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Aim To identify a set of scientific, systematic and clinically applicable nursing‐sensitive quality indicators for pernicious placenta previa (PPP). Design A modified Delphi‐Consensus Technique. Methods According to literature retrieval published between 2009–2019, 38 nursing‐sensitive quality indicators were chosen and a questionnaire was designed. An online survey was conducted in 20 hospitals in China, and data of experts’ opinions were collected and analysed by improved Delphi method. Results 38 nursing‐sensitive quality indicators were identified. The response rates in the two rounds of expert consultation were 97.4% and 100%, and the authoritative coefficients were 0.89 and 0.92. The coefficients of variation ranged from 0.04–0.28. The nursing‐sensitive quality indicators were successfully constructed based on the modified Delphi technique.

A cesarean hysterectomy (CH) is an emergency procedure that can save a woman's life in the event of postpartum hemorrhaging. If the CH is anticipated, it can take place in the general OR; however, more complex patients with multiple comorbidities are undergoing cesarean deliveries, resulting in unanticipated CHs and emergent procedures occurring in the obstetric OR. Many perinatal nurses believe they are not properly trained to provide the level of perioperative care required during a CH. Perinatal nurse leaders implemented a perinatal perioperative simulation program to address this knowledge gap. Feedback from perinatal nurses after completing the simulation revealed they gained a comprehensive understanding of the flow of the procedure and the instrumentation needed to perform it. The simulation also improved communication and leadership skills in the obstetric OR. Simulations may help perinatal nurses provide safer, higher quality care when a delivery develops into a high-risk operative procedure.

Aims and objective To examine whether nurses' assessment of their relationships and communication with lesbian women seeking perinatal care is associated with their personal and professional characteristics and knowledge of homosexuality. Background Recently, there has been a growing incidence of same-sex parenthood. Nurses administer health care to lesbian women from pregnancy planning through birth, providing consultation. Although there has been a shift in attitudes towards homosexuality, discrimination is still quite common. Design This research is part of a larger cross-sectional study carried out at women's healthcare centres, concerning nurses' perceived quality of perinatal care provided to lesbian women. Methods The study was conducted from December 2015-April 2016 at women's health centres in Israel encompassing 184 registered nurses who completed self-report questionnaires. They were assessed as to their knowledge of homosexuality and nurse-patient relationships and communication. The Squire checklist was used. Results Most (73.4%) had prior acquaintance with lesbian women; only 17.9% had been educated as to lesbian women's unique health needs; of these, 66.7% thought that they had been given professional tools for working with lesbian women; 60.4% were unaware of the importance of knowing the patient's sexual orientation. The average score on a homosexuality knowledge questionnaire was 10.4 on a scale of 0-17, indicating moderate levels of factual knowledge about homosexuality. A significant positive correlation was found between nurses' knowledge of homosexuality and assessment of their relationships and communication with lesbian women seeking perinatal care. In addition, nurses' personal and professional characteristics, such as place of birth, religiosity and familiarity with lesbian women, were related to their assessment of their relationships and communication. Conclusion Nurses' knowledge of homosexuality and personal and professional characteristics were associated with their perceptions regarding relationships and communication with lesbian women seeking perinatal care. Relevance to clinical practice Further training might broaden, refine rigid perceptions and contribute to advancing equal perinatal nursing care of lesbian women.

Aims and objectives To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals. Background A recently identified quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted or significantly delayed, indicating an error of omission. Former studies point to contributing factors to missed nursing care regarding hospital, unit and staff characteristics, perceptions of staffing adequacy as well as nursing teamwork, displayed in the Missed Nursing Care Model. Design This was a quantitative cross-sectional survey study. Methods The samples were all registered nurses and practical nurses (n = 864) working on 27 medical, surgical and intensive care inpatient units in eight hospitals throughout Iceland. Response rate was 69·3%. Data were collected in March–April 2012 using the combined MISSCARE Survey-Icelandic and the Nursing Teamwork Survey-Icelandic. Descriptive, correlational and regression statistics were used for data analysis. Results Missed nursing care was significantly related to hospital and unit type, participants’ age and role and their perception of adequate staffing and level of teamwork. The multiple regression testing of Model 1 indicated unit type, role, age and staffing adequacy to predict 16% of the variance in missed nursing care. Controlling for unit type, role, age and perceptions of staffing adequacy, the multiple regression testing of Model 2 showed that nursing teamwork predicted an additional 14% of the variance in missed nursing care. Conclusions The results shed light on the correlates and predictors of missed nursing care in hospitals. This study gives direction as to the development of strategies for decreasing missed nursing care, including ensuring appropriate staffing levels and enhanced teamwork. Relevance to clinical practice By identifying contributing factors to missed nursing care, appropriate interventions can be developed and tested.

To examine existing research literature to ascertain what is known about nursing practice in sexually transmitted infection care and identify promising research trends and limitations.Sexually transmitted infections continue to be a significant public health concern with more than 357 million new cases occurring annually worldwide. Nurses are vital for the prevention and care of those affected by sexually transmitted infections. As nursing scope of practice is evolving, there is an urgent need to develop a baseline understanding of the state of nursing knowledge in sexually transmitted infection care.Nurse researchers and policy and practice experts conducted a scoping review of primary research using Arksey and O'Malley's five-step methodological framework.Primary research literature published between 2000-2014 was searched. Seventeen full-text papers were thematically analysed. Electronic charts were created for data coding and extraction.The research literature in nursing and sexually transmitted infection care is heterogeneous in topic, method and populations investigated. Sexually transmitted infection care is undertaken by nurses in diverse settings and roles including nurse practitioners and public health, school and emergency room nurses. Three themes that illustrate the main focus of current literature were identified: (1) screening, (2) health education and counselling and (3) scope of nursing practice. Inconsistencies in nursing practice activities in sexually transmitted infection care were noted. Many nurses are not working to their full scope of practice.The research in sexually transmitted infection nursing practice is limited. Further research is needed to investigate the context of practice and patient care experiences; to design and test interventions to support nurses working to full scope of practice; and to improve the conceptualisation of nursing in sexually transmitted infection care.Nurses are effectively improving health outcomes among people affected by sexually transmitted infections; however, not working to the full scope of practice could limit our capacity to fully meet patient care needs.

SUMMARYBackground and Objectives Providing high-quality care to patients undergoing haemodialysis (HD) is a priority for nurses. The present study was conducted to explore the experiences of the quality of nursing care among patients, nurses, caregivers and physicians in an HD department in Iran. Methods This was a qualitative study, set in the HD department of Kowsar Hospital in Semnan, Iran. A total of 20 participants (patients, caregivers, nurses and doctors) were selected and were invited to semi-structured interviews with open-ended questions. The data obtained were analysed using conventional content analysis. Findings The analysis of the data led to the extraction of four themes: maintaining health, person/client, nursing responsibility and environment. Conclusion The findings of the present study showed that maintaining health, person/client interaction, nursing responsibility and environment are four important nursing metaparadigms that affect the quality of nursing care in HD departments.

Critically ill patients present a challenge to the whole veterinary team because they require invasive diagnostic tests, advanced procedures and intensive nursing care. It is important to start with an assessment of the patient to prioritise concerns and develop a care plan tailored for the individual. The nursing process involves the implementation and delivery of this plan, followed by evaluation of the nursing/treatments. This is a cyclical process that is repeated over and over again as the patient's key parameters are reassessed and a further plan is made. The aim of this article is to explore some key aspects of critical care nursing, including infection control and hand hygiene, the management of tubes and lines, and dealing with recumbent patients.

The purpose of this study was to identify the core nursing sensitive outcomes according to the most frequently used five North American Nursing Diagnosis Association-International for patients with cerebrovascular disease using the Nursing Outcomes Classification (NOC). A cross-sectional survey design was used. First, nursing problems were identified through 78 charts review, and then linkages between each of nursing problems and nursing sensitive outcomes were established and validated by an expert group for questionnaires. Second, 80 nurses working in the neurosurgical intensive care unit and neurosurgery departments of five Korean hospitals were asked to evaluate how important each outcome is and how often each outcome used to evaluate patient outcomes using 5-point Likert scale. Although there were some differences in the core outcomes identified for each of the nursing problem, consciousness, cognitive orientation, neurologic status and communication were considered the most critical nursing sensitive outcomes for patients suffering cerebrovascular disease. Core nursing sensitive outcomes of patients suffering cerebrovascular disease using NOC were identified to measure the effectiveness of nursing care.

For nurses working in mental health service settings, it is a priority to perform patient assessments to identify patients' general and behavioural risks and nursing care complexity using objective criteria, to meet the demand for care and to improve the quality of service by reducing health threat conditions to the patients' selves or to others (adverse events). This study highlights that there is a relationship between the complexity of psychiatric patient care, which was assigned a numerical value after the nursing assessment, and the occurrence of psychiatric adverse events in the recent histories of the patients. The results suggest that nursing supervision should be enhanced for patients with high care complexity scores.

This study was conducted to evaluate nursing documentation on patient hygienic care and to analyze the consistency between actual care given by nurses and that of documented in nursing record. Data were collected from 85 nurses employed at critical care units, on whom 255 sets of observations were performed through a structured participant observation form, which could be used to record the observation episodes and to audit nursing records. Results indicated that the most frequent performed hygienic care was oral care, perianal care, hand washing and bed bathing. The consistency between actual patient hygienic care and its documentation was 77.6%. The quality of nursing records was poor and inadequate to reflect individualized nursing care. Results suggest that more emphasis is needed in nursing practice and nursing education on the quality of record keeping in nursing to increase its evidential value.

PURPOSE. The purpose of this study is to publicize the experience of implementing and developing the nursing process in a sanitary area of primary health care (PHC), and to assess the outcomes reached during the past 9 years. METHODS. This descriptive longitudinal study was carried out in the 42 PHC centers in the 11th Primary Care Area of Madrid, Spain. FINDINGS. Between 2001 and 2009, 243,838 new nursing diagnoses were performed. The indicator of resolution capacity ranged from 75% to 80% for the attended problems. CONCLUSIONS. Nurses in the 11th PHC Area have effectively incorporated the nursing process as a work methodology in their caregiving practices. IMPLICATIONS FOR NURSING PRACTICE. The nursing process can be used to identify nursing care issues and assess the capacity for resolution. OBJETIVO. El objetivo de este estudio es dar a conocer la experiencia de implantacion y desarrollo del proceso enfermero en un Area Sanitaria de Atencion Primaria (AP) y evaluar los resultados alcanzados en los ultimos nueve anos. METODOS. Estudio descriptivo longitudinal, realizado en los 42 centros de AP del Area 11 de Madrid (Espana). RESULTADOS. Entre 2001 y 2009 se han realizado 243838 diagnosticos de enfermeria. El indicador de capacidad de resolucion se ha situado entre el 75 y el 80% de los problemas atendidos. CONCLUSIONES. Las enfermeras de AP del Area 11 han integrado el proceso enfermero como metodologia de trabajo en su practica asistencial. IMPLICACIONES. El proceso enfermero permite identificar problemas de cuidados y evaluar la capacidad de las enfermeras para su resolucion. PALABRAS CLAVE. Proceso Enfermero, Diagnosticos de Enfermeria, Atencion Primaria, Investigacion en Enfermeria, Efectividad.

PURPOSE. This case study demonstrates the sexual health challenges experienced by a woman newly married and recently migrated to the United States. DATA SOURCES. Data were obtained through the author's clinical experiences in primary healthcare nursing and published sources. DATA SYNTHESIS. The nursing diagnoses, nursing interventions, and patient outcomes for this woman were identified using the classifications of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. CONCLUSION. This case study demonstrates the appropriate nursing diagnoses, interventions, and outcomes that are relevant for an individual with a sexually transmitted infection. It provides a framework for nurse practitioners in primary health care when caring for individuals with sexually transmitted infections. IMPLICATIONS FOR NURSING PRACTICE. Based on the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification, and the Nursing Outcomes Classification provided the needed structure to improve the care of a woman with issues involving sexual health.

Clinical guidelines for obstetrical practice were first published by the Japan Society of Obstetrics and Gynecology (JSOG) and the Japan Association of Obstetricians and Gynecologists (JAOG) in 2008, and a revised version was published in 2011. The aims of this publication include the determination of current standard care practices for pregnant women in Japan, the widespread use of standard care practices, the enhancement of safety in obstetrical practice, the reduction in burdens associated with medico-legal and medico-economical problems, and a better understanding between pregnant women and maternity-service providers. These guidelines include a total of 87 Clinical Questions followed by several Answers (CQ&A), a Discussion, a List of References, and some Tables and Figures covering common problems and questions encountered in obstetrical practice. Each answer with a recommendation level of A, B or C has been prepared based principally on 'evidence' or a consensus among Japanese obstetricians in situations where 'evidence' is weak or lacking. Answers with a recommendation level of A or B represent current standard care practices in Japan. All 87 CQ&A are presented herein to promote a better understanding of the current standard care practices for pregnant women in Japan.

Aim. This article is a report of a study to examine how nursing staff spend their time on activities in a nursing home. Background. Few studies have investigated how nursing staff spend their time on activities in a nursing home. Such information is important for nurse managers in deciding on staff deployment, and for evaluating the effects of changes in nursing practice. Method. A work sampling study with an observational component was undertaken in 2009 with nursing staff at a nursing home. Results. A total of 430 activities were recorded for Registered Nurses, 331 for Endorsed Enrolled Nurses, 5276 for Personal Carers, and 501 for Recreational Activity Officers. Registered Nurses spent 48AE4% of their time on communication and 18AE1% on medication management. Endorsed Enrolled Nurses spent 37AE7% on communication and 29AE0% on documentation tasks. Communication was the most time-consuming activity for Recreational Activity Officers and Personal Carers, except that Personal Carers in a high care house spent more time on direct care duties. Hygiene duties and resident interaction were more frequently multitasked by the nursing staff in high care than in low care house. Conclusion. Nursing staff value their face-to-face interaction for successful care delivery. There is need, however, to investigate the effects of this form of communication on quality of care given to residents. Differences in multi-tasked activities between high care and low care houses should be considered when deploying staff in a nursing home.

Purpose. Rank and compare the 10 most frequently documented nursing diagnoses, interventions, and patient outcomes using NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification for care of patients with heart failure (HF). Methods. A descriptive comparative multisite study of documented care for 302 older adults with HF. Findings. There were four common nursing diagnoses, two interventions, and only three common outcomes across three sites. Conclusions. This and similar analyses of clinical nursing data can be used by nursing administrators and clinicians to monitor the quality and effectiveness of nursing care. Implications. Similar analyses may be used for continuing education, quality improvement, and documentation system refinement. Part 2 will discuss data retrieval and implications for building a multiorganizational data warehouse.

rochefort c.m. & clarke s.p. (2010) Nurses’ work environments, care rationing, job outcomes, and quality of care on neonatal units. Journal of Advanced Nursing 66(10), 2213–2224. Abstract Aim. This paper is a report of a study of the relationship between work environment characteristics and neonatal intensive care unit nurses’ perceptions of care rationing, job outcomes, and quality of care. Background. International evidence suggests that attention to work environments might improve nurse recruitment and retention, and the quality of care. However, comparatively little attention has been given to neonatal care, a specialty where patient and nurse outcomes are potentially quite sensitive to problems with staffing and work environments. Methods. Over a 6-month period in 2007–2008, a questionnaire containing measures of work environment characteristics, nursing care rationing, job satisfaction, burnout and quality of care was distributed to 553 nurses in all neonatal intensive care units in the province of Quebec (Canada). Results. A total of 339 nurses (61·3%) completed questionnaires. Overall, 18·6% were dissatisfied with their job, 35·7% showed high emotional exhaustion, and 19·2% rated the quality of care on their unit as fair or poor. Care activities most frequently rationed because of insufficient time were discharge planning, parental support and teaching, and comfort care. In multivariate analyses, higher work environment ratings were related to lower likelihood of reporting rationing and burnout, and better ratings of quality of care and job satisfaction. Conclusion. Additional research on the determinants of nurse outcomes, the quality of patient care, and the impact of rationing of nursing care on patient outcomes in neonatal intensive care units is required. The Neonatal Extent of Work Rationing Instrument appears to be a useful tool for monitoring the extent of rationing of nursing care in neonatal units.

OFLAZ F. & VURAL H. (2010) The evaluation of nurses and nursing activities through the perceptions of inpatients. International Nursing Review57, 232–239 Aim: To examine the relationship of inpatients' perceptions and satisfaction statements with nurses and the nursing activities presented and to determine nursing activities that were implemented mostly from the view of inpatients. Background: Nursing care is one of the fundamental components of health care, and studies have shown that it has a considerable influence on how patients experience hospitalization. However, nursing care is usually listed as one category in surveys. In fact, nursing care is an integrated combination of specific nursing activities, and to improve nursing practice we need to clarify how each nursing activity affects the perceptions of patients. Methods: This descriptive study uses cross-sectional survey design. The sample consists of 454 inpatients from a large-scale teaching hospital in Ankara, Turkey. A questionnaire survey including demographics and perceptions of the patients, along with a list of the activities that nurses were required to carry out, were administered to the patients. Findings: Age, gender and marital status were the variables influencing patients' perceptions. Technical nursing activities were recognized more by patients than activities related to care. All nursing activities were relevant to patient satisfaction statements. Most of the patients were satisfied with the nursing care despite the task-oriented environment. Conclusions: The results of this study show that nurses tend to do technical activities. All nursing activities were related to patient satisfaction statements. Nurses should be aware of the effect of each activity they are required to carry out on patients and the importance of good communication with patients.

Aims. The aim of this study is to evaluate the consistency between the care given to patients and that documented, by comparing care observations with nursing records and describing which interventions were reported and which were omitted. Background. Assumptions have been made about the relationship between documentation and care actually delivered, but there is insufficient evidence on the relationship between the actual care given and its recording. Design. Observational study of the care given, completed by interviews and retrospective survey of records. Methods. Structured observation during day shifts in the first six days of admission of pre and postsurgical care provided to 21 consecutive patients undergoing major abdominal surgery and audit of their nursing records. Each observation was completed by short interviews to nurses to ensure observations validity. Results. Only 40% of nursing activities observed were included in the nursing records (37% of the assessments and 45% of the interventions). This indicated that nurses carry out more activities than they report. Consistency between performed and recorded care decreased significantly during the days when a higher number of activities were performed. Consistency between recording and observation of assessment activities was 38% for physical needs and 0% for educational needs. Consistency was higher for the assessments of physical signs/symptoms and risk factors for complications compared to the assessment of basic needs and pain. Consistency was 47% for technical interventions and 3% for educational activities. Conclusions. Nursing records were not found to be an adequate tool for quality care evaluation, because they did not include all the caring activities that the nurses had carried out. Relevance to clinical practice. This study supports the need to identify documentation systems that are easy to complete. Moreover, nursing education should pay more attention to the competences in the field of holistic care and patient education.

The aim of this study was to assess patient satisfaction with nursing care and the relationship between patient satisfaction and patient characteristics. This cross-sectional study was conducted at a 1100-bed tertiary care teaching hospital in Turkey. Data were collected using the Newcastle Satisfaction with Nursing Care Scales and a patient information form. Overall, data indicated a high level of patient satisfaction. Hospitalization affected the Experience of Nursing Care Scale independently, while the type of ward, sex, income, and education independently affected the Satisfaction with Nursing Care Scale. Patients who underwent surgical procedures, male patients, the 40-59-year-old age group, those who had low levels of education or income, and patients who were hospitalized for long periods were most satisfied. Patients' sex, age, income, duration of hospitalization, and ward type were important factors that affected their satisfaction with nursing care. The characteristics of patients who have a low level of satisfaction with nursing care should be assessed and taken into consideration by nurses.

Aims and objectives. The focus of this paper is on one of four themes from a study exploring mentoring relationships between nurses in the intrapartum setting. The theme, relational learning, highlights how perinatal nurses engage with each other and engage with birthing women on a journey of learning in perinatal nursing practice. Background. Few studies have explored the contextual, lived experiences of informal mentoring relationships within nursing, particularly within perinatal nursing. Design. A qualitative feminist phenomenological study that considered a gender-centred, embodied exploration of human lived experiences was conducted. Method. Five registered nurses practicing on a tertiary level labour and delivery unit in eastern Canada were purposefully recruited. Data were collected by phenomenological interviews, practice observations in the clinical setting and reflective journaling. Results. Four themes emerged through thematic analysis and researcher interpretation: the meaning of nurse-to-nurse mentoring, mentoring as relational learning, mentoring as embodied learning and a contextual understanding of nurse-to-nurse mentoring. Relational learning came to be understood through feminist phenomenological analysis, which revealed that expert perinatal nursing knowledge develops within positive mentoring relationships between perinatal nurses practicing with birthing women. This learning extends beyond tasks to a holistic understanding of clinical situations within specific health and social contexts. The mentor models positive perinatal nursing practices and creates a sense of enthusiasm that harnesses the raw passion new nurses often have for practice. Conclusion. The findings in this study aim to promote the understanding of the importance of relational, experiential learning for perinatal nurses’ professional development. Relevance to clinical practice. The results from this study will encourage nurses and nurse leaders to support mentoring by providing adequate resources and positive feedback for mentoring relationships. This will foster and sustain expert nurses to support novice nurses in perinatal practice. The findings also offer insight for perinatal practices beyond nursing, including midwifery.

Background. Unfinished care has a strong relationship with quality of nursing care. Most issues related to tasks incompletion arise from staffing and workload. Objectives. This study was conducted to assess the workload of nurses, the nursing activities (tasks) nurses commonly performed on medical and surgical wards, elements of nursing care activities left incomplete by nurses during a shift, factors contributing to task incompletion and the relationship between staffing, demographic variables and task incompletion. Design. Exploratory survey using a self-administered questionnaire developed from IHOC survey, USA. Participants. All full time registered nurses working on the general medical and surgical wards of five government general hospitals in Kuwait. Methods. Research assistants distributed and collected back the questionnaires. Four working days were given to participants to complete and return the questionnaires. A total of 820 questionnaires were distributed and 95% were returned. Data analysis. Descriptive and inferential analysis using SPSS-11. Results. The five most frequently performed nursing activities were: administration of medications, assessing patient condition, preparing/updating nursing care plans, close patient monitoring and client health teaching. The most common nursing activities nurses were unable to complete were: comfort talk with patient and family, adequate documentation of nursing care, oral hygiene, routine catheter care and starting or changing IV fluid on time. Tasks were more complete when the nurse-patient load was less than 5. Nurses’ age and educational background influenced task completion while nurses’ gender had no influence on it. Conclusions. Increased patient loads, resulting in increased frequency of nursing tasks and non-nursing tasks, were positively correlated to incompletion of nursing activities during the shift. Relevance to clinical practice. Emphasis should be given to maintaining the optimum nurse–patient load and decreasing the non-nursing workload of nurses to enhance the quality of nursing care.

This US study uniquely listened to registered nurses with current licenses who do not work as nurses or are unemployed. An electronic survey was advertised in 13 Boards of Nursing newsletters. Investigated was why nurses left nursing, what would entice them to return to nursing, and what skill review is essential to competent and confident return to nursing practice. Herzberg's theory was used to study factors affecting registered nurses' decision to practise nursing. Data were analysed using SPSS and manifest content analysis. Nurses (n = 127) identified various work conditions as the primary reasons for leaving nursing. Work condition improvement, recognition of one's work, opportunities for professional growth and family needs consideration were identified as key enticing factors for returning to nursing. Many respondents identified needing review of medicines, intravenous skills, new technologies and a refresher course. Acting on their voiced concerns will enhance nurse recruitment and retention.

PURPOSE. This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self-management for a female veteran. DATA SOURCES. Data were obtained through the author's clinical practice in primary care nursing and research literature sources. DATA SYNTHESIS. The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification. CONCLUSIONS. This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations. IMPLICATIONS FOR NURSING PRACTICE. Employing the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.

Studies have shown that inadequate care, also referred to as abuse, violence, neglect and maltreatment occur in nursing homes in many countries. The aim of this study was to describe the frequency and types of inadequate care committed by staff in nursing homes. Another aim was to investigate if nursing staff reported differently depending on age, education level and years of experience working at nursing homes. A questionnaire survey was conducted among nursing staff (n = 616) in 16 nursing homes in the central part of Norway. Twenty items concerned staff behaviour in forms of acts of inadequate care. The respondents were asked to report how often they had observed colleagues commit acts and how often they themselves had committed such acts. The response rate was 79%. All in all, 91% of the nursing staff reported that they had observed at least one act of inadequate care and 87% reported that they had committed at least one act of inadequate care. Acts of negligent and emotional character were most frequently reported, both as observed and committed. Depending on the higher educational level that the nursing staff had more acts of all types were observed and committed. The oldest staff and those with longest experience at the present nursing home reported more observed and committed acts of physical character than did the others. The extent of inadequate care confirms that this is a common part of activities in nursing homes. Because emotional and negligent acts can be just as harmful as physical acts, more knowledge is needed about the reasons in order to take preventive actions.

Aim To explore the perspectives and experiences of nurse instructors and clinical nurses regarding the assessment of safe nursing care and its components in clinical practice. Background Safe nursing care is a key aspect of risk management in the healthcare system. The assessment of safe nursing care and identification of its components are primary steps to establish patient safety and risk management and enhance the quality of care in clinical practice. Methods This was an interview study, with qualitative content analysis. Semistructured interviews were conducted with 16 nurse instructors and clinical nurses including nurse managers chosen by purposive sampling based on theoretical saturation. Data collection and analysis were carried out simultaneously until data saturation was reached. Results Data analysis led to the extraction of four main themes: holistic assessment of safe nursing care; team working and assessment of safe nursing care; ethical issues; and challenges of safe nursing care assessment. Conclusion Identifying these four components in the assessment of safe nursing care offers a contribution to the understanding of the elements of safe care assessment and the potential for improved patient safety. Implications for Nursing Management Safe care management requires the accurate and reliable assessment of safe nursing care and the need for strategies for reporting actual or potential unsafe care and errors to ensure patient safety. Keywords: assessment, nurses, nursing, patient safety, qualitative research

Journal of Advanced Nursing 54(4), 511–517Factors influencing use of home care and nursing homesAim. This paper reports a study comparing the characteristics of patients who usehome care services and those who are cared for in nursing homes, and identifyingthe factors that influence the use of these care settings.Background. The increase in the functionally dependent older population has led toan increase in the number of nursing homes and home care agencies. It has becomeclear that, rather than disputing which is the better of these options, it would bebetter to determine the characteristics of patients who use the two long-term careservices. Gaining an understanding of the unique characteristics of patients who arecared for by home care agencies and those who are cared for in nursing homes willbe imperative for reforming and developing long-term care systems.Method. The research model was based on the Anderson Model of Health ServicesUtilization. Interviews were conducted with 99 stroke survivors from two home careagencies and four nursing homes, and their family members, between May andDecember 2001.Results. The patient characteristics that predicted greater use of home care ratherthan nursing home services were: being married, poor physical function, impairedcognitive function, higher rates of comorbidity, various medical complications, and/or number of catheters (e.g. urinary catheter, naso-gastric tube).Conclusion. Contrary to the findings of previous studies conducted in countries withageing populations, our findings indicate that in South Korea home care agencies,rather than nursing homes, provide care for severely impaired patients. This may bedue to differences between countries in their long-term care systems and culturalattitudes toward end-of-life care. Our results will contribute to the development orreformation of long-term care systems in countries with ageing populations, and tothe development of strategies for increasing access to these services.Keywords: empirical research report, health services utilization, home care, inter-views, long-term care, nursing homes, older people

Aims and objectives. To evaluate the success of a competency-based nursing orientation programme for a single-room maternity care unit by measuring improvement in self-reported competency after six months. Background. Single-room maternity care has challenged obstetrical nurses to provide comprehensive nursing care during all phases of the in-hospital birth experience. In this model, nurses provide intrapartum, postpartum and newborn care in one room. To date, an evaluation of nursing education for single-room maternity care has not been published. Design. A prospective cohort design comparing self-reported competencies prior to starting work in the single-room maternity care and six months after. Methods. Nurses completed a competency-based education programme in which they could select from a menu of learning methods and content areas according to their individual needs. Learning methods included classroom lectures, self-paced learning packages, and preceptorships in the clinical area. Competencies were measured by a standardized perinatal self-efficacy tool and a tool developed by the authors for this study, the Single-Room Maternity Care Competency Tool. A paired analysis was undertaken to take into account the paired (before and after) nature of the design. Results. Scores on the perinatal self-efficacy scale and the single-room maternity care competency tool were improved. These differences were statistically significant. Conclusions. Improvements in perinatal and single-room maternity care-specific competencies suggest that our education programme was successful in preparing nurses for their new role in the single-room maternity care setting. This conclusion is supported by reported increases in nursing and patient satisfaction in the single-room maternity care compared with the traditional labour/delivery and postpartum settings. Relevance to clinical practice. An education programme tailored to the learning needs of experienced clinical nurses contributes to improvements in nursing competencies and patient care.

Background The introduction of single room maternity care in the 1990s necessitated a new approach to nursing education and practice. A focus on perinatal nursing requires competence across the spectrum of labor, delivery, postpartum and newborn care. We sought to evaluate the nursing response to this change by comparing satisfaction with the workplace environment among single room maternity care nurses before and after they worked in the setting and among nurses working in traditional birth settings. Methods Six months before the opening of a pilot seven-bed single room maternity care unit, nurses who planned to work in the new unit completed a survey about their satisfaction with aspects of their work environment. Three months after the new unit opened the survey was repeated with this study group and also by a sample of nurses working in the delivery and postpartum areas. Results Responses indicated that single room maternity care nurses before and after working in the unit were significantly more satisfied with the physical setting, their ability to respond to patients' needs, their opportunity for teaching families, the nursing practice environment, peer support, and their perceived level of competency. They rated their satisfaction significantly higher than that of their colleagues in the traditional delivery and postpartum settings. Conclusions The positive transition to single room maternity care by obstetrical nurses was demonstrated by their improved overall satisfaction with the work environment. Evaluation of the nurses' responses to changes in health care delivery has important implications for justifying new clinical approaches and planning for future changes.

Background: The job of the nurse in labor and delivery is not only to ensure a safe delivery but also to create a positive and satisfying childbirth experience. Few studies have been conducted of women's perceptions about the ideal image of the obstetric nurse during labor, and most previous studies involved only North American or European women. The purpose of this study was to assess Taiwanese women's perspectives about their encounters with obstetric nurses during labor. Methods: Interviews of a convenience sample of 50 mothers experiencing normal childbirth in Taiwan were conducted. The interviews were tape recorded and transcribed, and the transcriptions were analyzed to develop coding categories and identify themes. Results: Sixty percent of the participants reported having received helpful nursing behaviors only; 38 percent reported having received both helpful and unhelpful nursing behaviors. Helpful labor-coping measures that were valued by participants included performing roles of emotional support providers, comforters, information/advice providers, professional technical skills providers, and advocates. Forty percent of the participants reported that some nurses had hindered their labor-coping ability by failing to provide emotional support, comfort measures, adequate or correct information/advice, or to perform technical duties. Conclusions: The ideal nursing image encompasses the roles of emotional supporter, comforter, information/advice provider, professional/technical skill provider, and advocate. The findings may help obstetric team members better understand patients' needs, and enable them to provide better support during labor and to prevent unhelpful nursing behaviors.

In Australia, nursing care plans have been the predominant means of documenting and communicating patient care. After 30 years of use, there is growing criticism from nurse clinicians and academics about the clinical utility of nursing care plans. A group of expert nurses at a major teaching hospital initiated a structured evaluation project that evaluated the clinical utility of nursing care plans and clinical protocols. The care plans and protocols were evaluated using a questionnaire that asked nurses to rate the care plans and clinical protocols on 10 measures, using a four-point Likert scale. The responses from the questionnaire indicated ongoing problems with the use of the care plans and a strong acceptance of the use of clinical protocols. Within this context, one could ask the question, are nursing care plans redundant?

This paper explores the role of nursing interaction within the context of handovers and seeks to identify the clinical discourses used by registered nurses, student nurses and care assistants in acute elderly care wards, to determine their influence on the delivery of patient care. The study design involved an ethnographic approach to data collection which involved: observations of formal nursing end of shift reports (23 handovers) and informal interactions between nurses (146 hours); interviews (n = 34) with registered nurses, student nurses and care assistants; and analysis of written nursing records. A grounded theory analysis was undertaken. Data were collected from five acute elderly care wards at a district general hospital in the south of England. Results from this empirical study indicate that handovers were formulaic, partial, cryptic, given at high speed, used abbreviations and jargon, required socialized knowledge to interpret, prioritized biomedical accounts and emphasized physical aspects of care. Patients' resuscitation status was highly salient to all grades of nurse. Doing 'paperwork' was accorded less status and priority than patient care, and was regarded as excessively time consuming. Despite this, there was evidence of repetition in nursing documents. Moreover, the delivery of clinical nursing appeared to be guided by personal records rather than formal records.

This study was conducted to determine the validity of maternal self-reports of obstetrical complications in developing countries. The participants in this cross-sectional study included 1027 women who attended one of two Bolivian referral hospitals for childbirth Hospital de la Mujer in La Paz and Hospital G. Urquidi in Cochabamba. The reasons for admission were for acute complications resulting during home delivery or were readmissions in the month following hospitalization for childbirth. Data collection was conducted through a questionnaire which recorded mothers perceptions of obstetrical complications. The hospital records and physical examinations of mothers provided their clinical conditions. Comparisons were made in the sensitivity specificity positive predictive value and percent agreement between the control group and study group. The response rate for the study was >98%. The most common reported maternal complications were labor disorders and malpresentation. There were 257 women who were defined as cases for at least one condition 428 controls (women with a normal progress of labor and delivery and no evidence of any obstetrical complication) and 342 women who did not meet the full case definition nor the criteria for controls. In general womens reports of obstetrical complications did not match medical diagnoses. The highest agreement was obtained for reporting eclampsia with less agreement on labor disorders postpartum hemorrhage and malpresentation. Therefore the maternal self-reports did not provide a valid estimate of the prevalence of obstetrical complications.

This study compares differences in attitude, of oral health care of nursing personnel working with dependent elderly and severely disabled patients. A questionnaire was administered to 398 personnel covering (1) personal oral health care habits. (2) experiences and attitudes in assisting oral care and (3) willingness to assist patients/residents with their daily oral hygiene. Three hundred and sixty - four persons answered the questionnaire, including 70 registered nurses, 148 nursing assistants and 146 home care aides. The study revealed that oral care assistance is viewed as more disagreeable than other nursing activities. Although registered nurses were found to have more positive attitudes toward oral care assistance than the other nursing groups, they were seldom invoked in the daily practice of oral hygiene care. The results indicate a gap between knowledge and practice in nursing personnel's attitudes toward oral health care of dependent elderly and severely disabled patients.

Background:Health researchers and provider groups have recommended that women in labor should receive continuous professional support. The objective of our study was to compare the risks and benefits of one-to-one nurse labor support with usual intrapartum nursing care. Methods: A randomized, controlled trial was conducted in a 637-bed university hospital in Montreal, Quebec, with 413 nulliparous women who were at more than 37 weeks' gestation, carrying singletons, and in labor. Women with scheduled cesarean section, scheduled induction, breech presentation, presence of paid labor support, or cervical dilatation over 4 cm were excluded. One-to-one care consisted of the presence of a nurse during labor and birth who provided emotional support, physical comfort, and instruction for relaxation and coping techniques. Usual care consisted of care for two or three laboring women with various types of supportive activities, Results: A beneficial trend due to one-to-one nurse support was found with a 17 percent reduction in risk of oxytocin stimulation (relative risk of experimental vs control = 0.83; 95% confidence interval = 0.67, 1.04). No significant differences were found in overall labor durations and overall rates of total cesarean section, cesarean section for cephalopelvic disproportion, epidural analgesia, admission to the neonatal intensive care unit, instrumental vaginal delivery, and perineal trauma. Conclusions: The beneficial trend attributed to one-to-one nursing in reduction of oxytocin stimulation suggests that implementation of recommendations for continuous professional support by intrapartum nursing staff may be appropriate in North America.

Crisis reactions, a stressful environment, infant care practices, and nurse behavior may cause difficulties in entering the natural parental role for parents of infants who are admitted to a neonatal intensive care unit (NICU). In connection with discussions in the Uppsala NICU on what constitutes good care, a philosophy of care, based on Callista Roy's adaptation model, was formulated for the purpose of providing developmentally supportive, family-centered care, and for defining good care and the professional nurse role. The philosophy describes the infant's needs and environment. Caring activities focus on support of the infant's and his parent's roles and self-concept in their progress towards independence from professional assistance. The philosophy is an essential component in the introductory program which integrates newly recruited personnel from different disciplines into the unit. It is presented as a suggestion of how a model-based philosophy of care can be formulated by operationalization of the theoretical concepts of a nursing model.

The purpose of this study was to document patients' responses (n = 246) to intraoperative care and to find out whether or not their opinions (n = 158) changed with time. Another goal was to develop a patient-based scale for continuous systematic evaluation. The data were collected by a structured questionnaire in two phases in 1993: first at the end of the patients' hospital stay, and then after a few weeks at home. The following themes were covered in the questionnaire: biological-physiological, experiential, cognitive, functional, ethical, the characteristics and competence of nursing professionals, and environmental. Statistical analysis suggested that the patients were satisfied with their intraoperative care. Problems occurred mainly in cognitive and experiential perspectives, such as the need for continuous access to information and coping with the anxiety related to the impending surgery. It also emerged that special attention must be paid to keeping the patient warm in the operating theatre and to looking after emergency patients, younger patients, and patients who only remain in the operating department for a short period of time. The patient's evaluations of the standards of care tended to be less critical in hospital than they were a few weeks after discharge.

Studies at area hospitals revealed many gaps between research evidence and intrapartum nursing practices. A randomized controlled trial involving 20 hospitals was used to evaluate the effectiveness of a marketing strategy to promote research-based nursing care. It was hypothesized that the strategy would result in lower rates of epidural analgesia, through increasing the amount of support nurses provided to their patients. Other outcomes included rates of narcotic analgesia, episiotomy, and operative delivery. The marketing strategy was unsuccessful in improving intrapartum nursing care. Much more research is needed about the factors that facilitate improvements in nursing practice.

This study examined the reliability of nursing diagnoses identified from the medical records of 100 patients hospitalized for HIV disease on a 22-bed designated unit at a large metropolitan teaching hospital in Los Angeles. The diagnoses were identified in two ways: (a) staff nurses identified 16 different nursing diagnoses using preprinted care plans found in the medical records, with 2 to 9 problems per patient (M = 4.8, SD = 1.6) and (b) the nurse researcher-identified 45 different nursing diagnoses derived from defining characteristics documented in the medical records, with 1 to 9 identified problems per patient (M = 3.3, SD = 1.8). The most frequent problems identified were the same as those addressed in the clinical literature: pain, respiratory problems, nutritional deficits, and psychosocial concerns. The results of this study raise concerns about the limitations of nursing diagnosis research using existent data bases and the use of preprinted care plans.

We explored the influence of nursing dependency over and above sociodemographic factors and medical conditions on the use of home care nursing resources by patients 65 years of age and older. Use measures were number of visits made by home care nurses, and length of nursing stay. Nurses' reports, direct observation of nursing care provided, patient interviews, and record abstraction were used to obtain data on 236 patients who were admitted to and discharged from a certified public home health agency. Nursing dependency explained a significant amount of variance over and above sociodemographic factors and medical conditions in number of visits made by nurses and length of nursing stay. Measures of nursing dependency should be incorporated into future studies that examine factors related to use of home care nursing resources.

In June, 1992, the NSW Health Department released their Discussion Paper on ‘The Role and Function of Nurse Practitioners in NSW’. The paper recommends legislative changes to enable nurse practitioners to initiate certain diagnostic tests, prescribe from a limited list of drugs, refer directly to specialist medical officers in certain circumstances and be reimbursed for some of the services they provide. Strict criteria for accreditation and evaluation are also recommended. Overseas literature confirms that nurse practitioners provide a safe, competent and cost effective service, which is well accepted by consumers. Opponents of the nurse practitioner concept in Australia have argued that it would be ‘dangerous practice’ and a ‘duplication of services’ to implement the Discussion Paper's recommendations. These arguments can not be substantiated. Of more concern is the attempt to divide nurses and nursing on the issue. To suggest that it is acceptable for nurse practitioners to provide services where doctors don't choose to practice or to provide service to disadvantaged groups of people, with whom doctors don't choose to work is unacceptable to nursing. Nurses provide nursing care, they do not provide medical care. Wherever nurses happen to be located, nurses are nurses and do nursing. Whether or not there is a doctor available is not the issue. Nurses do not seek to be doctors. Nurses do not seek to practice medicine. Nursing as a profession stands alone. This paper discusses the nurse practitioner concept as it is proposed for NSW, the implications for urban, rural and remote area nurses, the deliberate attempts to create division amongst nurses on the issue and the need for nurses to stand together to protect, validate and legitimise nursing practice.