; Kovacs, Allison; Mark, Barbara A
Missed nursing care is an emerging measure of front-line nursing care effectiveness in neonatal intensive care units (NICUs). Given Magnet® hospitals' reputations for nursing care quality, missed care comparisons with non-Magnet® hospitals may yield insights about how Magnet® designation influences patient outcomes. The purpose of this secondary analysis was to evaluate the relationship between hospital Magnet® designation and 1) the occurrence of nurse-reported missed care and 2) reasons for missed nursing care between NICU nurses employed in Magnet® and non-Magnet® hospitals. A random sample of certified neonatal intensive care unit nurses was invited to participate in a cross-sectional survey in 2012; data were analyzed from nurses who provided direct patient care (n=230). Logistic regression was used to model relationships between Magnet® designation and reports of the occurrence of and reasons for missed care while controlling for nurse and shift characteristics. There was no relationship between Magnet® designation and missed care occurrence for 34 of 35 types of care. Nurses in Magnet® hospitals were significantly less likely to report tensions and communication breakdowns with other staff, lack of familiarity with policies/procedures, and lack of back-up support from team members as reasons for missed care. Missed nursing care in NICUs occurs regardless of hospital Magnet® recognition. However, nurses' reasons for missed care systematically differ in Magnet® and non-Magnet® hospitals and these differences merit further exploration.
Psychiatric nurses are expert care providers for individuals with mental health needs. The art of caring spans across multiple species, is important to understand, and is universal whether intentions are toward individuals or animals. Pets are often cared for and viewed as family members. The current research examined psychiatric nurses' views on the similarities and differences of caring for patients and their pet dogs. Twenty-five nurses were interviewed. Similarities of caring for patients and canines included trusting relationships, companionship, daily basic needs, and improved communication through monitored body language. Differences in caring included personal expectations, unconditional love, and professional boundaries. Understanding the concepts of caring for patients and pet dogs will provide the opportunity for insight into familial versus professional relationships, improve communication with others, and strengthen the human-animal bond. [Journal of Psychosocial Nursing and Mental Health Services, 55(3), 46-52.].
King, Phyllis Ann; Thomas, Sandra P
This existential phenomenological study explored caring for the dying based on the philosophical works of Merleau-Ponty. Fourteen critical care nurses were asked to describe lived experiences of caring for dying patients. An encompassing theme of Promises to Keep emerged, with five subthemes, including the following: (a) promise to be truthful: "Nurses are in the game of reality," (b) promise to provide comfort: "I'll make him comfortable," (c) promise to be an advocate: "Just one more day," (d) "Promise that couldn't be kept," and (e) "Promise to remain connected." The essence of intensive care nurses' lived experience of caring for dying patients is captured in the theme Promises to Keep. Nurses accept the reality of death and express strong commitment to making it as comfortable, peaceful, and dignified as possible, despite critical care unit environments that foster a "paradigm of curing" rather than a "paradigm of caring.".
Community palliative care nurses in Perth have joined the throng of healthcare workers relying on personal digital assistants (PDAs) to store, access and send client information in 'real time'. This paper is guided by Heidegger's approach to technologies and Habermas' insights into the role of law in administering social welfare programs to reveal how new ethical and legal understandings regarding patient information add to nursing's professional responsibilities. This qualitative research interprets data from interviews with twenty community palliative care nurses about clients' legal rights to informational privacy and confidentiality. It explores nurses' views of their nursing responsibilities regarding clients' legal rights, liability issues, bureaucratic monitoring and enforcement procedures. It concludes that nurses and clients are construed as legal subjects entrenched in legal relations that have magnified since these nurses began using PDAs in 2005/2006.
Talbot, Rebecca; Brewer, Gayle
Care assistants have a unique insight into the lives of service users and those factors which may impede or enhance the delivery of high quality dementia oriented care. To address the paucity of research in this area, the present study examined care assistant experiences of dementia care in British long-term residential and nursing environments. Semi-structured interviews were conducted with eight care assistants and transcripts were analysed using interpretive phenomenological analysis. Super-ordinate themes emerging from the data were psychological wellbeing of the care assistant, barriers to effective dementia care, the dementia reality and organisational issues within the care environment. The study revealed important deficiencies in understanding and varying levels of dementia training. Whilst person centred strategies were being implemented, task orientated care remained dominant. Furthermore, care assistants reported taking the perspectives of those with dementia into account, and actively using these to develop relationship centred care.
Caffrey, Rosalie A
Rural elderly individuals are an underserved population with limited access to health care. There is an increasing need for independent community care nurses to provide assistance to home-based elderly individuals with chronic illnesses to prevent unnecessary medical and placement decisions and, thus, allow them to maintain independence and quality of life. This article describes the rural setting and why community care nurses are needed, and explores strategies for implementing the role of the independent nurse entrepreneur in caring for community-based elderly individuals in rural settings.
Wittenberg-Lyles, Elaine; Goldsmith, Joy; Ferrell, Betty
Although quality communication has been identified as a necessary component to cancer care, communication skills training programs have yet to focus on the unique role of nurses. This study explored communication barriers as reported by seven nurse managers to better identify communication skills needed for oncology nurses to practice patient-centered care. Thematic analysis of transcripts was used to identify barriers to patient and family communication and desirable patient-centered nursing communication skills. Overall, the nurse managers reported that nurses experience patient and family communication difficulties as a result of inconsistent messages to patients and family from other healthcare staff. Physician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family. Therefore, the authors of this article created the COMFORT communication training protocol, and key concepts and resources for nurse communication training through COMFORT are detailed in this article.
Chiang, Li-Chi; Liao, Mei-Nan
As clinical scientists on the interdisciplinary healthcare team, nurses use the art and science of current nursing knowledge to provide evidence-based healthcare to each patient and his/her family. Nurses not only comprise the largest contingent of medical personnel and provide 24-hour patient care but are also professional scientists that develop unique nursing knowledge through reflective practice. Five strategies for expanding the body of current evidence-based nursing scientific knowledge include: (1) reflecting empirically on the practice-service domain, (2) developing nursing knowledge using rigorous methodology, (3) emancipating nursing knowledge using innovative transformation, (4) using collaborative interdisciplinary healthcare that is based in patient-centered care, and (5) initiating innovative transformation in nursing education. Nurses are critical healthcare providers that make important contributions to today's healthcare system. Nursing scientists provide frontline, evidence-based transforming care that deserves to be respected and valued on an equal basis with the care and services that are provided by other medical personnel.
Høye, Sevald; Severinsson, Elisabeth
The aim of this study was to explore nurses' perceptions of their encounters with multicultural families in intensive care units in Norwegian hospitals. Immigrants from non-Western countries make up 6.1% of the population in Norway. When a person suffers an acute and critical illness the person's family may experience crises. Nurses' previous experiences of caring for culturally diverse patients and families is challenging due to linguistic differences, and contextual factors. Family members should be near their critically ill spouse to reduce the impact from a frightening environment. The study had a descriptive exploratory qualitative design with a retrospective focus. Three multistage focus groups consisting of 16 nurses were set up in intensive care units. The data were analysed by interpretive content analysis. The theme 'Cultural diversity and workplace stressors' emerged. This theme was characterised by four categories: 'impact on work patterns'; 'communication challenges'; 'responses to crises' and 'professional status and gender issues'. In conclusion, nurses' perception of their encounters with multicultural families in intensive care units seem to be ambiguous with challenges in interaction, and the nurses' stressors emanating from linguistic, cultural and ethnic differentness. To diminish cultural diversity the nurses strive for increased knowledge of different cultures and religions.
MacDonald, L D; Addington-Hall, J M; Hennessy, D A; Gould, T R
Two questions of importance to those concerned with maintaining standards and increasing the efficiency of Community Nursing are: (1) does reducing hospital provision alter the number of patients referred for Community Nursing or the type of care provided; (2) are Community Nursing Services directed towards those who most require them? A base-line study was carried out in the first quarter of 1988, before the closure of one of two general hospitals in an inner London Health Authority and was replicated in the same quarter of 1989, after all acute inpatient services had been transferred to the other hospital. Comparison of patients discharged before and after closure showed no significant differences in patients' age, sex, proportion living alone, length of stay in hospital, readmissions or deaths within one month of discharge. There was some decline in general nursing care. Total discharges declined by 20% while the number of referrals remained the same, indicating that proportionately more patients were discharged with a referral. Comparing referred and unreferred patients showed that Community Nursing Services were already being directed towards those most in need both before and after hospital closure. Results suggest that Community Nursing helps to maintain patients in the community.
Keogh, Brian; Gleeson, Madeline
This article presents the results of two small qualitative studies, which examined the experiences of six male registered psychiatric nurses (RPN) and five male registered general nurses (RGN) when caring for patients of the opposite sex. Semi-structured interviews were used to collect the data. The focus of the interviews was an attempt to describe the male nurses' experiences of caring for women with a particular emphasis on interventions that involved physical touch. Themes were generated from both studies and the common themes are presented here. Male nurses in this study were often apprehensive about using physical touch and they used coping strategies in response to their fears of being accused of using touch inappropriately. Several factors also influenced the male nurses when using physical touch as an intervention. These findings suggest that learning about caring for female patients needs to be included in the undergraduate curriculum and that further research on the experience of men as nurses is required.
Camuci, Marcia Bernadete; Martins, Júlia Trevisan; Cardeli, Alexandrina Aparecida Maciel; Robazzi, Maria Lúcia do Carmo Cruz
Objective to evaluate the nursing work load in a Burns Intensive Care Unit according to the Nursing Activities Score. Method an exploratory, descriptive cross-sectional study with a quantitative approach. The Nursing Activities Score was used for data collection between October 2011 and May 2012, totalling 1,221 measurements, obtained from 50 patients' hospital records. Data for qualitative variables was described in tables; for the quantitative variables, calculations using statistical measurements were used. Results the mean score for the Nursing Activities Score was 70.4% and the median was 70.3%, corresponding to the percentage of the time spent on direct care to the patient in 24 hours. Conclusion the Nursing Activities Score provided information which involves the process of caring for patients hospitalized in a Burns Intensive Care Unit, and indicated that there is a high work load for the nursing team of the sector studied. PMID:26107842
assessments of both the patient and the nurse (Charonko, 1992). Transcultural Nursing Madeleine Leininger (1991), in an effort to improve health care to...ethnically diverse clients, stresses the importance of considering cultural needs among patients. The founder of transcultural nursing, Leininger ...other health care services (1991) . Leininger describes transcultural nursing as a blend of nursing and anthropology which attempts to help nurses
Wälivaara, Britt-Marie; Sävenstedt, Stefan; Axelsson, Karin
The encounter between registered nurses and persons in need of healthcare has been described as fundamental in nursing care. This encounter can take place face-to-face in physical meetings and through meetings via distance-spanning technology. A strong view expressed in the literature is that the face-to-face encounter is important and cannot entirely be replaced by remote encounters. The encounter has been studied in various healthcare contexts but there is a lack of studies with specific focus on the encounter in home-based nursing care. The aim of this study was to explore the encounter in home-based nursing care based on registered nurses’ experiences. Individual interviews were performed with 24 nurses working in home-based nursing care. The transcribed interviews were analyzed using thematic content analysis and six themes were identified: Follows special rules, Needs some doing, Provides unique information and understanding, Facilitates by being known, Brings energy and relieves anxiety, and Can reach a spirit of community. The encounter includes dimensions of being private, being personal and being professional. A good encounter contains dimensions of being personal and being professional and that there is a good balance between these. This is an encounter between two human beings, where the nurse faces the person with herself and the profession steadily and securely in the back. Being personal and professional at the same time could encourage nurses to focus on doing and being during the encounter in home-based nursing care. PMID:23847697
Simmonds, Anne H
The Canadian Nurses' Association Code of Ethics (2008) and the College of Registered Nurses of Nova Scotia (CRNNS) Standards of Practice for Registered Nurses (CRNNS 2011) identify the provision of safe, compassionate, competent and ethical care as one of nursing's primary values and ethical responsibilities. While compassion has historically been viewed as the essence of nursing, there is concern that this has become an abstract ideal, rather than a true reflection of nursing practice. This paper describes a compassionate care initiative undertaken by the CRNNS and the initial outcomes of these educational workshops. This work is informed by an exploration of the multiplicity of factors that have brought this issue to the fore for nursing regulators, educators, administrators, the public as well as front-line staff. The two most significant areas of learning reported by workshop participants included understanding the connection between mindfulness, non-judgmental care and compassion/self-compassion and recognizing possibilities for action related to compassionate care, even in the face of personal and environmental constraints. Implications for nursing regulators and leaders include consideration of their roles and responsibilities in supporting nurses to meet professional practice standards, such as provision of compassionate care.
Poortaghi, Sarieh; Salsali, Mahvash; Ebadi, Abbas; Rahnavard, Zahra; Maleki, Farzaneh
Background: Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. Objectives: This study aimed to audit nursing care based on a nursing process model. Patients and Methods: This was a cross-sectional descriptive study in which a nursing audit checklist was designed and validated for assessing nurses’ compliance with nursing process. A total of 300 nurses from various clinical settings of Tehran university of medical sciences were selected. Data were analyzed using descriptive and inferential statistics, including frequencies, Pearson correlation coefficient and independent samples t-tests. Results: The compliance rate of nursing process indicators was 79.71 ± 0.87. Mean compliance scores did not significantly differ by education level and gender. However, overall compliance scores were correlated with nurses’ age (r = 0.26, P = 0.001) and work experience (r = 0.273, P = 0.001). Conclusions: Nursing process indicators can be used to audit nursing care. Such audits can be used as quality assurance tools. PMID:26576448
Forrester, D A; Murphy, P A; Price, D M; Monaghan, J F
In this study we explored the relationship between critical care family members' perceived needs and the assessment of these needs by a confederate sample of intensive care unit (ICU) nurses. Family needs were measured by using Molter's revised Critical Care Family Needs Inventory. Data consisted of 92 confederate pairs of Critical Care Family Needs Inventory responses obtained from 92 family members of adult patients hospitalized in a variety of ICUs and 49 ICU nurses providing direct care for these patients. Paired t tests (two tailed) were calculated to detect significant differences between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of the needs studied. Family members' perceptions and ICU nurses' assessments of the most and least important critical care family needs were identified. Significant (p less than 0.001 to p less than 0.05) differences were detected between confederate pairs of family members' perceptions and ICU nurses' assessments of the importance of 15 (50%) of the critical care family needs studied. Therefore, it appears that these nurses were only moderately accurate in their assessments of critical care family needs. Implications for nursing practice, education, and research were identified and discussed.
Baldacchino, Donia R
This study unit as part of the Continuing Professional Development (CPD) programme aimed at reviving the spiritual dimension in nursing care. This paper discusses the perceived impact of the study unit Spiritual Coping in Illness and Care on qualified nurses. The paucity of literature demonstrates some benefits perceived by the learners namely, clarification of the concepts of spirituality and spiritual care, self-awareness of personal spirituality and their current clinical practice which neglects the spiritual dimension. The ASSET model [Narayanasamy, A., 1999. ASSET: a model for actioning spirituality and spiritual care education and training in nursing. Nurse Education Today 19, 274-285] guided the teaching of this study unit. The nature of this study unit demanded an exploratory method of teaching to encourage the nurses to be active participants. Qualitative data were collected by a self-administered questionnaire from the three cohort groups of qualified nurses who undertook this study unit in 2003-2004 (A: n=33), 2004-2005 (B: n=35) and 2006-2007 (C: n=35). Learners found the study unit as a resource for updating their knowledge on spirituality in care and increased self-awareness of their own spirituality and nursing care. They acknowledged their role as change agents in order to implement holistic care in collaboration with the multidisciplinary team. Recommendations were proposed to integrate the spiritual dimension in education and patient care.
Wellington, Beverley; McGeehan, Claire
This paper presents a case study that demonstrates how collaborative working between professionals enhanced the holistic care for a patient following a traumatic brachial plexus injury. The paper will describe the patient's journey of care from initial presentation, diagnosis and assessment, acute care provision, discharge & rehabilitation to ongoing supportive counselling. The care encompasses input from both a nursing and occupational therapy perspective.
Jeffers, Stephanie; Ferry, Dawn
An elective course titled "Nursing Care at the End of Life" was designed for fourth-year nursing students in a baccalaureate nursing program. This course, taught by the authors, was designed to teach students about caring for the dying patient. Students were required to complete service learning with patients in a hospice or hospital setting. Students reported having a positive learning experience and gaining new knowledge and a deeper understanding of the needs of dying patients and their families.
Rouleau, Geneviève; Gagnon, Marie-Pierre; Côté, José; Payne-Gagnon, Julie; Hudson, Emilie; Dubois, Carl-Ardy
Despite the well-known advantages of information and communication technologies (ICTs), their overall impact on nursing care has not been synthesized. The objective of this overview of systematic reviews is to summarize the best evidence regarding the effects of ICTs on nursing care. We considered quantitative, qualitative and mixed-method reviews published since January 1995. Two reviewers independently screened the title and abstract of 5515 papers to assess their eligibility. From these, 72 full-text papers were evaluated and 28 publications met the inclusion criteria. Three reviewers extracted and compared their data. Preliminary results show that the following dimensions of nursing care are the most frequently reported: assessment, care planning and evaluation, documentation time, quality of care and patient safety. This overview provides a starting point from which to compare and contrast findings of separate reviews regarding the positive, neutral and negative effects of ICTs on nursing care.
Ferrell, Betty R; Dahlin, Constance; Campbell, Margaret L; Paice, Judith A; Malloy, Pam; Virani, Rose
The integration of palliative care in critical care settings is essential to improve care of the dying, and critical care nurses are leaders in these efforts. However, lack of education in providing end-of-life (EOL) care is an obstacle to nurses and other healthcare professionals as they strive to deliver palliative care. Education regarding pain and symptom management, communication strategies, care at the end of life, ethics, and other aspects of palliative care are urgently needed. Efforts to increase EOL care education in most undergraduate and graduate nursing curricula are beginning; yet, most critical care nurses have not received formal training in palliative care. Moreover, educational resources such as critical care nursing textbooks often contain inadequate information on palliative care. The ELNEC-Critical Care program provides a comprehensive curriculum that concentrates on the requirements of those nurses who are working in areas of critical care. Extensive support materials include CD-ROM, binder, Web sites, newsletters, textbooks, and other supplemental items. The ultimate goal is to improve EOL care for patients in all critical care settings and enhance the experience of family members witnessing the dying process of their loved ones.
Bucknall, T; Copnell, B; Shannon, K; McKinley, D
In the emergence of the evidence based practice movement, critical care nurses have struggled to identify scientific evidence on which to base their clinical practice. While the lack of critical care nursing research is a major concern, other important issues have significantly stalled the implementation of evidence even when it is available. A descriptive study of 274 critical care nurses was undertaken to examine nursing research activity in Victorian critical care units. The study aimed to identify critical care nurses' research skills, the barriers encountered in participation and implementation and the current availability of resources. Results revealed that 42 per cent of the nurses who participated in the study believed that they were not prepared adequately to evaluate research, and less than a third believed they were sufficiently skilled to conduct valid scientific studies. An association was found between nurses' ability to confidently perform research activities and higher academic qualifications. The study found that there is a lack of organisational support and management commitment for the development of evidence based nursing. In order to facilitate the implementation of evidence based practice, clinicians must be made aware of the available resources, be educated and mentored when carrying out and using clinical research, and be supported in professional initiatives that promote evidence based practice. It is argued that this will have positive implications for patient outcomes in the critical care environment.
Feet are not necessarily the most attractive part of the body as it ages, and given the choice, most older adults would rather ignore them. In fact, many older adults cannot even see them, reach them, or care for them properly. And when they ache or look misshapen and oddly colored; well, that's just part of growing old, isn't it? The feet are important for weight bearing, balance, and mobility. Over an average life span, the feet are subject to considerable stress and trauma. Age-related changes of the foot predispose the older adult to discomfort if not pain, fungal infection, reduced range of motion, and itchy dry skin. More than three fourths of older adults (i.e., those age over 65 years) complain of foot pain that is associated with a significant foot problem and have evidence of arthritic changes on x-ray. Impaired ambulation can make the difference between independence versus dependency on others, engagement versus isolation. Assisted living is about choices. Being unable to get where one wants to go or do what one wants to do because of foot problems is a barrier to full enjoyment of the opportunities in assisted living communities. This article describes foot problems associated with aging, diabetes, nursing assessment of the feet, and nursing interventions in the service of accessing and optimizing choices for quality of life.
Luther, Brenda; Hart, Sara
Nurses are ethically bound to engage in efforts of improving health and healthcare delivery and, even more important, nurses recently have been called out as key leaders in the reform of healthcare delivery, including many components of the Patient Protection and Affordable Care Act. The Patient Protection and Affordable Care Act, its history, and what healthcare will look like during and after implementation are addressed in this article. A discussion of the role and value of nurses in healthcare reform accompanies knowledge-building and action-oriented resources available to nurses and clients.
Moura, Denizielle de Jesus Moreira; Bezerra, Sara Taciana Firmino; Moreira, Thereza Maria Magalhães; Fialho, Ana Virgínia de Melo
This study aimed to identify the nursing care practices to the client with hypertension in the scientific production in the last ten years. It was carried out a bibliographic study, using in the BIREME, the LILACS, SciELO and BDENF's data basis, selecting thirty articles. The results were exposed in charts, tables and graphics, where prevails, in the literature analyzed, the nursing consultation as the more used practice, through the nursing attendance systematization and the Health Education with individual approaches, besides the realization of home visits with family approach. One believes that the systematization of nursing care will contribute in an expressive manner to the adhesion to the antihypertensive treatment.
Enabling patients to remain in their home is only possible when the different services, both from within and outside the hospital are able to communicate and when the recommended actions are properly coordinated. Entrusting the coordination of the care to the Spasad (polyvalent service for home assistance and nursing care) enables the expectations of the patients and family carers to be analysed. This allows the team to put in place the appropriate actions both in terms of assistance and nursing care.
Enabling patients to remain in their home is only possible when the different services, both from within and outside the hospital are able to communicate and when the recommended actions are properly coordinated. Entrusting the coordination of the care to the Spasad (polyvalent service for home assistance and nursing care) enables the expectations of the patients and family carers to be analysed. This allows the team to put in place the appropriate actions both in terms of assistance and nursing care.
Jia, Huanguang; Pei, Qinglin; Sullivan, Charles T; Cowper Ripley, Diane C; Wu, Samuel S; Vogel, W Bruce; Wang, Xinping; Bidelspach, Douglas E; Hale-Gallardo, Jennifer L; Bates, Barbara E
Introduction Effective post-acute multidisciplinary rehabilitation therapy improves stroke survivors’ functional recovery and daily living activities. The US Department of Veterans Affairs (VA) places veterans needing post-acute institutional care in private community nursing homes (CNHs). These placements are made under the same rules and regulations across the VA health care system and through individual per diem contracts between local VA facilities and CNHs. However, there is limited information about utilization of these veterans’ health services as well as the geographic variation of the service utilization. Aim The aims of this study were to determine rehabilitation therapy and restorative nursing care utilization by veterans with stroke in VA-contracted CNHs and to assess risk-adjusted regional variations in the utilization of rehabilitation therapy and restorative nursing care. Methods This retrospective study included all veterans diagnosed with stroke residing in VA-contracted CNHs between 2006 and 2009. Minimum Dataset (a health status assessment tool for CNH residents) for the study CNHs was linked with veterans’ inpatient and outpatient data within the VA health care system. CNHs were grouped into five VA-defined geographic regions: the North Atlantic, Southeast, Midwest, Continental, and Pacific regions. A two-part model was applied estimating risk-adjusted utilization probability and average weekly utilization days. Two dependent variables were rehabilitation therapy and restorative nursing care utilization by veterans during their CNH stays. Results The study comprised 6,206 veterans at 2,511 CNHs. Rates for utilization of rehabilitation therapy and restorative nursing care were 75.7% and 30.1%, respectively. Veterans in North Atlantic and Southeast CNHs were significantly (p<0.001) more likely to receive rehabilitation therapies than veterans from other regions. However, veterans in Southeast CNHs were significantly (p<0.001) less likely to
DeVore, Adam D; Allen, Larry A; Eapen, Zubin J
The management of acute heart failure is shifting toward treatment approaches outside of a traditional hospital setting. Many heart failure providers are now treating patients in less familiar health care settings, such as acute care clinics, emergency departments, and skilled nursing facilities. In this review we describe the current pressures driving change in the delivery of acute heart failure and summarize the evidence regarding treatments for acute heart failure outside of the inpatient setting. We also provide considerations for the design of future treatment strategies to be implemented in alternative care settings.
McCauley, Kathleen; Bradway, Christine; Hirschman, Karen B; Naylor, Mary D
Background Between one and two of every five hospitalized older adults have cognitive deficits, often not accurately assessed or well managed. Cognitive impairment adds substantially to the complexity of these patients’ care, places them at high risk for poor outcomes and increases the cost of health care. Methods We describe three evidence-based interventions, each capitalizing on the unique contributions of nurses and designed to improve outcomes of hospitalized older adults who have cognitive deficits. Interventions of varying intensity were compared across three hospitals (Phase I) and subsequently within the same hospitals (Phase II). All enrolled patients were screened during their index hospitalizations and cognitive deficits were communicated to relevant health care team members (Augmented Standard Care-ASC, lowest intensity). At one hospital, ASC was the only intervention. Patients at a second hospital also had care influenced by specially prepared registered nurses (Resource Nurse Care-RNC, medium intensity). Finally, patients at third hospital also received advanced practice nurse coordinated care (Transitional Care Model-TCM, higher intensity). In Phase II, newly enrolled patients at these same hospitals all received the TCM. We summarize major themes from review of multiple data sources and researcher recollections related to facilitators and barriers to implementing a complex research study. Findings Effective implementation of the three intervention strategies depended on clinician engagement and communication; degree of participation by nurses in the educational program with subsequent practice improvement; and success of advanced practice nurses in implementing the TCM with both with patients, family caregivers and clinicians. Implications Based on lessons learned in implementing complex research studies within the “real world” of clinical practice settings, recommendations focus on strengthening facilitators, minimizing barriers and gaining
Ferrell, Betty; Malloy, Pam; Mazanec, Polly; Virani, Rose
Nurses spend the most time of any health care professional caring for patients and families dealing with the challenges of serious illness. The demand for nursing expertise in palliative care is growing as more people are living with chronic, life-limiting illnesses. Nursing faculty must prepare future nurses to meet this demand. The new American Association of Colleges of Nursing Palliative Competencies And Recommendations for Educating undergraduate nursing Students document, released February 2016, identifies the 17 competencies that all undergraduate nursing students should achieve by the time of graduation. This historic document is a revision of the 1998 American Association of Colleges of Nursing Peaceful Death document and is now the guiding framework for undergraduate nursing education. In an effort to support nursing faculty and prepare nursing students to deliver quality palliative care, an innovative, interactive on-line undergraduate End-of-Life Nursing Education Consortium (ELNEC) curriculum is under development and will be released in January 2017. This new curriculum will meet the competencies and recommendations for achieving those competencies outlined in the Competencies And Recommendations for Educating undergraduate nursing Students document.
Ritter, J; Fralic, M F; Tonges, M C; McCormac, M
Changes within the health care system necessitate changes in nursing practice. Given the financial environment and the need to balance the cost/quality equation, case management will become increasingly important and has the potential to become the predominant care delivery system of the 1990s. This transition represents a tremendous opportunity for nursing. The CCM role offers many potential advantages and benefits for individual nurses and the profession as a whole. Nurses practicing as case managers have the opportunity to function in a highly professional, independent manner with a great deal of interdisciplinary collaboration. In addition to the challenges and satisfactions of the work itself, the nurse case manager may also enjoy a higher salary and more scheduling control and flexibility. The broader advantages of case management include its benefits to patients and institutions and its fit with current trends in the health care environment. Nurse case managers manage hospital systems to produce optimal clinical outcomes for patients in the shortest time using as few resources as possible. This approach to care delivery places nurses in a position to demonstrate the tremendous contribution they can make to achieving the institution's goal of delivering high-quality, cost-effective care. Thus, case management fits extremely well with current trends in health care financing and outcome measurement. The model described in this article illustrates one approach to implementing these important concepts in a critical care setting.
Introduction Competence of nurses is a complex combination of knowledge, function, skills, attitudes, and values. Delivering care for patients in the Intensive Cardiac Care Unit (ICCU) requires nurses’ competences. This study aimed to explain nurses’ competence in the ICCU. Methods This was a qualitative study in which purposive sampling with maximum variation was used. Data were collected through semi-structured interviews with 23 participants during 2012–2013. Interviews were recorded, transcribed verbatim, and analyzed by using the content-analysis method. Results The main categories were “clinical competence,” comprising subcategories of ‘routine care,’ ‘emergency care,’ ‘care according to patients’ needs,’ ‘care of non-coronary patients’, as well as “professional competence,” comprising ‘personal development,’ ‘teamwork,’ ‘professional ethics,’ and ‘efficacy of nursing education.’ Conclusion The finding of this study revealed dimensions of nursing competence in ICCU. Benefiting from competence leads to improved quality of patient care and satisfaction of patients and nurses and helps elevate nursing profession, improve nursing education, and clinical nursing. PMID:27382450
Fitzgerald, Ruth P
Doctor flight from rural areas is an international phenomenon that places great pressure on primary health care delivery. In New Zealand, the response to these empty doctors' surgeries has been the introduction of nurse-led rural health clinics that have attracted controversy both in the media and from urban-based doctors over whether such nurse-led care is a direct substitution of medical care. This article analyzes the reflections of nurses working in some of these clinics who suggest that their situation is more complex than a direct substitution of labor. Although the nurses indicate some significant pressures moving them closer to the work of doctoring, they actively police this cross-boundary work and labor simultaneously to shore up their nursing identities. My own conclusions support their assertions. I argue that it is the maintenance of a holistic professional habitus that best secures their professional identity as nurses while they undertake the cross-boundary tasks of primary rural health care. There are clear professional benefits and disadvantages for the nurses in these situations, which make the positions highly politicized. These recurring divisions of labor within medical care giving and the elaboration of new types of care worker form an appropriate although neglected topic of study for anthropologists. The study of the social organization of clinical medicine is much enriched by paying closer attention to its interaction with allied health professions and their associated understandings of "good" care.
Sathe, Prachee M.; Patwa, Urvil D.
Pulmonary embolism, Deep Vein Thrombosis (DVT) and Disseminated intravascular coagulation (DIC) are important sources of mortality and morbidity in intensive care unit (ICU). And every time D-dimer remains the the commonest investigation. Many times D-dimer is erroneously considered as a diagnostic test in above mentioned conditions. Its interpretation requires cautions. To circumvent this source of error it is necessary to understand D-dimer test and its significance in various disorder. This article review some basic details of D-dimer, condition associated with its increased level and some prognostic value in intracranial hemorrhage and gastrointestinal (GI) bleed. PMID:25337485
Buntin, Melinda Beeuwkes; Colla, Carrie Hoverman; Escarce, José J
Objective To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies. Data Sources Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data. Study Design We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems. Data Extraction Methods A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement. Principal Findings Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill. Conclusions Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites. PMID:19490159
Nasrabadi, Alireza Nikbakht; Peyrovi, Hamid; Valiee, Sina
Nursing errors are common in critical care units, and nurses are in the first line of confrontation. The purpose of this study was to explore the processes of managing nursing errors in critical care units in Iran and to develop a theoretical explanation of the phenomenon. This was a grounded theory study. We recruited a sample of 18 critical care nurses for the study. The sampling method was purposive and then changed to theoretical. The data were collected through in-depth interviews. For data analysis, we employed the constant comparative analysis technique. The core category of the study was "continuous situational analysis." The main categories were situational analysis and error removal. When nurses confronted an error, they opted for analyzing the error situation in terms of the nature of error, probable consequences, monitoring, and life threat. Accordingly, they employed error removal strategies such as self-action, cooperation, notifying, and censoring. These steps happened concurrently, successively, or cyclically. To manage their committed errors, nurses usually go through an informal process. Nurse-managers need to design effective error management strategies and require the practicing nurses to adhere to them. A practical model for effective prevention and management of nursing errors in critical care units is necessary.
Carlén, Pontus; Bengtsson, Anita
Psychiatric nurses have a major influence on the lives of patients with suicidal behaviour in inpatient care. Despite this, there is a lack of knowledge about how nurses experience patients with suicidal behaviour in a deeper sense. The aim of this study was to investigate how psychiatric nurses experience patients with suicidal behaviour within an inpatient psychiatric context. Semi-structured interviews were carried out with 11 psychiatric nurses, each of whom had more than 5 years of experience caring for patients with suicidal behaviour. Data were analysed using qualitative latent content analysis. Two main themes emerged from the data analysis. These are 'labelled' and 'suffering'. In the nurses' natural attitude, they saw patients as being labelled with different conditions and/or behaviours based on objective signs. These were categorized into different groups or identities such as psychiatric diagnosis, mask wearer, screened-off, or the social, relapsing or determined patient. On reflection, however, the nurses described the patients' suffering in terms related to feelings of hopelessness, meaninglessness, and being out of control. The nurses' experiences of the patients as suffering were based on their subjective reflective experience of the patients. The study gives support to the conclusion that two main logic systems are represented in the care of patients with suicidal behaviour: technical practical and nursing perspectives. In order to ensure that these two logic systems combine, it is necessary for the psychiatric care organization to intervene to support the nurses in reflecting on their everyday work.
De Carlo, Paola; Guerra, Denise; Rega, Maria Luisa; Galletti, Caterina
Scopo. Nella letteratura infermieristica internazionale compassion e compassionate care hanno assunto una notevole importanza e si rivelano essere un fenomeno in divenire. Il concetto di compassionate nursing care risulta poco descritto ed oggettivato nella pratica infermieris-tica nel nostro Paese. Scopo di questo studio è stato di descrivere le esperienze di un campione di infermieri italiani circa il significato di cure infermieristiche compassionevoli. Metodo. È stato condotto uno studio qualitativo. Per la raccolta dei dati sono stati utilizzati i focus group, per analizzare i dati trascritti è stata utilizzata l’analisi di contenuto. Per lo studio è stato individuato un campione propositivo di 21 infermieri, di questi 15 hanno dato la disponibilità a partecipare. Risultati e discussione. Tutti i partecipanti hanno espresso liberamente le loro opinioni. Dall’analisi dei dati relativi alle quattro aree indagate con i focus group: definizione, la propria esperienza, tipologie di pazienti e formazione alle cure infermieristiche compassionevoli sono emersi aspetti contrastanti che variano da accezioni negative e negazione dei termini stessi a significati positivi di amore, carità, empatia, supporto, sostegno, relazione. Interessante ed innovativo è stato l’attribuire l’insegnamento delle cure compassionevoli ai parenti. Conclusioni. E’ risultato difficile per i partecipanti dare una definizione precisa sul significato di cure infermieristiche compassionevoli. E’ emersa la necessità e il desiderio di approfondire questo tema che risulta essere originale e un punto di forza per migliorare l’assistenza infermieristica. Infatti, puntare al recupero di questi valori educando gli infermieri ad erogare cure infermieristiche compassionevoli può sicuramente rappresentare un’implicazione futura per la professione.
Garwick, Ann W.; Svavarsdóttir, Erla Kolbrun; Seppelt, Ann M.; Looman, Wendy S.; Anderson, Lori S.; Örlygsdóttir, Brynja
Aim To identify and compare how school nurses in Reykjavik, Iceland and St. Paul, Minnesota coordinated care for youth with asthma (ages 10–18) and to develop an asthma school nurse care coordination model. Background Little is known about how school nurses coordinate care for youth with asthma in different countries. Design A qualitative descriptive study design using focus group data. Methods Six focus groups with 32 school nurses were conducted in Reykjavik (n=17) and St. Paul (n=15) using the same protocol between September 2008 – January 2009. Descriptive content analytic and constant comparison strategies were used to categorize and compare how school nurses coordinated care, which resulted in the development of an International School Nurse Asthma Care Coordination Model. Findings Participants in both countries spontaneously described a similar asthma care coordination process that involved information gathering, assessing risk for asthma episodes, prioritizing health care needs and anticipating and planning for student needs at the individual and school levels. This process informed how they individualized symptom management, case management and/or asthma education. School nurses played a pivotal part in collaborating with families, school and health care professionals to ensure quality care for youth with asthma. Conclusions Results indicate a high level of complexity in school nurses’ approaches to asthma care coordination that were responsive to the diverse and changing needs of students in school settings. The conceptual model derived provides a framework for investigators to use in examining the asthma care coordination process of school nurses in other geographic locations. PMID:25223389
Laughlin, Candia Baker; Beisel, Marie
High-quality, accessible, and efficient primary care is needed as the U.S. health care system undergoes significant change. Advancing the role of registered nurses in the primary care setting is important to the solution. A large academic health center implemented five initiatives to improve the care of chronically ill patients through the expanded role of RNs in the context of the health care team. Role evolution of nurses in the pilots required some continuing education and some additional nursing support to release the pilot nurses from their usual duties. These strategies allowed the nurses to apply interventions that enhanced the coordination of care and promoted patient self-management skills. Some short-term improvements in health status were realized and barriers to self-care were identified and resolved.
Hitchings, Kim S; Capuano, Terry Ann; Herzog, Mary Ellen
More than 25 years ago, the name "Friends of Nursing" was adopted by an academic, community Magnet(®) hospital to signify a model for community support of nursing. From inception, the intent was to recruit philanthropic dollars to promote recognition of and excellence in nursing practice, education, and research. Although philanthropy in health care settings is common, what is unique about this program is the long-standing, dedicated conceptual framework for nursing philanthropy and the very significant number of philanthropic dollars from literally thousands of donors to support a diverse range of activities to affect and advance the professional excellence of nurses and the quality of patient care. This model has been successfully replicated within a wide variety of other health care organizations and nursing services throughout the United States and abroad.
Kadmon, Ilana; Kislev, Livia
This article will look at the theory of a Learning Organization as described by Senge and the Israeli Breast Care Nurses as an example. A description of the theory of a Learning Organization, the role of the Breast Care Nurses in Israel and the relation between the two will be described. Since 1996, the role of the Breast Care Nurse was founded in Israel. At that time, the role with its importance was very hard to be recognized by the health care team and other professionals of the multidisciplinary team for breast cancer patients. Since the role was initiated, it had been developing all over Israel through the support given by the Israel Cancer Association. As a learning organization, the Breast Care Nurses have a few goals: To learn to give patients the most updated and relevant information; to be a part and be seen as equal as the other members of the multidisciplinary team for breast cancer patients; to have knowledge which empowers them as a working group; to enable to teach students, mainly nursing students, in basic and further education and to help continually teach a new generation of nurses. This learning organization involves some formal and informal education. Although oncology nurses do much of the ideas we have described, we suggest using a strict model to help in implementing a Learning Organization. Future research can examine the outcomes of a Learning Organization on oncology nursing. PMID:27981086
Castles, Amy; Bailey, Carol; Gates, Bob; Sooben, Roja
It has been well documented that people with learning disabilities receive poor care in acute settings. Over the last few years, a number of learning disability liaison nurse services have developed in the United Kingdom as a response to this, but there has been a failure to systematically gather evidence as to their effectiveness. This article…
Martinez, Elena Araujo; Tocantins, Florence Romijn; de Souza, Sônia Regina
This study aimed to identify the way nurses communicate with children and to analyze how this communication takes place during nursing care. It is a descriptive study that uses concepts associated with social representations. The authors interviewed 49 nurses who care for children in the hospital setting. Data collection occurred through semi-structured interviews. After thematic analysis, results emphasized the importance of spoken language, behavioral language and professional attitude. As evidenced, communication is presented as a phenomenon separate from child care, transcending the transmission of linear information. It is concluded that, in terms of understanding the communication phenomenon in child care, the way in which communication is presented and translated characterizes the relevance of nursing actions that point to a comprehensive perspective in child care.
The aim of resuscitation is to sustain life with intact neurological functioning and the same quality of life previously experienced by the patient. Advanced cardiac life support (ACLS) was designed to achieve this aim. However the requirement for ACLS training for critical care nurses working in Canadian critical care units is inconsistent across the country. The purposes of this article are to explore the evidence surrounding ACLS training for critical care nurses and its impact on resuscitation outcomes, and to review the evidence surrounding ACLS knowledge and skill degradation with strategies to support code blue team efficiency for an effective resuscitation. Using the search terms ACLS training, resuscitation, critical care, and nursing, two databases, CINAHL and MEDLINE, were used. The evidence supports the need for ACLS training for critical care nurses. The evidence also supports organized ongoing refresher courses, multidisciplinary mock code blue practice using technologically advanced simulator mannequins, and videotaped reviews to prevent knowledge and skill degradation for effective resuscitation efforts.
Anderson, Daren R; St Hilaire, Daniel; Flinter, Margaret
Care coordination is a core element of the Patient-Centered Medical Home and requires an effective, well educated nursing staff. A greater understanding of roles and tasks currently being carried out by nurses in primary care is needed to help practices determine how best to implement care coordination and transform into PCMHs. We conducted an observational study of primary care nursing in a Community Health Center by creating a classification schema for nursing responsibilities, directly observing and tracking nurses' work, and categorizing their activities. Ten nurses in eight different practice sites were observed for a total of 61 hours. The vast majority of nursing time was spent in vaccine and medication administration; telephone work; and charting and paper work, while only 15% of their time was spent in activity that was classified broadly as care coordination. Care coordination work appeared to be subsumed by other daily tasks, many of which could have been accomplished by other, lesser trained members of the health care team. Practices looking to implement care coordination need a detailed look at work flow, task assignments, and a critical assessment of staffing, adhering to the principal of each team member working to the highest level of his or her education and license. Care coordination represents a distinct responsibility that requires dedicated nursing time, separate from the day to day tasks in a busy practice. To fully support these new functions, reimbursement models are needed that support such non visit-based work and provide incentives to coordinate and manage complex cases, achieve improved clinical outcomes and enhance efficiency of the health system. This article describes our study methods, data collection, and analysis, results, and discussion about reorganizing nursing roles to promote care coordination.
Martin, Ashley E.; D’Agostino, Jo Ann; Passarella, Molly; Lorch, Scott A.
Objective Nurses provide parental support and education in the neonatal intensive care unit (NICU), but it is unknown if satisfaction and expectations about nursing care differ between racial groups. Study Design A prospective cohort was constructed of families with a premature infant presenting to primary care between 1/1/10-1/1/13 (N = 249, 52% white, 42% Black). Responses to questions about satisfaction with the NICU were analyzed in ATLAS.ti using standard qualitative methodology. Results 120 (48%) parents commented on nursing. 57% of the comments were positive, with black parents more negative (58%) than white parents (33%). Black parents were most dissatisfied with how nurses supported them, wanting compassionate and respectful communication. White parents were most dissatisfied with inconsistent nursing care and lack of education about their child. Conclusions Racial differences were found in satisfaction and expectations with neonatal nursing care. Accounting for these differences will improve parental engagement during the NICU stay. PMID:27583386
Angus, Jocelyn; Nay, Rhonda
This paper examines the marginalisation of nursing discourse, which followed the enactment of the Aged Care Act 1997. This neo-reform period in aged care, dominated by theories of economic rationalism, enshrined legislation based upon market principles and by implication, the provision of care at the cheapest possible price. This paper exposes some of the gaps in the neo-reform period and challenges the assertion that the amalgamation of nursing homes and hostels in such an environment can provide better quality of care and life for residents. It argues that this amalgamation entails a transformation towards a social model of care and fails to address the professional healthcare needs of the acutely sick and complex extreme old person and makes evident new gaps in the provision of aged care services. The paper proceeds to present strategies where the future for nursing practice in aged care necessarily involves a judicious balancing of individual cases alongside economic prescriptions of care and ever-changing public policy initiatives. It concludes that this can be achieved through a more interactive public, professional and advocacy discourse. The methodology involves extensive analysis of public documents including media, academic journals, government reports and interviews with recognised leaders in the field of aged care. The study utilises a critical interpretative framework consistent with the logic of Michel Foucault.
Milner, Kerry A; Foito, Kim; Watson, Sherylyn
Nurse educators need to equip nursing students with suitable resources and education so they can develop their own spiritual care, as well as recognize spiritual care needs in patients. There is a paucity of literature on teaching strategies for spiritual care and prayer in undergraduate nursing programs. This article describes how one faith-based school implemented strategies to facilitate spiritual development in students, which are integrated throughout the curriculum and utilized in the U.S. and a study-abroad program in Ireland.
Background Within the setting of a public health service we analyse the distribution of resources between individuals in nursing homes funded by global budgets. Three questions are pursued. Firstly, whether there are systematic variations between nursing homes in the level of care given to patients. Secondly, whether such variations can be explained by nursing home characteristics. And thirdly, how individual need-related variables are associated with differences in the level of care given. Methods The study included 1204 residents in 35 nursing homes and extra care sheltered housing facilities. Direct time spent with patients was recorded. In average each patient received 14.8 hours direct care each week. Multilevel regression analysis is used to analyse the relationship between individual characteristics, nursing home characteristics and time spent with patients in nursing homes. The study setting is the city of Trondheim, with a population of approximately 180 000. Results There are large variations between nursing homes in the total amount of individual care given to patients. As much as 24 percent of the variation of individual care between patients could be explained by variation between nursing homes. Adjusting for structural nursing home characteristics did not substantially reduce the variation between nursing homes. As expected a negative association was found between individual care and case-mix, implying that at nursing home level a more resource demanding case-mix is compensated by lowering the average amount of care. At individual level ADL-disability is the strongest predictor for use of resources in nursing homes. For the average user one point increase in ADL-disability increases the use of resources with 27 percent. Conclusion In a financial reimbursement model for nursing homes with no adjustment for case-mix, the amount of care patients receive does not solely depend on the patients’ own needs, but also on the needs of all the other residents
Nokes, Kathleen M; Aponte, Judith; Nickitas, Donna M; Mahon, Pamela Y; Rodgers, Betsy; Reyes, Nancy; Chaya, Joan; Dornbaum, Martin
Although there is general consensus that nursing students need knowledge and significant skill to document clinical findings electronically, nursing faculty face many barriers in ensuring that undergraduate students can practice on electronic health record systems (EHRS). External funding supported the development of an educational innovation through a partnership between a home care agency staff and nursing faculty. Modules were developed to teach EHRS skills using a case study of a homebound person requiring wound care and the Medicare-required OASIS documentation system. This article describes the development and implementation of the module for an upper-level baccalaureate nursing program located in New York City. Nursing faculty are being challenged to develop creative and economical solutions to expose nursing students to EHRSs in nonclinical settings.
This article explores mental health nurses' diabetes training needs. A survey of inpatient and community mental health nurses was undertaken using a 16-item self-reporting questionnaire. Two hundred and twenty questionnaires were sent out and 138 returned, providing a response rate of 63%. Analysis shows that mental health nurses are currently involved in a range of diabetes care activities, however, their knowledge and skills may not be up to date. Mental health nurses also report the growing impact of diabetes care on their workload. Areas of identified training needs include taking blood glucose readings, giving dietary advice, liaison with diabetes nurse specialists and weight management. Mental health services and education providers need to consider developing specific training courses for mental health nurses.
Armero-Barranco, David; Ruiz-Mateos, María; Alcaraz-Baños, Miguel; Bernal-Páez, Fernando Luis
We report the case of a 73-year-old man with medical diagnoses of long-standing diabetes mellitus, chronic ischemia of the lower limbs and intermittent claudication, for which the patient had been treated with minimally invasive radiological surgery. On arrival at the radiology unit, the patient had nursing diagnoses of anxiety and fear. Intraoperatively, the client had nursing diagnoses of pain, urine retention and infection risk. At discharge, a collaboration problem was detected and hemorrhagic risk. The patient received individualized nursing care. Interventions were planned following the nursing intervention classification (NIC) and the expected results for these interventions followed the Nursing Outcomes Classification (NOC) taxonomy. The application of an appropriate nursing care plan contributes to making the patient's hospital stay easier, more comfortable and less traumatic.
Bull, Rosalind; FitzGerald, Mary
Operating room nurses continue to draw criticism regarding the appropriateness of a nursing presence in the operating room. The technological focus of the theatre and the ways in which nurses in the theatre have shaped and reshaped their practice in response to technological change have caused people within and outside the nursing profession to question whether operating room nursing is a technological rather than nursing undertaking. This paper reports findings from an ethnographic study that was conducted in an Australian operating department. The study examined the contribution of nurses to the work of the operating room through intensive observation and ethnographic interviews. This paper uses selected findings from the study to explore the ways in which nurses in theatre interpret their role in terms of caring in a technological environment.
Brownhill, Suzanne; Chang, Esther; Bidewell, John; Johnson, Amanda
Community (district) nurses play a significant role in assisting and supporting bereaved informal carers (family members and friends) of recently decease clients of palliative care. Bereavement care demands a wide range of competencies including clinical decision-making. To date, little has been known about the decision-making role of community nurses in Australia. The aim of this study was to conduct in-depth examination of an existing data set generated from semi-structured interviews of 10 community nurses providing follow-up bereavement care home visits within an area health service of a metropolitan region of Sydney, Australia. A grounded theory approach to data analysis generated a model, which highlights an interaction between 'the relationship','the circumstances' (surrounding the bereavement),'the psychosocial variant', 'the mix of nurses', 'the workload', and 'the support' available for the bereaved and for community nurses, and elements of 'the visit' (central to bereavement care). The role of community nurses in bereavement care is complex, particularly where decision-making is discretionary and contingent on multiple variables that effect the course of the family's grief. The decision model has the potential to inform community nurses in their support of informal carers, to promote reflective practice and professional accountability, ensuring continuing competence in bereavement care.
Brennan, Patricia Flatley
High-tech home care includes the use of information technologies, such as computer networks, to provide direct care to patients in the home. This paper presents the justification and design of a project using a free, public access computer network to deliver home care nursing. The intervention attempts to reduce isolation and improve problem solving among home care patients and their informal caregivers. Three modules comprise the intervention: a decision module, a communications module, and an information data base. This paper describes the experimental evaluation of the project, and discusses issues in the delivery of nursing care via computers.
Palliative care is expanding out of the hospice, and out of the narrow confines of its association with cancer. It should be a part of all care. District nurses are ideally placed to implement and coordinate palliative care in the community, making use of the talents of many other agencies and professionals. However, because of a lack of communication between these agencies, there is confusion about their roles, and many patients may not be receiving optimal care. This article argues that by promoting interagency and interprofessional communication and cooperation, district nurses can strengthen their role at the heart of palliative care provision in the community.
Ward-Griffin, C; McKeever, P
Increasing reliance on family care of elderly people at home calls for a critical analysis of the relationship between formal and informal caregivers. Although much has been written about how health professionals and family caregivers should relate to one another, we know very little about the relationships that develop between them. Using data from a qualitative study, this article illustrates that relationships between community nurses and family members caring for frail elders are complex, dynamic, and multifaceted. Shifting boundaries in caring work leads to changes in nurse-family caregiver relationships, which can be categorized as four distinct, yet interconnected, types: (1) nurse-helper, (2) worker-worker, (3) manager-worker, and (4) nurse-patient. Each type is described, and implications for nursing practice and research are discussed.
The purpose of this phenomenological study was to explore the lived experience of nurses who practice Reiki for self-care. In-person interviews were conducted with 11 nurses who met specific study criteria, using open-ended questions to examine the experience of nurses who are Reiki practitioners, to understand their perceptions of Reiki use in self-treatment, and to appreciate its meaning for them. The Colaizzi method was utilized in data analysis and independent decision trail audits were completed to promote study rigor and trustworthiness of results. Thematic categories and major and minor thematic clusters emerged around the topics of daily stress management, self-healing, spirituality, and interconnectedness of self, others, and beyond. Implications of the study findings for nursing practice and nursing education are discussed. Potential applications of study findings to Jean Watson's transpersonal caring theory located within a caring science framework are explored and recommendations for future research are offered.
Paré, Guy; Sicotte, Claude; Moreault, Marie-Pierre; Poba-Nzaou, Placide; Nahas, Georgette; Templier, Mathieu
We investigated the effects of the introduction of mobile computing on the quality of home care nursing practice in Québec. The software, which structured and organized the nursing activities in patients' homes, was installed sequentially in nine community health centres. The completeness of the nursing notes was compared in 77 paper records (pre-implementation) and 73 electronic records (post-implementation). Overall, the introduction of the software was associated with an improvement in the completeness of the nursing notes. All 137 nurse users were asked to complete a structured questionnaire. A total of 101 completed questionnaires were returned (74% response rate). Overall, the nurses reported a very high level of satisfaction with the quality of clinical information collected. A total of 57 semi-structured interviews were conducted and most nurses believed that the new software represented a user-friendly tool with a clear and understandable structure. A postal questionnaire was sent to approximately 1240 patients. A total of 223 patients returned the questionnaire (approximately 18% response rate). Overall, patients felt that the use of mobile computing during home visits allowed nurses to manage their health condition better and, hence, provide superior care services. The use of mobile computing had positive and significant effects on the quality of care provided by home nurses.
Leon, Ana M; Knapp, Sandra
The literature indicates that involvement of families in critical care settings is effective in meeting the needs of families and patients during a medical crisis. This article presents basic concepts from family systems theory, including cultural considerations useful in developing nursing care plans that integrate family involvement in the care of critically ill patients.
Salehian, Maryam; Heydari, Abbas; Aghebati, Nahid; Moonaghi, Hossein Karimi; Mazloom, Seyed Reza
Introduction The aim of this principle-based concept analysis was to analyze caring in nursing education and to explain the current state of the science based on epistemologic, pragmatic, linguistic, and logical philosophical principles. Methods A principle-based concept analysis method was used to analyze the nursing literature. The dataset included 46 English language studies, published from 2005 to 2014, and they were retrieved through PROQUEST, MEDLINE, CINAHL, ERIC, SCOPUS, and SID scientific databases. The key dimensions of the data were collected using a validated data-extraction sheet. The four principles of assessing pragmatic utility were used to analyze the data. The data were managed by using MAXQDA 10 software. Results The scientific literature that deals with caring in nursing education relies on implied meaning. Caring in nursing education refers to student-teacher interactions that are formed on the basis of human values and focused on the unique needs of the students (epistemological principle). The result of student-teacher interactions is the development of both the students and the teachers. Numerous applications of the concept of caring in nursing education are available in the literature (pragmatic principle). There is consistency in the meaning of the concept, as a central value of the faculty-student interaction (linguistic principle). Compared with other related concepts, such as “caring pedagogy,” “value-based education,” and “teaching excellence,” caring in nursing education does not have exact and clear conceptual boundaries (logic principle). Conclusion Caring in nursing education was identified as an approach to teaching and learning, and it is formed based on teacher-student interactions and sustainable human values. A greater understanding of the conceptual basis of caring in nursing education will improve the caring behaviors of teachers, create teaching-learning environments, and help experts in curriculum development
The attitudes of hospice nurses towards psychosexual issues in palliative care were surveyed. Sexuality was acknowledged to be both important and relevant in hospice nursing. A high level of awareness of sexual and relationship issues was apparent, reflecting broadly liberal attitudes.
Stein, Shayna; And Others
Examined anticipation of stresses in 223 patients recently admitted to nursing homes, who completed the stresses in Institutional Care Scale (SIC). Factor analysis revealed five factors significantly related to psychological and physical variables. Suggests using SIC for admission screening in nursing homes. Appendix contains the SIC. (NRB)
Richie, Mary Fern; And Others
Psychiatric nursing faculty practice offers the academic nurse opportunity to generate salary support and integrate students into the real world of mental health care. It promotes scholarship and knowledge-building and has a direct impact on the lives of patients. (Author/JOW)
Braun, Kathryn L.; Rose, Charles L.
Relatives (N=62) of matched pairs of patients in geriatric foster homes and nursing homes rated care provided to their relatives. Significantly more foster family patients had positive pre-placement attitudes than did nursing home patients. Upon follow-up, relatives of foster patients reported seeing more patient improvement, satisfaction,…
Dal Sasso, Grace Marcon; Barra, Daniela Couto Carvalho
The aim of this work was to measure the cognitive workload to complete printed nursing process versus computerized nursing process from International Classification Practice of Nursing in intensive care units. It is a quantitative, before-and-after quasi-experimental design, with a sample of 30 participants. Workload was assessed using National Aeronautics and Space Administration Task-Load Index. Six cognitive categories were measured. The "temporal demand" was the largest contributor to the cognitive workload, and the role of the nursing process in the "performance" category has excelled that of computerized nursing process. It was concluded that computerized nursing process contributes to lower cognitive workload of nurses for being a support system for decision making based on the International Classification Practice of Nursing. The computerized nursing process as a logical structure of the data, information, diagnoses, interventions and results become a reliable option for health improvement of healthcare, because it can enhance nurse safe decision making, with the intent to reduce damage and adverse events to patients in intensive care.
Güler, Elem Kocaçal; Eşer, İsmet; Fashafsheh, Imad Hussein Deeb
Eye care is an important area of critical care. However, lack of eye care studies is a common issue across the globe. The aim of this study is to determine the views and practices of intensive care unit (ICU) nurses on eye care in Turkey and Palestine. This descriptive study was conducted using a self-administrated questionnaire. The data were collected from 111 nurses in nine kinds of ICUs in two education hospital. Normal saline (75.9%) was the most commonly reported solution for eye hygiene among the Palestinian nurses, and gauze soaked in normal saline or sterile water (64.3%) were the most frequently used supplies by the Turkish nurses. Although both Palestinian and Turkish ICU nurses took some precautions to prevent eye complications in critical patients, there were some gaps and insufficiencies in the eye care of ICU patients. There is a need for continuing training in this area.
Khan, Ehsan Ullah
Hypertension is a prevalent chronic illness that is implicated in many cardiovascular diseases. Practice nurses and the district nursing team have a major role to play in its management. In this article, current British Hypertension Society guidelines are presented and discussed with regards to their evidence base. Implications for nursing practice are highlighted.
Mahon, Paula R
The aim of this study is to examine key features within the cultural context in a Canadian Paediatric Intensive Care Unit (PICU) environment as experienced by nurses and to identify what these influences are and how they shape nurses' intentions to remain at critically ill children's bedsides for the duration of their careers. This is a qualitative study which follows a critical ethnographic approach. Over 20 hours of observation and face-to-face semi-structured interviews were conducted. Approximately one third of the nursing population at the research site PICU were interviewed (N=31). Participants describe a complex process of becoming an expert PICU nurse that involved several stages. By the time participants became experts in this PICU they believed they had significantly narrowed the power imbalance that exists between nursing and medicine. This study illuminates the role both formal and informal education plays in breaking the power barrier for nurses in the PICU. This level of expertise and mutual respect between professions aids in retaining nurses in the PICU. The lack of autonomy and/or respect shown to nurses by administrators appears to be one of the major stressors in nurses' working lives and can lead to attrition from the PICU. Family Centred Care (FCC) is practiced in paediatrics and certainly accentuated in the PICU as there is usually only one patient assigned per nurse, who thus afforded the time to provide comprehensive care to both the child and the family. This is considered one of the satisfiers for nurses in the PICU and tends to encourage retention of nurses in the PICU. However, FCC was found to be an inadequate term to truly encompass the type of holistic care provided by nurses in the PICU.
Lazure, G; Vissandjée, B; Pepin, J; Kérouac, S
This paper aims to illustrate how Leininger's Theory of Culture Care Diversity and Universality has influenced the research process of a study that emerged from a care management partnership between Canadian nursing teachers and Tunisian nurses. The purpose of the study was to investigate the meanings of care as viewed by university hospital-based Tunisian nurses. The qualitative analysis of data gathered through observation-participation and interviews highlights recurrent patterns and reveals three major professional care themes. For Tunisian nurses care means to secure the patient's cooperation towards the medical regimen within established rules in the hospital; to contribute to curing the patient by using current technology as well as by maintaining their technical skills and improving their medical knowledge; to take charge of the patient to assist the physician in treating disease. This study showed that Tunisian nurses emphasize curing rather than widely shared community values such as interdependence, intercommunication, understanding, presence and responsibility for others. Discussion of the study's findings draws upon the perspective provided by Freire's Oppressed Group Theory. In order to promote cultural congruence within the Care Management Partnership Project in Tunisia, the three predicted modes of care within Leininger's theory guide the decisions and actions for future nursing research and partnership activities.
This paper describes how a critical care nurse consultant's clinical role has evolved within a surgical high dependency unit (SHDU) in a large teaching hospitals trust. In order to provide some background to role development, an overview of the research exploring the nature of advanced nursing practice in the context of critical care will be presented. From the outset, advanced nursing practice was not perceived as the acquisition and application of technical procedures usually undertaken by doctors, but possibly an integration of medicine and nursing where holistic nursing assessment is combined with symptom-focused physical examination. A reflective account of practical problems encountered relating to role integration, professional autonomy, legal and consent issues, non-medical prescribing, and role evaluation will be presented. A model of working that can be applied to high dependency units, integrating the role of the advanced nurse practitioner within the clinical team, will be described.
Zamanzadeh, Vahid; Valizadeh, Leila; Azimzadeh, Roghaieh; Aminaie, Nasim; Yousefzadeh, Sedigeh
Introduction: The essence of professional nursing is caring and so, nursing education must make caring as a significant part of their curricula. In this regard, little research exists about how nursing students perceive caring. The aim of this study is to investigate the nursing students' perception toward caring and thus, the impact of socialization process on their perception of caring will be determined. Methods: A cross-sectional study was done among all first and fourth-year nursing students (n=230) in Tabriz and Urmia faculties of nursing, 2012. Data were collected using Larson's Caring Questionnaire that assessed the importance of nursing care behaviors (n=50) in six dimensions: "being accessible", "explains and facilitates", "comforts", "anticipates", "trusting relationship" and "monitors and follows through". Results: The importance of caring behaviors was evaluated by the first and fourth-year nursing students in moderate to high level and also, the both groups considered higher ranks for "monitors and follows through" and "being accessible" and lower ranks for "anticipates" and "trusting relationships". The fourth-year students only ranked "explains and facilitates" higher than the first-year students, but the "comforts" dimension is not differed significantly between groups. Conclusion: The findings demonstrated that nursing education in this study has not likely succeeded in producing intended changes in the nursing students' perceptions. It is recommended to exactly find the perceptual changes or in principle the professional socialization process of nursing students, more research using longitudinal designs be conducted to examine the differences in students' perceptions of caring upon entering and completing the nursing program. PMID:25276752
da Silva, Rafael Celestino; Ferreira, Márcia de Assunção; Apostolidis, Thémistoklis; Brandão, Marcos Antônio Gomes
Objective: to propose a conceptual framework for clinical nursing care in intensive care. Method: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. Results: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks. Conclusion: the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization. PMID:26487133
da Silva, Rafael Celestino; Ferreira, Márcia de Assunção
The objective of this study was to identify the social representations that nurses have about technology applied to intensive care, and relate them to their ways of acting while caring for patients. This qualitative study was performed using social representations as the theoretical-methodological framework. Interviews were performed with 24 nurses, in addition to systematic analysis and thematic content analysis. The results were organized into three categories about the lack of technological knowledge, approach strategies, mastering that knowledge and using it. The knowledge necessary to handle the technology, and the time of experience using that technology guide the nurses' social representations implying on their care attitudes. In conclusion, the staffing policy for an intensive care setting should consider the nurses' experiences and specialized education.
Despite the relational worldview that underpins nursing caring, the cultural value of individualism remains firmly embedded in nursing's conceptual systems. Individualism forms the basis of notions such as autonomy, self-reliance, personal rights and entitlement. When nurses concomitantly espouse the value of care, an orientation that stands in contrast to the predominant societal motif of the autonomous individual, they find themselves having to reconcile contrary ideals. The significance of the coexistence of the values of individualism and care rests upon the capability of each to contrast and sharpen our understanding of the other. The convergent outcome is the empowerment of nurses to refine their understanding of the human condition in illness and health, and to articulate a public practice of care that would temper the fundamental mark of nointerference in the traditional notion of individualism in American culture.
Jones, C B
Changes in health care delivery and cyclic fluctuations in the registered nurse (RN) labor market affect health care costs, access, and quality. This study provides insight into one factor central to these issues, the job-change behavior of RNs. The theory of human capital provides the foundation to guide investigation, and econometric modeling is used to explore relationships among study variables. Model results show clear differences in job change behavior of nurses employed in hospital and nonhospital settings. These differences are a reflection, not only of individual nurse preferences, but also of wages, working conditions, and opportunities associated with various health care settings. Understanding these relationships is essential to leaders in the nursing profession as they plan for and respond to changes in health care delivery.
Oberlies, Amanda Stefancyk
The American Organization of Nurse Executives conducted an evaluation of the hospitals participating in the Care Innovation and Transformation (CIT) program. A total of 24 hospitals participated in the 2-year CIT program from 2012 to 2013. Reported outcomes include increased patient satisfaction, decreased falls, and reductions in nurse turnover and overtime. Nurses reported statistically significant improvements in 4 domains of the principles and elements of a healthful practice environment developed by the Nursing Organizations Alliance.
Weslin, Anna T; Silva-Smith, Amy
Performing arts medicine is a growing health care profession specializing in the needs of performing artists. As part of the performing arts venue, the dancer, a combination of athlete and artist, presents with unique health care needs requiring a more collaborative and holistic health care program. Currently there are relatively few advanced practice nurses (APNs) who specialize in performing arts health care. APNs, with focus on collaborative and holistic health care, are ideally suited to join other health care professionals in developing and implementing comprehensive health care programs for the performing artist. This article focuses on the dancer as the client in an APN practice that specializes in performing arts health care.
van Dijk, Pim A. D.; Bot, Arjan G. J.; Neuhaus, Valentin; Menendez, Mariano E.; Vrahas, Mark S.
Background: Little is known about the effect of preinjury residence on inpatient mortality following hip fracture. This study addressed whether (1) admission from a nursing home residence and (2) admission from another hospital were associated with higher inpatient mortality after a hip fracture. Methods: Using the National Hospital Discharge Survey database, we analyzed an estimated 2 124 388 hip fractures discharges, from 2001 to 2007. Multivariable logistic regression analysis was performed to identify whether admission from a nursing home and admission from another hospital were independent risk factors for inpatient mortality. Our primary null hypothesis is that there is no difference in inpatient mortality rates after hip fracture in patients admitted from a nursing home, compared to other forms of admission. The secondary null hypothesis is that there is no difference in inpatient mortality after hip fracture in patients whose source of admission was another hospital, compared to other sources of admission. Results: Almost 4% of the patients were admitted from a nursing home and 6% from another hospital. The mean age was 79 years and 71% were women. The majority of patients were treated with internal fixation. Admission from a nursing home residence (odds ratio [OR] of 2.1, confidence interval [CI] 1.9-2.3) and prior hospital stay (OR 3.4, CI 3.2-3.7) were associated with a higher risk of inpatient mortality after accounting for other comorbidities and type of treatment. Conclusions: Patients transferred to an acute care hospital from a long-term care facility or another acute care hospital are at particularly high risk of inpatient death. This subset of patients should be considered separately from patients admitted from other sources. Level of Evidence: Prognostic level II. PMID:26328224
Mariutti, Mariana Gondim; de Almeida, Ana Maria; Panobianco, Marislei Sanches
This qualitative study aimed to understand how women having an abortion experience the nursing care they receive. The statements of 13 hospitalized women were analyzed through content analysis. The central category "Nursing care experienced in situations of abortion" was constituted from 4 subcategories: care centered in physical needs; fear of judgment in abortion situations; legal aspects defining care; the need for support in abortion situations. These women identified nursing care as based on physical aspects, without contemplating their individuality and specificities. Results indicated the need to create an environment that stimulates listening, helping these women to elaborate their feelings and allowing professionals to behave closer to these women's reality, in order to reduce their own desires and conflicts and contemplate the integrality of care.
Children living in foster care are a unique population with specialized healthcare needs. This article will assist forensic nurses and advanced practice forensic nurses, particularly those working in pediatrics, in understanding the needs of children in foster care and implementing a practice plan to better meet their healthcare needs. To that end, a basic understanding of the foster care system is crucial and involves an appreciation of the interface between the legal system and the child welfare system. Most important to providing care to children in foster care is a true understanding of trauma exposure and its potential effects on the lives of children: physically, developmentally, emotionally, and psychologically. This article will assist forensic nurses working with pediatric populations to more fully understand the needs of children in foster care and to develop innovative interventions to appropriately meet their unique needs.
Bertram, Julie E; Narendorf, Sarah Carter; McMillen, J Curtis
Older youth served in the foster care system have elevated rates of mental health disorders and are high users of mental health services, yet concerns have been raised about the quality of this care. This paper describes the details of a psychiatric nurse's work within a multidisciplinary team to address gaps in care for older youth with psychiatric disorders. We describe the process, outcomes, and lessons learned in developing and piloting a psychiatric nurse intervention for older youth in the foster care system as part of a multidimensional treatment foster care program. Our experiences support further work to develop a role for nursing to improve the quality of mental health treatment in foster care.
Llamas Urrutia, Carmen
The author sets out to know the degree of use of the Nursing Treatment Process (NTP) and its possible relationship with these factors: its profile, knowledge about NTP and the Virginia Henderson Model (VHM), nurses case loads and nurses opinions. The subjects in this study have been nurses in the Sant Martí sanitary district in Barcelona. The methodology used consisted in transversal and qualitative descriptive studies performed in 2001; the use of NTP by means of an audit of at home patient visits, NTP-VHM knowledge and profile by means of an anonymous self-administered questionnaire which had 30 theoretical-practical questions; nurses case load study by means of an analysis of the population attended to by nurse per year and nursing activities; and a qualitative study which used opinion questions and interviews.
Johanson, Linda S
Much has been written about teaching students of the Millennial Generation (those born between the years 1980 and 2000) and about intergenerational dynamics in the healthcare workforce. However, little can be found in the literature regarding generation-specific nursing care of Millennial patients. This article presents six categories of considerations for nurses caring for patients of the Millennial Generation based on the characteristics, attitudes, and values that have influenced them as well as the healthcare issues confronting this group of young adults.
Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is
Strong, Margaret; Kane, Irene; Petras, Denise; Johnson-Joy, Cheryl; Weingarten, Joseph
Direct care nurses and nurse leaders were surveyed on their perceptions of the appropriateness, importance, and use in daily practice of 10 clinical nursing competencies needed for nurses to be successful in the future. Competencies needed in the 21st century are not based entirely on task-driven motor skills because comprehensive knowledge is essential to care for complex patients. Differences identified between direct care nurses, leaders, and educational levels provide educational opportunities for both groups.
Lewandowski, L A; Kramer, M
To investigate whether special care unit nurses have characteristics different from nurses who work in nonintensive care settings and whether SCU nurses make more effective role transformations than non-SCU nurses, this posthoc descriptive study utilized data from 213 new graduate nurses in their first jobs in eight medical centers across the United States. The 213 nurses were a subsample of 307 new graduate nurses in a parent study that tested effect of a bicultural orientation program in role transformation. The nurses in the subsample worked in one of four nursing areas: medical--surgical, medical--surgical specialty, parent--child, and SCU. They were pretested at six weeks of employment regarding their: professional, bureaucratic, and service role conceptions; total role deprivation; professional, bureaucratic, and bicultural role behavior; self-esteem; and degree of self-actualization. SCU nurses had significantly higher self-actualization scores initially than medical--surgical nurses. Posttesting at nine months of employment included all of the above variables plus measures of empathy and change-agent activity. Performance ratings and resignations were examined at one year of employment. Analyses of variance of the difference scores and posttest-only scores showed no significant differences by type of unit except for self-actualization. To examine the relationship between the degree of specialization and the variables under study, units were rank ordered according to degree of specialization. Nurses working on units which required the most specialization had significantly higher increases in bicultural scores and self-esteem and trends toward higher increases in bureaucratic role conception and higher performance ratings. However, SCU nurses also had the most decrease in professional role conception scores, least increase in self-actualization scores, least amount of empathy with co-workers, and least amount of effective change-agent activity
Neidlinger, S H; Bartleson, B J; Drews, N; Hukari, D
From innovations shared by nurse executives and nurse intrapreneurs in acute care hospitals, The Venture Actualization in Nursing Model emerged. Derived from a nursing perspective, this model captures the steps of the nurse innovation process, linking the nurse executive and nurse intrapreneur role components to the process that leads to venture success.
King, S J; de Sales Turner
This phenomenological study was undertaken to explore in depth the experiences of registered nurses caring for adolescent anorexic females within paediatric wards of general hospitals in Victoria, Australia. A qualitative design underpinned by the philosophy of Edmund Husserl was employed for this study. Audio taped in-depth interviews with five registered nurses working within the public health care system were conducted. Using Colaizzi's procedural steps of analysis, six themes of meaning were explicated. They were: (a) personal core values of nurses; (b) core values challenged; (c) emotional turmoil; (d) frustration; (e) turning points; and (f) resolution. These themes, when taken together, described the essence of the journey undertaken by registered nurses who cared for adolescent anorexic females. The findings of this study indicated that there is a need for extensive registered nurse preparation, on-going support, and development of education programmes to enable registered nurses to care for these patients with greater understanding. Further, the participants identified the need for new care regimes and protocols to be developed that incorporated new ways of thinking. They also expressed a desire to be have greater involvement in the planned care of their patients.
de Jong, Alette E E; Leeman, Jolan; Middelkoop, Esther
Existing workload measurement instruments fail to represent specific nursing activities in a setting where patients are characterized by a diversity of cause, location, extent and depth of burns, of age and of history. They also do not include educational levels and appropriate time standards. The aim of this study was to develop a reliable measurement instrument for nursing workload in burn care, in order to match quality of patient care with staffing needs. In the first phase, a time study by semi-structured interviews and observations was used to assess direct and indirect care activities. A total of 34 nursing activities were identified, defined, connected to educational levels and attached to time standards. Two independent raters completed a test computer program by assessing performed nursing activities in 36 patients. This yielded intra-class correlations of 0.82, indicating good reliability. In the second phase, a computer program was developed to process quantity and quality of available staff and the sum of time standards of nursing activities per patient per day and to calculate the balance. After 1 year of running this program, the database was used to distinguish patients' care demand into five care categories. This instrument justifies the investment of time by nursing staff needed for daily activities in the burn unit. It provides quick insight into the balance between care demand and staffing needs and can be used to optimise resource planning.
Hunt, Selina R.; Corazzini, Kirsten; Anderson, Ruth A.
Director of nursing turnover is linked to staff turnover and poor quality of care in nursing homes; however the mechanisms of these relationships are unknown. Using a complexity science framework, we examined how nurse management turnover impacts system capacity to produce high quality care. This study is a longitudinal case analysis of a nursing home (n = 97 staff) with 400% director of nursing turnover during the study time period. Data included 100 interviews, observations and documents collected over 9 months and were analyzed using immersion and content analysis. Turnover events at all staff levels were nonlinear, socially mediated and contributed to dramatic care deficits. Federal mandated, quality assurance mechanisms failed to ensure resident safety. High multilevel turnover should be elevated to a sentinel event for regulators. Suggestions to magnify positive emergence in extreme conditions and to improve quality are provided. PMID:24652943
Clayton, Michelle; Greenslade, Lynda
Following the overview of liver disease in part 1, the second part of this series looks at how a new competency framework was developed for nurses caring for people with or at risk of liver disease to address the increasing burden of the disease across public health, primary care and secondary care. Understanding of liver disease and its risk factors remains poor among many health professionals; a competency framework enables nurses and teams to identify and develop the skills, knowledge and understanding they need to provide high-quality, person-centred care.
Flagg, Amanda J
Patient-centered care (PCC) has become a key focus in the delivery of health care. It is necessary to gain some perspective of its fit into nursing, which has become physically and mentally demanding in the care of diverse populations. Although there is no agreed-upon definition or classification, there are several key aspects that work with PCC that are discussed in detail. This article provides more clarity to the role of nursing using several aspects of PCC in its many forms to improve the quality of care provided in a way that is both manageable and safe.
Rushton, Carole; Edvardsson, David
Relationships are central to enacting person-centred care of the older person with cognitive impairment. A fuller understanding of relationships and the role they play facilitating wellness and preserving personhood is critical if we are to unleash the productive potential of nursing research and person-centred care. In this article, we target the acute care setting because much of the work about relationships and older people with cognitive impairment has tended to focus on relationships in long-term care. The acute care setting is characterized by archetypal constraints which differentiate it from long-term care, in terms of acuity and haste, task-orientated work patterns and influence from "the rule of medicine," all of which can privilege particular types of relating. In this article, we drew on existing conceptualizations of relationships from theory and practice by tapping in to the intellectual resources provided by nurse researchers, the philosophy of Martin Buber and ANT scholars. This involved recounting two examples of dyadic and networked relationships which were re-interpreted using two complementary theoretical approaches to provide deeper and more comprehensive conceptualizations of these relationships. By re-presenting key tenets from the work of key scholars on the topic relationships, we hope to hasten socialization of these ideas into nursing into the acute care setting. First, by enabling nurses to reflect on how they might work toward cultivating relationships that are more salutogenic and consistent with the preservation of personhood. Second, by stimulating two distinct but related lines of research enquiry which focus on dyadic and networked relationships with the older person with cognitive impairment in the acute care setting. We also hope to reconcile the schism that has emerged in the literature between preferred approaches to care of the older person with cognitive impairment, that is person-centred care versus relationship-centred care
Altafin, Juliana Aparecida Morini; Grion, Cintia Magalhães Carvalho; Tanita, Marcos Toshyiuki; Festti, Josiane; Cardoso, Lucienne Tibery Queiroz; Veiga, Caio Fabrício Fonseca; Kamiji, Danielle; Barbosa, Álan Roger Gomes; Matsubara, Caio Cesar Takeshi; Lara, Aline Bobato; Lopes, Cesar Castello Branco; Blum, Djavani; Matsuo, Tiemi
Objective The nursing workload consists of the time spent by the nursing staff to perform the activities for which they are responsible, whether directly or indirectly related to patient care. The aim of this study was to evaluate the nursing workload in an adult intensive care unit at a university hospital using the Nursing Activities Score (NAS) instrument. Methods A longitudinal, prospective study that involved the patients admitted to the intensive care unit of a university hospital between March and December 2008. The data were collected daily to calculate the NAS, the Acute Physiology and Chronic Health Evaluation (APACHE II), the Sequential Organ Failure Assessment (SOFA) and the Therapeutic Intervention Scoring System (TISS-28) of patients until they left the adult intensive care unit or after 90 days of hospitalization. The level of significance was set at 5%. Results In total, 437 patients were evaluated, which resulted in an NAS of 74.4%. The type of admission, length of stay in the intensive care unit and the patients’ condition when leaving the intensive care unit and hospital were variables associated with differences in the nursing workload. There was a moderate correlation between the mean NAS and APACHE II severity score (r=0.329), the mean organic dysfunction SOFA score (r=0.506) and the mean TISS-28 score (r=0.600). Conclusion We observed a high nursing workload in this study. These results can assist in planning the size of the staff required. The workload was influenced by clinical characteristics, including an increased workload required for emergency surgical patients and patients who died. PMID:25295824
Drake, Gareth; de C Williams, Amanda C
The objective of this review was to examine the effects of nursing education interventions on clinical outcomes for acute pain management in hospital settings, relating interventions to health care behavior change theory. Three databases were searched for nursing education interventions from 2002 to 2015 in acute hospital settings with clinical outcomes reported. Methodological quality was rated as strong, moderate, or weak using the Effective Public Health Practice Project Quality Assessment Tool for quantitative studies. The 12 eligible studies used varied didactic and interactive teaching methods. Several studies had weaknesses attributable to selection biases, uncontrolled confounders, and lack of blinding of outcome assessors. No studies made reference to behavior change theory in their design. Eight of the 12 studies investigated nursing documentation of pain assessment as the main outcome, with the majority reporting positive effects of education interventions on nursing pain assessment. Of the remaining studies, two reported mixed findings on patient self-report of pain scores as the key measure, one reported improvements in patient satisfaction with pain management after a nursing intervention, and one study found an increase in nurses' delivery of a relaxation treatment following an intervention. Improvements in design and evaluation of nursing education interventions are suggested, drawing on behavior change theory and emphasizing the relational, contextual, and emotionally demanding nature of nursing pain management in hospital settings.
Spigolon, Dandara Novakowski; Moro, Claudia Maria Cabral
This study aimed to develop an Essential Data Set for Nursing Care of Patients with Endometriosis (CDEEPE), represented by archetypes. An exploratory applied research with specialists' participation that was carried out at Heath Informatics Laboratory of PUCPR, between February and November of 2010. It was divided in two stages: CDEEPE construction and evaluation including Nursing Process phases and Basic Human Needs, and archetypes development based on this data set. CDEEPE was evaluated by doctors and nurses with 95.9% of consensus and containing 51 data items. The archetype "Perception of Organs and Senses" was created to represents this data set. This study allowed identifying important information for nursing practices contributing to computerization and application of nursing process during care. The CDEEPE was the basis for archetype creation, that will make possible structured, organized, efficient, interoperable, and semantics records.
Sidani, Souraya; Reeves, Scott; Hurlock-Chorostecki, Christina; van Soeren, Mary; Fox, Mary; Collins, Laura
There is limited evidence of the extent to which Healthcare professionals implement patient-centered care (PCC) and of the factors influencing their PCC practices in acute care organizations. This study aimed to (1) examine the practices reported by health professionals (physicians, nurses, social workers, other healthcare providers) in relation to three PCC components (holistic, collaborative, and responsive care), and (2) explore the association of professionals' characteristics (gender, work experience) and a contextual factor (caseload), with the professionals' PCC practices. Data were obtained from a large scale cross-sectional study, conducted in 18 hospitals in Ontario, Canada. Consenting professionals (n = 382) completed a self-report instrument assessing the three PCC components and responded to standard questions inquiring about their characteristics and workload. Small differences were found in the PCC practices across professional groups: (1) physicians reported higher levels of enacting the holistic care component; (2) physicians, other healthcare providers, and social workers reported implementing higher levels of the collaborative care component; and (3) physicians, nurses, and other healthcare providers reported higher levels of providing responsive care. Caseload influenced holistic care practices. Interprofessional education and training strategies are needed to clarify and address professional differences in valuing and practicing PCC components. Clinical guidelines can be revised to enable professionals to engage patients in care-related decisions, customize patient care, and promote interprofessional collaboration in planning and implementing PCC. Additional research is warranted to determine the influence of professional, patient, and other contextual factors on professionals' PCC practices in acute care hospitals.
McIntosh, Nathalie; Burgess, James F; Meterko, Mark; Restuccia, Joseph D; Alt-White, Anna C; Kaboli, Peter; Charns, Martin
The objective of this study was to assess the role of provider coordination on nurse manager and physician perceptions of care quality, while controlling for organizational factors. Findings indicated that nurse-nurse coordination was positively associated with nurse manager perceptions of care quality; neither physician-physician nor physician-nurse coordination was associated with physician perceptions. Organizational factors associated with positive perceptions of care quality included facility support of education for nurses and physicians, and the use of multidisciplinary rounding.
Responses from 132 baccalaureate nursing programs indicated that the majority include spiritual dimensions in program philosophy and curriculum, but few had definitions of spirituality and nursing care. Content typically addressed patients' spiritual needs, dying, and holism. Respondents were uncertain about faculty preparation to teach about…
Caffrey, Rosalie A
Few nurses have the experience of developing an independent practice. This ethnographic study explores the process and challenges of becoming an entrepreneur as described by nurses developing independent practices in community care gerontologic nursing. The process included developing a legal contract, marketing strategies, and reimbursement amounts and strategies. Major barriers to implementing this role identified by the nurses included ignorance and confusion by others about their role, financial issues related to an uncertain income, time management, and legal concerns especially around delegation. These were experienced and dedicated nurses who were also risk-takers and enjoyed the independence of practicing nursing because they believed it was meant to be practiced. Suggestions for research, education, and practice are included.
Hebert, Kathy; Moore, Harold; Rooney, Joan
End-of-life nursing encompasses many aspects of care: pain and symptom management, culturally sensitive practices, assisting patients and their families through the death and dying process, and ethical decisionmaking. Advocacy has been identified as a key core competency for the professional nurse, yet the literature reveals relevant barriers to acquiring this skill. Challenges exist, such as limitations in nursing school curricula on the death and dying process, particularly in multicultural settings; differing policies and practices in healthcare systems; and various interpretations of end-of-life legal language. Patricia Benner's conceptual model of advocacy behaviors in end-of-life nursing provides the framework in which nurses can become effective patient advocates. Developing active listening and effective communication skills can enhance the nurse-patient trust relationship and create a healing environment. PMID:22190882
Roth, Carol P; Ganz, David A; Nickles, Lorraine; Martin, David; Beckman, Robin; Wenger, Neil S
We evaluated the quality of care provided to older patients with complex needs in a dual-eligible, community-based Medicare Special Needs Plan that used a nurse care manager model. Care provided by physicians was substantially supplemented by nurse care managers, as measured by Assessing Care of Vulnerable Elders quality indicators. We describe selected nurse care manager activities for six geriatric conditions (falls, dementia, depression, nutrition, urinary incontinence, and end-of-life care) during provision of patient care coordination and management for patients in the highest decile of clinical complexity. We identify areas of high nurse performance (i.e., falls screening, functional assessment, behavioral interventions for dementia problems, advance care planning) and areas of potential missed opportunities (i.e., follow up for new memory problems, targeted dementia counseling, nutrition, and behavioral approaches to urinary incontinence). Increasing the collaborative interaction between nurses providing care in this model and physicians has the potential to enhance nurses' contributions to primary care for vulnerable older adults.
Croyère, Nicole; Belloir, Marie-Noelle; Chantler, Lyn; McEwan, Lisa
Oral care for patients receiving non-specialist palliative care has been reported to be lacking in several respects. The present study explored the oral care social representation of nurses and health-care assistants providing non-specialist palliative care. A mixed methodology utilising a questionnaire and focus groups was adopted. The research identified difficulties in providing oral care in this setting. The participants reported managing their emotions around carrying out oral care. They had resources available and were convinced of the positive effects. However, their personal efficacy needed to be reinforced and they needed to receive positive feedback.
Hsu, Hsiao-Hui; Zheng, Xin-Yi; Hsu, Mei-Yu
Epidermolysis bullosa (EB) is a rare hereditary, chromosomal disease of the skin. Life-threatening septicemia may result if appropriate care is not provided to alleviate the extensive skin irritation that is the main symptom of this disease. This case report describes the experience of the author in nursing a wound area on a newborn that was suspected of being caused by EB. This wound area comprised blisters and peeling skin that covered 30% of the entire skin area of the infant. A holistic assessment conducted from December 1st, 2013 to January 7th, 2014 revealed that this large of an area of damage to the skin and mucosa considerably complicated the task of wound care and caused severe pain to the infant. In response to the special needs of this case, our medical team conducted a literature review of wound care for this rare disease. Based on the suggestions of previous empirical studies, nursing measures for the skin, mucosa, and wounds of the newborn were then administered through inter-team cooperation. These actions effectively reduced the pain, controlled the infection, and accelerated wound healing. In addition, progressive contact was used to guide the primary caregivers of the newborn, which alleviated their physical and psychological stresses effectively. The caregivers were educated systematically on wound care and guided to learn techniques for nursing and dressing wounds. Thus, these caregivers were better prepared to continue providing wound care at home. We suggest that healthcare professionals reference empirical studies when providing care to EB newborns during the acute-care period and provide wound care and supportive therapies to control the occurrence of complications using a multidisciplinary team-care model. In addition, social resources should be used effectively in nursing care plans to mitigate the effect of this rare disease on families.
Gardner, Deborah B
Following the 2014 mid-term elections, what will the next 2 years of Republican leadership do to change the structures still being put into place to meet the goals of the Affordable Care Act (ACA)? Nurses need to be visible by creating partnerships with their new state and federal representatives and by demonstrating collaboration through identified shared values. Nurses must hold all congressional leaders accountable for continuing to improve access to quality and affordable health care, while containing costs and strengthening incentives to provide a client-centered approach to care delivery. As health care reform legislation is a highly charged political battleground, nurses must support legislative changes in the ACA that will strengthen our health care system, not weaken it.
Lammintakanen, Johanna; Kivinen, Tuula; Saranto, Kaija; Kinnunen, Juha
The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.
Mamier, Iris; Taylor, Elizabeth Johnston
To measure nurse-provided spiritual care, robust instrumentation is needed. This study psychometrically evaluated an instrument that operationalizes frequency of nurse-provided spiritual care, the Nurse Spiritual Care Therapeutics Scale (NSCTS). The 17-item NSCTS, with an established content validity index of 0.88, was administered online to registered nurses (RNs) in four hospitals. Responses from 554 RNs (24% response rate), most who identified as Christian, provided evidence for the NSCTS' reliability and validity. Internal reliability was supported by an alpha coefficient of .93. Validity was evidenced by item-total correlations ranging from .40 to .80, low to modest direct correlations between the NSCTS and Daily Spiritual Experience Scale and Duke University Religiosity Index, and strong loadings between 0.41 and 0.84 on one factor (explaining 49.5% of the variance) during exploratory factor analysis.
Ellis, Wendy; Kaasalainen, Sharon; Baxter, Pamela; Ploeg, Jenny
In long-term care (LTC), the complexity of residents' conditions and their treatment requirements present challenges for nurses managing medications. The purpose of this qualitative descriptive study was to explore medication management as described by licensed nurses working in LTC. A total of 22 licensed nurses from 2 LTC facilities located in the Canadian province of Ontario participated in 4 focus groups. Thematic content analysis was used to organize data into themes and a conceptual model was developed. The overarching theme was that nurses are "racing against time" to manage medications and 3 subthemes described how they coped with this important care process: preparing to race, running the race, and finishing the race. Barriers to safe medication management included time restraints, knowledge limitations, interruptions and distractions, and poor communication. The findings can be used to better inform health-care providers and to guide future research. They also have the potential to directly impact outcomes related to safe medication management in LTC.
Patient satisfaction is an important indicator of the quality of nursing care. However, it raises numerous dilemmas: lack of consistent conceptualization and a theoretical framework, lack of reliable measurement approaches, and inconsistency of instruments. (SK)
Field, John; Pearson, Alan
Beyond the initial 'shock-horror' reaction in the mass media, little attention is paid by nurses or the public to nurses who murder patients. This study used discursive inquiry to uncover social constructions of this phenomenon and their implications for the definition and treatment of such murders. The mass media and professional literature were searched for commentary on cases of nurses who had been convicted of murder between 1980 and 2006. The retrieved texts were subjected to discursive analysis. Discursive constructions included the profile of murderous nurses; types of murders; contexts in which murder occurs; factors that aid detection and apprehension; legal processes and punishment; and reactions of the public, profession, regulators and families. The findings imply that murder of a patient by a nurse might occur in any setting in which nurses care for vulnerable patients--the old, the young, the sick and the disabled. Trust in nurses assists a nurse to murder. Nurses have a responsibility to understand how their workplaces can form crucibles in which murder can take place. The profession needs to acknowledge the possibility of nurses who murder patients and to commence a discussion about what might be done to limit the harm they do.
Haggerty, Lois A; Grace, Pamela
Clinical wisdom, an essential foundation of nursing care that provides for the "good" of individual patients while taking into account the common good, is a concept that is difficult to define and comprehend. However, understanding what constitutes clinical wisdom is essential for the education of the types of nurses who are most likely to provide leadership that is consistent with the goals of nursing as outlined in the 2005 Code of Ethics for Nurses of the International Council of Nurses and the 2001 Code of Ethics for Nurses With Interpretive Statements of the American Nurses Association. The three key elements of wisdom, derived from the psychology and philosophy literature, are (1) balancing and providing for the good of another and the common good, (2) the use of intellect and affect in problem solving, and (3) the demonstration of experience-based tacit knowing in problematic situations. We conceptualized clinical wisdom as a more specific variant of general wisdom by examining how the core elements described can be linked to wisdom for nursing practice. In doing so, the nature of clinical wisdom is clarified and strategies are suggested to assist nurse educators in developing wise nurses.
Nagington, Maurice; Walshe, Catherine; Luker, Karen A
Quality of care is a prominent discourse in modern health-care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse-patient-carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi-structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health-care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved.
As more nurses move from the acute care setting to long-term-care and home health care, different practice issues arise. To maximize liability protection, nurses must understand the legal issues unique to each delivery system.
Dellefield, Mary Ellen
Purpose: This article is a critical review of the history, research evidence, and state-of-the-art technology in interdisciplinary care planning and the written plan of care in American nursing homes. Design and Methods: We reviewed educational and empirical literature. Results: Interdisciplinary care planning and the written care plan are…
The notion of patient-centered care has long been linked with nursing practice since Florence Nightingale. The discipline of nursing is focused on the holistic care of individuals, families, and communities in times of sickness and/or health. However, in psychiatric-mental health nursing, the concepts of mental health and psychiatric illness still remain marginalized in our health care delivery systems, as well as in nursing education, knowledge development, and practice. Even with the concept of patient-centered homes, acute and primary care providers are reluctant to embrace care of those with psychiatric illness in their respective settings. Psychiatric illness was and continues to be in the shadows, hidden and often ignored by the larger community as well as by health care providers. This paper describes a Health Resources Services Administration (HRSA) Advanced Nursing Education (ANE) training grant's objective of reintegrating psychiatric-mental health practice into ALL health care delivery systems using the concept of patient-centered nursing care as a foundation for, and promotion of, the Psychiatric-Mental Health Nurse Practitioner (PMH-NP) as the "navigator" for not only the patients and their families, but also for their acute and primary care colleagues using an Interprofessional Education Model. The major barriers and lessons learned from this project as well as the need for psychiatric-mental health nurses to reclaim their role as a consultant/liaison in acute, primary, and long-term care settings will be discussed. The PMHNP as a consultant/liaison is being revitalized as an innovative advanced practice nursing health care model in North Carolina.
Both the nation's health-care and nursing education systems are in crisis. While the care provided by registered nurses (RNs) is essential to patients' recovery from acute illness and to the effective management of their chronic conditions, the United States is experiencing a nursing shortage that is anticipated to increase as baby boomers age and…
Queiroz, Fernanda Cristina; Nascimento, Lucila Castanheira; Leite, Adriana Moraes; Flória-Santos, Milena; de Lima, Regina Aparecida Garcia; Scochi, Carmen Gracinda Silvan
This study reports on a literature review about child postoperative pain management by nursing professionals, in the period from 1993 to 2005. Three themes were identified: factors influencing nurses' management of child pain, interventions to relieve child pain, and nurses' assessment and response to children's pain experience. Child pain management is a complex act that involves elements of the dimensions related to the children themselves, health professionals and family members. The lack of studies in this area reveals the need for research, with a view to (re)considering pediatric nursing care.
Planning for patient discharge is an essential element of any admission to an acute setting, but may often be left until the patient is almost ready to leave hospital. This article emphasises why discharge planning is important and lists the essential principles that should be addressed to ensure that patients leave at an optimum time, feeling confident and safe to do so. Early assessment, early planning and co-ordination of all the teams involved in the patient's care are essential. Effective communication between the various teams and with the patient and their family or carer(s) is necessary. Patients should leave hospital with all the information, medications and equipment they require. Appropriate plans should have been developed and communicated to the receiving community or non-acute team. When patient discharge is effective, complications as a result of extended lengths of hospital stay are prevented, hospital beds are used efficiently and readmissions are reduced.
Castner, Jessica; Wu, Yow-Wu B; Dean-Baar, Susan
The aim of this study was to delineate the multi-level relationships of individual registered nurse (RN) and nursing unit factors on missed nursing care. This was a quantitative model-building study using a descriptive, cross-sectional design. Surveys (N = 553) and administrative unit records from nurses in one hospital system undergoing merger were included. The results showed that 36% of the variation in missed nursing care is due to the unit context, with a corresponding 64% due to individual nurse differences. At the unit level, workload, skill mix, and critical unit type affected the amount of missed nursing care. At the individual nurse level, more experience, supplies problems, communication problems, and involvement in errors of commission all increased the perception of the amount of missed nursing care. Education level was not related to the amount of missed nursing care. The findings highlight the importance of unit- and individual-level interventions to redesign hospital nursing care.
Spiritual nursing care is increasingly being cited in the nursing literature as a fundamental ethical obligation. This obligation is based upon the argument that nurses provide holistic care, spirituality is a universal dimension of the person, and so nurses should care for the spiritual dimension. However, the literature on the spiritual dimension in nursing illustrates widely differing foundational assumptions about this important aspect of care. The philosophic categories of humanism, theism, and monism can be used to illustrate the different understandings of the spiritual dimension, and the implications of these understandings for the competence of the nurse and the nature of the nurse-patient interaction in the context of spiritual care.
Siem, Carol A; Wipke-Tevis, Deidre D; Rantz, Marilyn J; Popejoy, Lori L
The Minimum Data Set, a comprehensive assessment tool for nursing home residents, is used for clinical decision-making, research, quality improvement, and Medicare and Medicaid reimbursement. Within the Minimum Data Set, pressure ulcers and skin condition are evaluated. Because information about pressure ulcer prevalence and care in hospital-based skilled nursing facilities is sparse, a study was conducted to: a) determine pressure ulcer prevalence upon admission to hospital-based skilled nursing facilities in the state of Missouri, and b) ascertain methods of assessment, treatment, and documentation of skin and pressure ulcer care in these facilities. Prevalence data were obtained from analysis of the Minimum Data Set data, and a survey was conducted to obtain skin care practices. The vast majority of residents (96%) were admitted from acute care facilities, and pressure ulcer prevalence on admission was 18.4% +/- 8.0%. Seventy-seven percent (77%) of the 88 surveys mailed were returned. The Braden or Norton Scale for risk assessment is reportedly used by 55% of facilities; whereas, 35% use a facility-developed tool. Commonly reported pressure ulcer prevention/treatment interventions used include: dietitian referral, use of barrier ointments, and a written repositioning schedule. Incontinence management and minimizing the head of bed elevation were infrequently used. Nearly one-half (47%) of facilities reported daily reassessment and documentation of wound status, suggesting less-than-optimal, time-consuming wound care practices. Despite the limitations inherent in survey designs and the use of databases such as the Minimum Data Set, the results of this study suggest that pressure ulcers are a common problem in acute care and hospital-based skilled nursing facilities and research-based risk assessment, prevention, and wound assessment strategies have not been widely implemented. The results of this study provide a basis for developing educational programs and a
Leadership, whether it is nursing, medical or healthcare leadership, is about knowing how to make visions become reality. The vision that many nurses hold dear to their hearts is one where patients are treated with dignity and respect at all times; where systems are designed for the benefit of individual needs; and where the work performed by nurses and other carers is valued and respected. Achieving such a vision will require a paradigm shift in the philosophy, priorities, policies, and power relationships of the health service. Fundamentally, it will require the rhetoric of patient centred care to become a reality. The following scenario is set in the UK in the year 2012 and describes a health service that is on the pathway to achieving this vision. It tells the story from a nursing perspective and outlines the three key foundation stones that helped nursing achieve the vision of a patient centred health service: (1) development of patient centred care measures as part of performance management and the clinical governance agenda; (2) leadership based on personal growth and development principles; (3) new clinical career and competency framework for nursing. Key Words: nursing leadership; patient centred care; career framework PMID:11700384
Araújo, Sarah Nilkece Mesquita; Luz, Maria Helena Barros Araújo; da Silva, Grazielle Roberta Freitas; Andrade, Elaine Maria Leite Rangel; Nunes, Lívio César Cunha; Moura, Renata Oliveira
OBJECTIVE: to analyze nursing care provided to cancer patients with oral mucositis based on the Nursing Process (NP). METHOD: this exploratory, descriptive, cross-sectional and quantitative study was conducted with 213 patients undergoing chemotherapy and/or radiotherapy in two cancer facilities: one philanthropic and one private service. RESULTS: the participants were mainly female, aged 45.8 years old on average, with up to 11 years of schooling and income of up to one times the minimum wage. Severe mucositis was related to chemotherapy associated with radiotherapy. Only 25.3% of the patients reported having received guidance from nurses during their treatment concerning self-care. The perceptions of patients regarding quality of care did not significantly differ between the private and public facilities. The basic human needs mainly affected were comfort, eating, and hygiene. Based on this finding, one NP was established listing the diagnoses, interventions and expected results to establish an ideal, though individualized, standard of nursing care to be provided to these patients. CONCLUSION: to understand oral mucositis is crucial to establish nursing care that includes prevention based on the implementation of an oral care plan. PMID:26039297
Hassani, Parkhide; Abdi, Alireza; Jalali, Rostam; Salari, Nader
Background Intuition is defined as an irrational unconscious type of knowing. This concept was incorporated into nursing discipline for 3 decades, but nowadays its application is uncertain and ignored by educational institutions. Therefore, this study aimed to explore critical care nurses’ understanding of the use of intuition in clinical practice. Materials and methods In a descriptive phenomenological study, 12 nurses employed in critical care units of the hospitals affiliated with Kermanshah University of Medical Sciences, were recruited to a study using purposive, semistructured interviews, which were then written down verbatim. The data were managed by MaxQDA 10 software and analyzed as qualitative, with Colaizzi’s seven-stage approach. Results Of the 12 nurses who participated in the study, seven (58.3%) were female and married, 88.3% (ten) had a Bachelor of Nursing (BSc) degree, and the means ± SD of age, job experience, and critical care experience were 36.66±7.01, 13.75±6.82, and 7.66±3.36 years, respectively. We extracted three main themes, namely “patient conditions”, “nurse readiness”, and “outcome”, and seven subthemes – including “clinical signs”, “patient behaviors”, “prognosis”, “being sensitive”, “desire to act”, “prediction”, and “satisfaction” – integral to understanding the use of intuition in clinical practice by critical care nurses. Conclusion The findings showed that some nurses were attracted by the patients’ conditions and were more intuitive about them, and following their intuition prepared the nurses to under-take more appropriate measures. The positive results that the majority of the nurses experienced convinced them to follow their intuitions more often. PMID:26929677
One hundred thirty-two randomly selected baccalaureate nursing programs in the Unites States responded to a survey exploring how the spiritual dimension of nursing care currently is being taught. The majority of programs included the concept of the spiritual dimension in curricula, but few programs had definitions of spirituality or spiritual nursing care. Content addressed most consistently by programs included assessment of spiritual needs, the needs of dying individuals, and the spiritual dimension as a component of holism or culture. There appeared to be a lack of clarity in the understanding of the concept of spirituality, as well as uncertainty about levels of faculty knowledge and comfort with teaching this topic.
Rahman, Anna N.; Simmons, Sandra F.; Applebaum, Robert; Lindabury, Kate; Schnelle, John F.
Purpose: This article describes and evaluates a long distance coaching course aimed at improving nutritional care in nursing homes (NHs). The course was structured to provide more support than traditional training programs offer. Methods: In a series of 6 monthly teleconferences led by an expert in NH nutritional care, participating NH staff…
Lloyd-Williams, Mari; Field, David
Responses from 46 of 108 nurse educators in the United Kingdom indicated that diploma students received a mean of 7.8 hours and degree students 12.2 hours of palliative care training. Although 82% believed it should be a core component, 67% had difficulty finding qualified teachers. Palliative care knowledge was not formally assessed in most…
The mobile palliative care and support team nurse works in different departments within the hospital. The clinical situation of a patient enables the team to identify in what ways she is declining and thereby participate in the care management in order to favour the patient's return home.
This study explored how direct care workers in nursing homes conceptualize good care and how their conceptualizations are influenced by external factors surrounding their work environment and the relational dynamics between them and residents. Study participants were drawn from a local service employees' union, and in-depth interviews were…
Kuehn, Mary Beth
The purpose of this qualitative, phenomenological study was to describe how nursing faculty are cared for in the workplace. Participants were interviewed individually or in a focus group to understand their experience. Following data analysis, the following themes were created: the process of being cared for included connecting, openly sharing,…
Moutardier, Nelly; Woehrel, Estelle; Sourdaine, Marie-Lise
As soon as the patient leaves the operating theatre, in the recovery room, then in the surgical clinical unit, nurses carry out stoma care and monitor the possible occurrence of complications. Stoma therapists educate patients in caring for the stoma themselves, advise them in the choice of equipment and support them as they regain autonomy.
Keddy, B A
Mental health professionals have the experience and skills necessary to provide care and support to colleagues and peers in these troubled and stressful times. Yet, traditionally nurses have not been supportive of one another. Not receiving much interest from the feminist movement and not willingly to embrace feminist social activism, the nursing profession has suffered as it continues to embrace racist, classist, sexist, and homophobic outdated theories and research practices. Without a collective voice which unites all nurses in a common struggle, issues related to mental health nursing will continue to be viewed in a fragmented way. Until feminist research, theory, and practice become central to the profession's ideology, nurses will continue to be divided among themselves, unable to provide the necessary caring for one another.
Matney, Susan A; Dolin, Gay; Buhl, Lindy; Sheide, Amy
A care plan provides a patient, family, or community picture and outlines the care to be provided. The Health Level Seven Consolidated Clinical Document Architecture (C-CDA) Release 2 Care Plan Document is used to structure care plan data when sharing the care plan between systems and/or settings. The American Nurses Association has recommended the use of two terminologies, Logical Observation Identifiers Names and Codes (LOINC) for assessments and outcomes and Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT) for problems, procedures (interventions), outcomes, and observation findings within the C-CDA. This article describes C-CDA, introduces LOINC and SNOMED CT, discusses how the C-CDA Care Plan aligns with the nursing process, and illustrates how nursing care data can be structured and encoded within a C-CDA Care Plan.
Penrod, Janice; Yu, Fang; Kolanowski, Ann; Fick, Donna M.; Loeb, Susan J.; Hupcey, Judith E.
Alzheimer’s dementia manifests in a complex clinical presentation that has been addressed from both biomedical and phenomenological perspectives. Although each of these paradigmatic perspectives has contributed to advancement of the science, neither is adequate for theoretically framing a person-centered approach to nursing care. The need-driven dementia-compromised behavior (NDB) model is discussed as an exemplar of midrange nursing theory that promotes the integration of these paradigmatic views to promote a new level of excellence in person-centered dementia care. Clinical application of the NDB promotes a new level of praxis, or thoughtful action, in the care of persons with dementia. PMID:17378465
As the health care landscape continues to change with reform, obtaining funding for clinical initiatives is becoming increasingly difficult. At Catholic Health Initiatives, a number of nurse executives have recognized the need for creative philanthropy to advance specific projects. They have embraced opportunities for partnerships with their hospital foundation chief development officers to leverage philanthropy toward clinical innovations and to improve quality of care. Following are their discussions which reveal just how important nurse and employee involvement is to attracting and using philanthropy dollars in the next era of health care.
Alexander, Gina K; Rollins, Kari; Walker, Danielle; Wong, Lily; Pennings, Jacquelyn
The promotion of self-care and the prevention of burnout among nurses is a public health priority. Evidence supports the efficacy of yoga to improve physical and mental health outcomes, but few studies have examined the influence of yoga on nurse-specific outcomes. The purpose of this pilot-level randomized controlled trial was to examine the efficacy of yoga to improve self-care and reduce burnout among nurses. Compared with controls (n = 20), yoga participants (n = 20) reported significantly higher self-care as well as less emotional exhaustion and depersonalization upon completion of an 8-week yoga intervention. Although the control group demonstrated no change throughout the course of the study, the yoga group showed a significant improvement in scores from pre- to post-intervention for self-care (p < .001), mindfulness (p = .028), emotional exhaustion (p = .008), and depersonalization (p = .007) outcomes. Implications for practice are discussed.
The mechanically ventilated patient often represents the ultimate in vulnerability and demands the highest standards of nursing care. Not only may the patient be unconscious but also the artificial airway is an unnatural invasion of the most innate physiological mechanism--breathing, and the nurse must safeguard this during all aspects of care. Nursing these patients is immensely satisfying and varied. It ranges from caring for the patient's activities of daily living to carrying out the highly technical and invasive monitoring and interventions which require specialist knowledge and skills. This article, the first in a two-part series, covers the types of ventilation, suction therapy, oral and eye care, elimination, body position, physiotherapy and the physiological effects of mechanical ventilation.
Silva, Denise Conceição; Alvim, Neide Aparecida Titonelli
The purpose of this qualitative research was to characterize the elements that constitute the environment of the Surgical Center and to analyze its implications for dynamic of care and nursing care. Based on the Environmental Theory's principals. Participated twelve nurses from the Surgical Center of a College Hospital in Rio de Janeiro. Data were gathered through the creativity and sensitivity technique "Map-Speaker", semi-structered interviews and participant observation, and were analyzed by thematic categories. The results showed that care can happen directly and indirectly in favor of full client recovery, counting the environment that the integrate in purpose to maintain harmonic and balanced. The nurse interventions aim to maintain the environment in favorable conditions so that a higher standard of care can be promoted.
Poltroniere, Silvana; Cecchetto, Fátima Helena; de Souza, Emiliane Nogueira
The aim of this study is to show what nurses from hospitalization units know about Alzheimer's disease (AD) and the demands of care for patients and their families. This is a descriptive and exploratory study with a qualitative approach. The data were collected through semistructured interviews. Data saturation occurred after interviewing eleven nurses in two private hospitals. Six categories emerged from the content analysis: AD characterization, risk factors, ways to diagnose, complications, treatment medication, patient and family care. It was observed that nurses have partial knowledge regarding AD, focusing their care actions only on the clinical change that caused admission. They recognize signs and symptoms but only show themselves as supporting assistants, instead of acting more autonomously in dealing with care needs and family support.
Fringer, André; Huth, Martina; Hantikainen, Virpi
In geriatric care, movement support skills of nurses are often limited, resulting in unnecessary functional decline of older adult residents and physical strain of nurses. Kinaesthetics training aims to improve movement competences of nurses and residents. The aim of this qualitative descriptive study is to describe nursing teams' experience with…
Skeet, M; Thompson, R
The authors describe a crisis point which led them from considering a reorientation of the present BSc (Nursing) curriculum at the University of Cape Town, South Africa to undertaking a radical revision of the degree programme. While examining final year students they realized that the nurses' excellent personal qualities apparent in everyday relationships, were not being used in their professional practice on hospital wards. It is suggested that this is due partly to an educational programme which neglected what the students already had (common sense and logic) and what they already knew from life experience and from instinct and intuition. It is also supposed that when hospital wards are their first clinical learning areas, nurses divorce patients and disease from the 'real' world, from the essentials of daily living and from the components of an individualized lifestyle. A staged process of learning experience, to include looking after healthy, elderly and disabled individuals in homes and institutions--with minimal nurse supervision--before exposure to hospital life, is advocated. In its present form the nursing process is seen as limiting the creativity of nursing practice and the authors suggest that further development of this approach is necessary if nursing science is to be interpreted as an art. Finally, the authors outline an experimental curriculum which takes cognisance of their experiences and syllogistic reasoning, together with a brief description of the first few months of its implementation at the University of Cape Town.
Mayer, Deborah K
Nursing research and nurse researchers have been an integral and significant part of the Oncology Nursing Society's (ONS's) history, as evidenced by the development of the Nursing Research Committee within a few years of ONS's establishment. Ruth McCorkle, PhD, RN, FAAN, was the committee's first chairperson in 1979. This was followed by the creation of the Advanced Nursing Research Special Interest Group in 1989 under the leadership of Jean Brown, PhD, RN, FAAN. ONS also began to recognize nurse researchers in 1994 by creating the annual ONS Distinguished Researcher Award to recognize the contributions of a member who has conducted or promoted research that has enhanced the science and practice of oncology nursing. The list of recipients and of their work is impressive and reflects the wide range of our practice areas (see http://bit.ly/1MTC5cp for the recipient list). In addition, the ONS Foundation began funding research in 1981 and has distributed more than $24 million in research grants, research fellowships, and other scholarships, lectures, public education projects, and career development awards (ONS Foundation, 2015). And, in 2006, the Putting Evidence Into Practice resource was unveiled, which provides evidence-based intervention reviews for the 20 most common problems experienced by patients with cancer and their caregivers (www.ons .org/practice-resources/pep) .
Salzmann-Erikson, Martin; L Tz N, Kim; Ivarsson, Ann-Britt; Eriksson, Henrik
This article presents intensive psychiatric nurses' work and nursing care. The aim of the study was to describe expressions of cultural knowing in nursing care in psychiatric intensive care units (PICU). Spradley's ethnographic methodology was applied. Six themes emerged as frames for nursing care in psychiatric intensive care: providing surveillance, soothing, being present, trading information, maintaining security and reducing. These themes are used to strike a balance between turbulence and stability and to achieve equilibrium. As the nursing care intervenes when turbulence emerges, the PICU becomes a sanctuary that offers tranquility, peace and rest.
Sfakianaki, Efrosyni; Sfakianakis, George N; Georgiou, Mike; Hsiao, Bernard
Renal scintigraphy is a powerful imaging method that provides both functional and anatomic information, which is particularly useful in the acute care setting. In our institution, for the past 2 decades, we have used a 25-minute renal diuretic protocol, technetium-99m ((99m)Tc) mercaptoacetyltriglycine with simultaneous intravenous injection of furosemide, for all ages and indications, including both native and transplant kidneys. As such, this protocol has been widely used in the workup of acutely ill patients. In this setting, there are common clinical entities which affect patients with native and transplant kidneys. In adult patients with native kidneys one of the most frequent reasons for emergency room visits is renal colic due to urolithiasis. Although unenhanced computed tomography is useful to assess the anatomy in cases of renal colic, it does not provide functional information. Time zero furosemide renal scintigraphy can do both and we have shown that it can effectively stratify patients with renal colic. To this end, 4 characteristic patterns of scintirenography have been identified, standardized, and consistently applied: no obstruction, partial obstruction (mild vs high grade), complete obstruction, and stunned (postdecompressed) kidney. With the extensive use of this protocol over the past 2 decades, a pattern of "regional parenchymal dysfunction" indicative of acute pyelonephritis has also been delineated. This information has proved to be useful for patients presenting with urinary tract infection and suspected pyelonephritis, as well as for patients who were referred for workup of renal colic but were found to have acute pyelonephritis instead. In instances of abdominal trauma, renal scintigraphy is uniquely suited to identify urine leaks. This is also true in cases of suspected leak following renal transplant or from other iatrogenic/postsurgical causes. Patients presenting with acute renal failure can be evaluated with renal scintigraphy. A
Rahimi, Majid; Fadayevatan, Reza; Abedi, Heidar Ali
Background: The use of long-term care services has risen and this trend is expected to continue as the population reaches old age. Objectives: This study was performed to assess the caring conditions in nursing homes. Patients and Methods: This study was conducted with a qualitative approach using conventional qualitative content analysis. The study was conducted on 23 Iranian participants including 14 elders and 9 caregivers. Data was collected with unstructured interviews and continued to the point of data saturation. Analysis of data was performed continually and concurrently with data collection through a comparative method. Results: Three themes emerged from 595 open codes including care as unpleasant task, sustained care and insufficient resources. Ten subthemes indicated participants’ experiences and understanding of caring conditions in a nursing home. Conclusions: The prevailing given care was the routine one with a focus on physical aspects, although there was some psychological care given to the older people. The findings of this research are guidelines for managers and care planners in nursing homes who should pay attention to physical and psychological care needs of older people. In addition, it is important to pay close attention to the needs of caregivers and provision of instructions for treatment, supervision and education of caregivers and medical students to provide a better care. PMID:27186382
Edwards, Marie; Throndson, Karen; Girardin, Julie
The purpose of this study was to enhance our understanding of Canadian critical care nurses' experiences of and responses to situations of conflict in the ICU. Through a 35-item web-based survey, members of the Canadian Association of Critical Care Nurses were asked questions regarding the types, causes and frequency of conflict experienced, the nursing interventions found most helpful in situations of conflict, and the resources found most helpful in responding to situations of conflict. A total of 241 nurses responded to the survey. The mean age of the nurses was 43 years, and the majority were female (89.2%), direct care providers (66.4%), with greater than 11 years of experience in critical care (58.3%), and working in medical/surgical ICUs (66.4%) in tertiary care hospitals (67.2%). Approximately 51% of the nurses reported being involved in at least one situation of conflict related to the management of a patient in the last week worked. The most common types of conflict encountered were disagreements between the team and family (46.5%) or within the team (35.3%). The nurses acknowledged the importance of clear, consistent and honest communication with patients and families when conflict arises and rank-ordered the resources found most helpful to patients, families, and nurses in conflict situations. Implications for practice and education are discussed and recommendations for future research are outlined.
Lea, Dale Halsey; Monsen, Rita Black
Suggests new practice roles for nurses resulting from genomic research and outlines the proposed position of genomics nurse care coordinator. Discusses national and international initiatives to certify nurses' genetic knowledge and skills for practice. (Contains 22 references.) (SK)
Vargas, Mara Ambrosina de Oliveira; Ramos, Flávia Regina Souza
This qualitative investigation was supported by Foucault's analysis with emphasis on the notion of governability, and had the following objectives: to analyze the relationship between techno-biomedicine and bioethics as discourses of the contemporaneousness implied in the production of nurses' subjectivity within the context of the Intensive Care Unit (ICU); and approach the responsibility implied in health care as one of the unfolding strategies of technology of speech of bioethics and biotechnology, creating certain forms of the nurse understanding and intervening in the Intensive Care Unit (ICU). From the perspective of the multiple ways that can emerge when analyzing a critical reading of analyzed texts and interviews with nurses, responsibility in health care was unfolded into categories that expressed the responsibility in front of new languages and of nursing as a guardian of certain attributes in the Intensive Care Unit (ICU).
McConnell, Eleanor S; Karel, Michele J
As the prevalence of Alzheimer disease and related dementias increases, dementia-related behavioral symptoms present growing threats to care quality and safety of older adults across care settings. Behavioral and psychological symptoms of dementia (BPSD) such as agitation, aggression, and resistance to care occur in nearly all individuals over the course of their illness. In inpatient care settings, if not appropriately treated, BPSD can result in care complications, increased length of stay, dissatisfaction with care, and caregiver stress and injury. Although evidence-based, nonpharmacological approaches to treating BPSD exist, their implementation into acute care has been thwarted by limited nursing staff expertise in behavioral health, and a lack of consistent approaches to integrate behavioral health expertise into medically focused inpatient care settings. This article describes the core components of one evidence-based approach to integrating behavioral health expertise into dementia care. This approach, called STAR-VA, was implemented in Veterans' Health Administration community living centers (nursing homes). It has demonstrated effectiveness in reducing the severity and frequency of BPSD, while improving staff knowledge and skills in caring for people with dementia. The potential for adapting this approach in acute care settings is discussed, along with key lessons learned regarding opportunities for nursing leadership to ensure consistent implementation and sustainability.
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...
... nursing home care beyond six months. 17.60 Section 17.60 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Community Nursing Home Care Facilities § 17.60 Extensions of community nursing home care beyond six months. Directors of health care facilities may authorize, for...
Ghaffari, Fatemeh; Nayeri, Nahid Dehghan; Norouzinezhad, Faezeh; Tayebi, Zahra
Introduction The increasing complexity of patient care conditions in intensive care units, along with the development of these units, has increased the need for qualified nurses and health professionals. Therefore, due to recent changes and in response to the shortage of capable nurses, a master’s major in intensive care nursing has been created. One of the main challenges of this curriculum is to ensure that graduates have the required competencies. The current study aimed to explain the pathology of apprenticeships for a masters in nursing critical care. Methods This qualitative study was conducted for masters in nursing critical care students of Tehran University of Medical Sciences in 2014–2015. The sampling was purposeful. Data were collected through face-to-face interviews with 15 students. Conventional content analysis was used to analyze the data. Results Three categories “ineffective management, unfavorable context for achieving skills, and lack of clinical instructors and sufficient competence” were extracted. Conclusion Preparing settings for entering students such as having an adequate training field and expert educators, providing conditions for orientation of educators and participation in the related workshops, and recruitment of experienced instructors in the apprenticeships field can increase the quality of MS levels. PMID:28243401
Piven, Mary L.; Bailey, Donald; Ammarell, Natalie; Corazzini, Kirsten; Colón-Emeric, Cathleen S.; Lekan-Rutledge, Deborah; Utley-Smith, Queen; Anderson, Ruth A.
The purpose of this study was to describe how Minimum Data Set (MDS) Coordinators' relationship patterns influence nursing home care processes. The MDS Coordinator potentially interacts with staff across the nursing home to coordinate care processes of resident assessment and care planning. We know little about how MDS Coordinators enact this role or to what extent they may influence particular care processes beyond paper compliance. Guided by complexity science and using two nursing home case studies as examples (pseudonyms Sweet Dell and Safe Harbor), we describe MDS Coordinators' relationship patterns by assessing the extent to which they used and fostered the relationship parameters of good connections, new information flow, and cognitive diversity in their work. Sweet Dell MDS Coordinators fostered new information flow, good connections, and cognitive diversity, which positively influenced assessment and care planning. In contrast, Safe Harbor MDS Coordinators did little to foster good connections, information flow, or cognitive diversity with little influence on care processes. This study revealed that MDS Coordinators are an important new source of capacity for the nursing home industry to improve quality of care. Findings suggest ways to enhance this capacity. PMID:16585806
The Australian health care system is responsible for delivering health services to an increasingly diverse health population. Nurses are in a position to positively influence health-related outcomes by actively addressing the differences individuals bring to their health care experiences. By focusing diversity on health inequities, nurses can play an important role in identifying those at risk of poorer health. This paper discusses diversity in the health population through health inequities and proposes directions for nursing practice. These suggested directions include application of a definition of diversity that include health determinants; targeting specific groups with programmes and services designed to reduce health inequalities; engaging in political action to promote effective policy development; preparing nurses at an undergraduate and graduate level to build capacity for addressing diversity and health inequities; and identifying effective interventions through research studies that address inequities in the health population.
Tedder, Jan; Register, Nancy
The HUG (Help, Understanding, and Guidance for Young Families) is an innovative approach to pediatric nursing care developed by the authors and designed to support parents in optimizing the health and well-being of their children. Research evidence suggests that there is a gap between what the pediatric world promises and what it delivers and between what parents want from their providers and what they actually get. The HUG is intended to distill aspects of the literature into accessible, memorable, and practical strategies that pediatric nurses at all levels and in varied settings can use. Three HUG strategies are Start Here, Not There; See, Then Share; and Gaze, Then Engage. Nurses' use of the HUG is aimed at helping nurses enhance their relationships with parents, helping parents feel heard and attended to, encouraging parents to share what worries them most, and increasing nurses' job satisfaction.
Oosterhouse, Kimberly J; Vincent, Catherine; Foreman, Marquis D; Gruss, Valerie A; Corte, Colleen; Berger, Barbara
Delirium, the most frequent complication of hospitalized older adults, particularly in intensive care units (ICUs), can result in increased mortality rates and length of stay. Nurses are neither consistently identifying nor managing delirium in these patients. The purpose of this study was to explore ICU nurses' identification of delirium, actions they would take for patients with signs or symptoms of delirium, and beliefs about delirium assessment and management. In this cross-sectional study using qualitative descriptive methods guided by the theory of planned behavior, 30 ICU nurses' responses to patient vignettes depicting different delirium subtypes were explored. Descriptive and content analyses revealed that nurses did not consistently identify delirium; their actions varied in different vignettes. Nurses believed that they needed adequate staffing, balanced workload, interprofessional collaboration, and established policy and protocols to identify and manage delirium successfully. Research is needed to determine if implementing these changes increases recognition and decreases consequences of delirium.
McWilliams, J Michael; Chernew, Michael E; Zaslavsky, Alan M; Landon, Bruce E
Objective To determine how the inclusion of post-acute evaluation and management (E&M) services as primary care affects assignment of Medicare beneficiaries to accountable care organizations (ACOs). Data Sources Medicare claims for a random 5 percent sample of 2009 Medicare beneficiaries linked to American Medical Association Group Practice data identifying provider groups sufficiently large to be eligible for ACO program participation. Study Design We calculated the fraction of community-dwelling beneficiaries whose assignment shifted, as a consequence of including post-acute E&M services, from the group providing their outpatient primary care to a different group providing their inpatient post-acute care. Principal Findings Assignment shifts occurred for 27.6 percent of 25,992 community-dwelling beneficiaries with at least one post-acute skilled nursing facility stay, and they were more common for those incurring higher Medicare spending. Those whose assignment shifted constituted only 1.3 percent of all community-dwelling beneficiaries cared for by large ACO-eligible organizations (n = 535,138), but they accounted for 8.4 percent of total Medicare spending for this population. Conclusions Under current Medicare assignment rules, ACOs may not be accountable for an influential group of post-acute patients, suggesting missed opportunities to improve care coordination and reduce inappropriate readmissions. PMID:23350910
Payne, Sarah; Cole, Elaine
Many patients with minor burns present at emergency departments and urgent care centres, where their management is often undertaken by experienced nurses rather than experts in treating burns. This article describes a small study of the clinical decision making that underpins nurses' management of minor burns in these non-specialist settings. The results suggest that, due to a lack of relevant research, nurses base their decisions on previous experience or expert colleagues' opinions and advice rather than on the evidence.
Cumming, M; Boreland, F; Perkins, D
Community primary health care nurses in rural and remote settings are required to provide palliative care as part of their generalist role. They have limited access to specialist medical and nursing support and sometimes there are no resident GPs. A study consisting of a mailed survey and follow-up interviews was conducted to explore the experiences of these nurses and to determine how personally and professionally equipped they felt for palliative care service provision. Most participants were registered nurses experienced in nursing and in rural and remote settings, who juggled multiple generalist work roles. They had only occasional palliative care patients, and more than half had provided palliative care for a friend or family member. Some nurses found palliative care rewarding, others preferred not to have to do it. However, even those who did not enjoy working with palliative care patients often went beyond the 'call of duty' to support a home death if that was what the patient wanted. Three-quarters had attended palliative care education in the last 2 years but 88% wanted more education. Barriers to education included competing work roles, work load, geographical isolation and lack of backfill. Support from managers and peers was considered important, as was accessing timely and relevant clinical support.
Having benefited from professional redeployment that has fully met his expectations, a former soldier who has become a nurse shares with us his work in a medical/social organization with residents of areas facing job insecurity.
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How many times have we read a report or piece of research that suggests nurses could be taking on more of the work currently performed by doctors? It is invariably accompanied by figures suggesting that the NHS would save squillions of pounds every year if only consultants and GPs let nurses take on more responsibilities. Not only that, but access to services would improve and outcomes would be unaffected or might even be enhanced.
Le Boeuf, Dominique
The implementation of cooperation protocols as provided for by the "Hospital, patients, health and regions" Law may greatly alter the organisation of healthcare practices. But an excessively limited vision, focused on the medical act to be delegated, might remove the clinical aspect of the nurse's role and reduce it to merely executing prescriptions. The French National Order of Nurses, through the opinions it will give to national health Authorities, wishes to prevent this danger.
Rantz, Marilyn J; Skubic, Marjorie; Alexander, Greg; Popescu, Mihail; Aud, Myra A; Wakefield, Bonnie J; Koopman, Richelle J; Miller, Steven J
As in acute care, use of health information technology in long-term care holds promise for increased efficiency, better accuracy, reduced costs, and improved outcomes. A comprehensive electronic health record (EHR), which encompasses all health care measures that clinicians want to use-both standard health care assessments and those acquired through emerging technology-is the key to improved, efficient clinical decision making. New technologies using sensors to passively monitor older adults at home are being developed and are commercially available. However, integrating the clinical information systems with passive monitoring data so that clinical decision making is enhanced and patient records are complete is challenging. Researchers at the University of Missouri (MU) are developing a comprehensive EHR to: (a) enhance nursing care coordination at TigerPlace, independent senior housing that helps residents age in place; (b) integrate clinical data and data from new technology; and (c) advance technology and clinical research.
The hospital world, in constant development, is becoming more complex and reduces the possibility for the actors to have fixed landmarks. Changes affect the organization, the rhythms and the division of labour in the field of health. The idea of a project of medical nursing care would thus come to offer the possibility of acquiring a global culture, a factor of integration and management of diversity. The notion of collective performance, of putting in coherence skills and means at the service of the treated person would then be federative. The organization in pole which meets a will to replace the current vision of the hospital, which is very fragmented, by a more integrated conception, invites the professionals to cooperate. Management by process which would consist in crossing structuring in pole with the transverse processes of taking care of the patients invites to focus on inter phases. Furthermore, this organization multiplying exchanges and intelligence, by giving initiative to the ground, can allow the Director of the Care to be proactive. To work in network rather than in a pyramidal way is an opportunity. The quality of the cooperation among the actors being determining to move from a logic of territory to a logic of project.
Jordal, Kristin; Heggen, Kristin
Nursing education programmes and the nursing curriculum have been criticised for presenting an outdated and feminised description of care, which has had the effect of marginalising men, as well as hindering a more modern outlook for the profession. This article uses interview-based data from a qualitative study on Norwegian students' experiences in the first year of training. Using a narrative analysis method, the paper explores how male nursing students use stories to describe care and shows how their storytelling illustrates a way for men to negotiate their role in a feminised profession. The paper aims to deepen our understanding of the ways in which male students can challenge this historically female profession to broaden itself by including male-based caregiving as part of nursing care. In addition, the paper highlights the potential of stories and storytelling as a teaching and learning strategy in nursing education.
de Avelar, Vanessa Luciana Lima Melo; de Paiva, Kely César Martins
This study considers the configuration of the identity of nurses working in a Mobile Emergency Care Service, based on the model of Dubar. This is a qualitative study, in which data were collected mainly through interviews, with nurses and other team members, and analyzed according to the technique of content analysis. About the identity of the nurse, the results point to a different subject, experienced, lonely, closer to the welfare activities, in search of training and recognition, wrapped in complex labor relations. Due the limitations of research and the issues that emerged in the research process, suggestions for future research are aligned at the end of the article.
Searby, Adam; Maude, Phil
: This article reports a qualitative study of the phenomenon of posttraumatic amnesia, a common behavioral sequelae to traumatic brain injury frequently encountered by nurses on trauma wards. Specifically, it focuses on the experiences of newly registered Australian graduate nurses (N = 6) providing care for this patient cohort. An atheoretical qualitative descriptive design (Sandelowski, 2000) has been used to explore graduate nurses' experiences with posttraumatic amnesia. Themes that emerged from the transcripts were perceptions of behavior, difficulties in clinical management, safety, risk of wandering, external support, containment, and advocating for patient safety.
Uto, Yumiko; Kumamoto, Ichiro
The importance of appropriate staffing of nurses has been emphasized and optimal provision of nursing care has increased in order to improve the quality of nursing service. Since the introduction of the nursing information system in 1987, we have creatively categorized the classification of index of patient's need for nursing to collect ever-objective data on the index of patient's need for nursing and utilized it as an indicator to evaluate the amount of nursing care necessary for patients. We also weighted the index of patient's need for nursing and categorized it into categories A, B, and C based on the accumulated data on the index of patient's need for nursing, and calculated the cost of nursing care by adding the nurse salary data to the weighting. In addition, we developed a system in which measurement of amount of nursing care based on the data on the index of patient's need for nursing and calculation of nursing care cost could be done by utilizing the hospital Data Warehouse (DWH) and adopted a system approach that could contribute to improvement in patient service and make hospital management better.
Amorim, Thais Vasconselos; Arreguy-Sena, Cristina; Alves, Marcelo da Silva; Salimena, Anna Maria de Oliveira
This is a case study research that aimed to know, with the adoption of the Theory of Human Caring, the meanings of therapeutic interpersonal relationship between nurse and user on the preoperative nursing visit after the experience of the surgical process. The convenience sample was composed of three nurses and three users of an institution that has updated records to perform highly complex cardiovascular surgery, comprising nine combinations of therapeutic interactions. It was used instruments, structured according to the theory of Jean Watson and North American Nursing Diagnosis Association, Nursing Intervention Classification and Nursing Outcomes Classification taxonomies. The legal and ethical aspects of research involving human subjects were assured. The results revealed three clusters to grasp the significance of preoperative visits by users and five clusters to capture the perception of nurses when they experience this clinical experience.
O'Brien, M E; Pheifer, W G
As suggested earlier we have chosen in this article to discuss only a small group of key physical and psychosocial concerns and needs associated with HIV and AIDS. These were the issues most frequently discussed by a study group of people living with HIV. We recognize, however, that holistic nursing intervention considers the totality of the individual living with HIV: body, mind, and spirit. It is to that end that the discussed nursing diagnoses and interventions are directed. Ultimately, the successful identification of and intervention in HIV related problems rests in the unique relationship between nurse and patient sharing as collaborators in the healing experience. The body of contemporary nursing and behavioral science research in the area of HIV/AIDS continues to grow. Presently the National Center for Nursing Research is supporting studies focusing on such areas as the use of designated versus general care settings for HIV patient care, quality of nursing care in HIV/AIDS, the effects of nurse-managed home care for AIDS patients, stress and coping in caregivers of AIDS children, the testing of interventions for black women with AIDS, and prevention studies (National Center for Nursing Research, personal communication, 1992). Nevertheless, as the HIV pandemic continues to grow and expand its demographic parameters, more research, particularly with such populations as women and children, is urgently needed. Studies exploring prevention issues and symptom management also are most important. Some suggestions for future study include examination of cultural variables associated with coping with HIV and AIDS; longitudinal research on surviving HIV over time; intervention studies to test specific nursing therapeutics in various settings such as hospital, home, and clinic; and finally, research describing the impact of HIV and AIDS on family functioning and adaptation. It is only through continued study of the impact of HIV, on both the individual living with HIV
Wlody, Ginger Schafer
This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.
Edwards, Marie Patricia; Throndson, Karen; Dyck, Felicia
Conflict over treatment plans is a cause of concern for those working in critical care environments. The purpose of this study was to explore and describe critical care nurses' perceptions of their roles in situations of conflict between family members and health-care providers in intensive care units. Using a qualitative descriptive design, 12 critical care nurses were interviewed individually and 4 experienced critical care nurses participated in focus group interviews. The roles described by the nurses were as follows: providing safe, competent, quality care to patients; building or restoring relationships of trust with families; and supporting other nurses. The nurses highlighted the level of stress when conflict arises, the need to be cautious in providing care and communicating with family members, and the need for support for nurses. More research related to working in situations of conflict is required, as is enhanced education for critical care nurses.
Abudari, Gassan; Zahreddine, Hassan; Hazeim, Hassan; Assi, Mohammad Al; Emara, Sania
Background Palliative care is not yet integrated into the health-care system in Saudi Arabia. King Faisal Specialist Hospital and Research Centre-Riyadh (KFSH&RC-Riyadh) is a tertiary care facility and regional cancer centre in Saudia Arabia with a highly multinational nursing workforce. Little is known about these nurses' knowledge of and attitudes towards palliative care. Aim To determine the palliative care knowledge and attitudes of the nursing workforce of KFSH&RC-Riyadh and any influencing factors. Method A questionnaire including demographic data, the Palliative Care Quiz for Nurses (PCQN), and Frommelt Attitude Toward Care of the Dying scale (FATCOD) was completed by 395 staff nurses from 19 countries. Results The nurses scored a mean of 111.66 out of 150 on the FATCOD scale and of 9.06 out of 20 on the PCQN. These scores indicate moderate attitudes towards but a knowledge deficit regarding palliative care. The nurses' palliative care training and years of nursing experience significantly affected the scores. The level of palliative care integration in the nurses' home countries was the most significant factor in multiple regression tests. Conclusion Palliative care integration into the health-care system of the country in which nurses train significantly influences their knowledge of and attitudes towards palliative care. Incorporating palliative care into nursing education might promote positive attitudes towards palliative care in nurses while enhancing their knowledge and skills.
Acuña-Reyes, Raquel; Cigarroa-Martínez, Didier; Ureña-Bogarín, Enrique; Orgaz-Fernández, Jose David
Objectives: Determine the domain of preventive dentistry in nursing personnel assigned to a primary care unit. Methods: Prospective descriptive study, questionnaire validation, and prevalence study. In the first stage, the questionnaire for the practice of preventive dentistry (CPEP, for the term in Spanish) was validated; consistency and reliability were measured by Cronbach's alpha, Pearson's correlation, factor analysis with intra-class correlation coefficient (ICC). In the second stage, the domain in preventive dental nurses was explored. Results: The overall internal consistency of CPEP is α= 0.66, ICC= 0.64, CI95%: 0.29-0.87 (p >0.01). Twenty-one subjects in the study, average age 43, 81.0% female, average seniority of 12.5 were included. A total of 71.5% showed weak domain, 28.5% regular domain, and there was no questionnaire with good domain result. The older the subjects were, the smaller the domain; female nurses showed greater mastery of preventive dentistry (29%, CI95%: 0.1-15.1) than male nurses. Public health nurses showed greater mastery with respect to other categories (50%, CI95%: 0.56-2.8). Conclusions: The CDEP has enough consistency to explore the domain of preventive dentistry in health-care staff. The domain of preventive dentistry in primary care nursing is poor, required to strengthen to provide education in preventive dentistry to the insured population. PMID:25386037
Merighi, Miriam Aparecida Barbosa; de Jesus, Maria Cristina Pinto; Santin, Karine Ribeiro; de Oliveira, Deíse Moura
The nurse has a key role in involving parents in the care of newborns in the neonatal intensive care unit. The aim of this study was to comprehend how the nurses experience the care provided to newborns in the presence of the parents. This is a qualitative study using social phenomenology, with the participation of seven nurses, interviewed between January and February 2009. The nurses perceived the needs of parents; had positive expectations regarding the care provided and acknowledge themselves to be the link between them, helping them to live with the hospitalized child. However, in emergencies, the nurses had difficulties in caring for the neonate in the presence of the parents. The nurses positively evaluated the presence of parents in the neonatal intensive care unit, involving them permanently in the care of the newborn. The study evokes the emergence of a care context (nurse/neonate/parents) that precedes the proximity between the subjects and the demands presented by them.
Link, Denise G; Perry, Diane; Cesarotti, Evelyn L
Beginning in January 2014, millions of Americans will enroll in health insurance plans under the Affordable Care Act. Some of these individuals were obtaining health care in safety net health clinics, emergency departments, or urgent care centers; many were going without needed care and will be new to the health care system. In addition to these newly insured, the ranks of older Americans and persons in need of chronic disease management will be on the rise. The way in which health care is delivered will have to change in order for the health care workforce to meet the demand for their services without sacrificing quality or access. Nurse practitioners and registered nurses have the education and skills to provide health promotion, disease prevention, and chronic disease management services that will make up a sizable portion of the demand. Amending state practice acts so that the authority to practice matches the ability to practice and opening provider panels to advanced practice nurses will provide opportunities to establish or expand sustainable nurse-led primary care practices in health care shortage areas. Along with these changes, models of health care delivery that incorporate differentiated practice roles and shared interprofessional responsibility for providing care will maximize the capacity of the system to provide the health care that people need.
El Hussein, Mohamed Toufic; Jakubec, Sonya L
The strategy of mnemonics has long been used as an aid to learning biology, physiology, pathophysiology, and health assessment in nursing. An application of an alphabetical mnemonics strategy to teaching and learning nursing processes and constructing care plans has been explored for patients with increased intracranial pressure (ICP), hepatic failure, and chronic renal failure. A specific application of this strategy for teaching care planning for patients with ICP is described. Student feedback appears to be positive, and reviews of the teaching-learning experience have received approval in students' evaluation of instruction. The mnemonics strategy presented has the potential for applicability and transferability to other areas of nursing care planning and other course contexts.
Martins, Júlia Trevisan; Robazzi, Maria Lúicia do Carmo Cruz; Marziale, Maria Helena Palucci; Garanhani, Mara Lúcia; Haddad, Maria do Carmo Lourenço
This study had the aim of understanding the meaning of being a nurse in a management position in Intensive Care Units as well as the feelings coming from this function. Eight nurses from the University Hospital of Parand, Brazil, were interviewed. This is a qualitative, exploratory and descriptive study in which the dejourian theoretical framework was used. The data were gathered from January to March of 2007 through semi-structured interviews, which were then transcribed categorized and subcategorized. The data were analyzed by the analysis of content approach. It was observed that managing means: to provide the patient with care, to manage the nursing assistance as well as the health team. The feelings of pleasure are related to: taking care of the patient, developing team work, the results of the work and the external acknowledgement.
Kwiecień, Katarzyna; Wujtewicz, Maria; Mędrzycka-Dąbrowska, Wioletta
Intensive care units and well-qualified medical staff are indispensable for the proper functioning of every hospital facility. Due to demographic changes and technological progress having extended the average life expectancy, the number of patients hospitalized in intensive care units increases every year [9,10]. Global shortages of nursing staff (including changes in their age structure) have triggered a debate on the working environment and workload the nursing staff are exposed to while performing their duties. This paper provides a critical review of selected methods for the measurement of the workload of intensive care nurses and points out their practical uses. The paper reviews Polish and foreign literature on workload and the measurement tools used to evaluate workload indicators.