Search

This paper is concerned with the evaluation of a workshop for teachers of nursing devoted to an individualized teaching and learning strategy. The paper gives a brief account of the history of such workshops and continues by defining individualized teaching. Following this the characteristics of the Keller Plan strategy are outlined. This is followed by details of the course organization; its aims and objectives, and the characteristics of the course members. Finally, the method of evaluation is described and results are discussed. [ABSTRACT FROM AUTHOR]

Objective: To review the definition of ‘primary care’ and ‘inappropriate’ patients in ED and develop a generally acceptable working definition of a ‘primary care’ presentation in ED. Method: A Medline review of articles on primary care in ED and the definitions used. Results: A total of 34 reviewed papers contained a proposed definition or comment on the definition for potential ‘primary care’, ‘general practice’, or ‘inappropriate’ patients in ED. A representative definition was developed premised on the common factors in these papers: • Low urgency/acuity – triage categories four or five in the Australasian Triage Scale • Self-referred – by definition, patients referred by general practitioner/community primary medical services are not primary care cases because a primary care service has referred them on • Presenting for a new episode of care (i.e. not a planned return because planned returns are not self-referred) • Unlikely to be admitted (in the opinion of Emergency Nurse interviewers) or ultimately not admitted Discussion: This definition can be applied either prospectively or retrospectively, depending on the purpose. Appropriateness must be considered in light of a legitimate role for ED in primary care and the balance of resources between primary care and emergency medicine in local settings. [ABSTRACT FROM AUTHOR]

This paper is concerned with the phenomenon of human suffering and is an attempt to justify and begin theoretical development of this phenomenon for nursing science. The paper is divided into three sections. The first section describes the interest of nursing science in the phenomenon and critically examines relevant literature in order to further conceptualize development and clarification. This section concludes with a theoretical definition of suffering derived from this critique. Suffering is defined as an individual's experience of threat to self and is a meaning given to events such as pain or loss. The second section elaborates on this definition and examines how it can inform theoretical discussion in two areas with import for nursing -- the patient's experience of suffering and the nurse's experience of patient suffering. The final section briefly considers some implications for clinical research. [ABSTRACT FROM AUTHOR]

The aim of this paper is to demonstrate the utility of qualitative methods for nursing research, to this end a case is made for the use of fieldwork methods. The paper focuses upon a study which was concerned with student nurses' accounts of their experience of being learners of nursing. An overview of the students' construction of their nursing world is given and then the discussion moves to one particular aspect described as `nursing in the dark'. This is a conceptual category which deals with the data pertaining to the student's difficulties concerning what they could say to patients. The reader is thus furnished with a substantive as well as a methodological view of the study. The analysis draws upon the work of Glaser & Strauss, both in the attempt to generate ground theory and by reference to their work concerning awareness contexts. [ABSTRACT FROM AUTHOR]

The proposition of this paper is principally that if the term 'reassurance' is used by nurses its meaning should be clearly stated and the methods by which it may be achieved should be clearly identified. The author begins by attempting to identify a workable definition of the term and by arguing a case for taking the approach that it is a nursing interpersonal skill rather than a nursing psychotherapy. Using this as the basis for the rest of the discussion he then suggests that as an interpersonal skill it is open to analysis and behaviours can be identified which help to achieve a restoration of the patient's confidence. Further to this, learning objectives are stated in the hope that the concept of reassurance can be seen as a skill which can be enhanced by educational processes. Full competence in the use of interpersonal skills is not a stable feature in all human beings; in every individual nurse there is scope for the development and training of interpersonal skills. Finally, the author attempts to achieve the major aim of the paper--stating nursing actions which may be employed in order to achieve this reassurance of the patient. [ABSTRACT FROM AUTHOR]

There is strong rationale for improving care for people with chronic conditions, including osteoarthritis (OA). Successful implementation of healthcare reform requires new concepts and directions that are strongly supported by policy, new models of care (service redesign) and changes in day-to-day practice (healthcare provider and patient practice). In this paper we discuss the extent to which policy about management of OA of the hip and knee has been translated into new service models in Australia. A structured search of government and other key health websites in Australia was performed to identify policy, funding initiatives and new services models for managing OA of the hip and knee. This search was supported by a literature review. Musculoskeletal conditions were designated a National Health Priority in Australia in 2002. Under the Better Arthritis and Osteoporosis Care initiative, Australia has developed a national policy for OA care and national evidence-based clinical practice guidelines for management of OA of the hip and knee. Only two well-described examples of new chronic disease management service models, the Osteoarthritis Clinical Pathway (OACP) model and the Osteoarthritis Hip and Knee Service (OAHKS) were identified. Primarily focused within acute care public hospital settings, these have been shown to be feasible and acceptable but have limited data on clinical impact and cost-effectiveness. While policy is extant, implementation has not been systematic and comprehensive. Clinicians have evidence-based recommendations for OA management but are poorly supported by service models to deliver these effectively and efficiently. [ABSTRACT FROM AUTHOR]

Aims. This paper reports findings from a large-scale quasi-experimental study that used a measure of caring as a means of evaluating person-centred nursing and aims to illustrate the synergy between the concepts of caring and person-centredness. Background. Evidence would suggest that effective person-centred nursing requires the formation of therapeutic relationships between professionals, patients and others significant to them in their lives and that these relationships are built on mutual trust, understanding and a sharing of collective knowledge. This correlates with the conceptualisation of caring that is underpinned by humanistic nursing theories. Design. A pretest post-test design was used in this study to evaluate the effect of person-centred nursing on a range of outcomes, one of which was nurses' and patients' perception of caring. Methods. The Person-Centred Nursing Index was the main data collection tool. The Caring Dimension Inventory and Nursing Dimensions Inventory, were component parts of the Person-Centred Nursing Index and were used to measure nurses' and patients' perceptions of caring. The Person-Centred Nursing Index was administered at five points in time over a two-year intervention period. Results. Nurses had a clear idea of what constituted caring in nursing, identifying statements that were reflective of person-centredness, which was consistent over time. This was in contrast to patients, whose perceptions were more variable, highlighting incongruencies that have important implications for developing person-centred practice. Conclusion. The findings confirm the Caring Dimension Inventory/Nursing Dimensions Inventory as an instrument that can be used as an indicator of person-centred practice. Furthermore, the findings highlight the potential of such instruments to generate data on aspects of nursing practice that are traditionally hard to measure. Relevance to clinical practice. The findings would suggest that nurses need to be aware of patients' perceptions of caring and use this to influence changes in practice, where the prime goal is to promote person-centredness. [ABSTRACT FROM AUTHOR]

In this paper I explore the possibilities of nursing as safeguarding through a phenomenological description of a small sculpture by the German artist Käthe Kollwitz. My discussion will be grounded in Heidegger's understanding of technicity as a pervasive systematizing and aggressive challenging-out. The method is grounded in Merleau-Ponty's and Heidegger's contention that strong artworks are truth-disclosing and show up our precognitive contact with the world. Bringing nursing concerns to an encounter with single strong artworks can help us cultivate a more receptive openness to our patients. [ABSTRACT FROM AUTHOR]

The paper explores consequences of applying the view that illness is negative first-person experience in caring practice. The main reason this is an important issue is that it is empirically documented that patients conceive of illness in different ways. Communicating about illness in caring practice can therefore involve difficulties. I argue that many of these difficulties can be avoided if nurses focus directly on the extension of the concept of illness – patients’ experiences like the state of being in pain – and not on how this extension is represented as (the intension) illness. This argument is compatible with different views on the nurse–patient relationship as a communicative process. All it requires is the acceptance of minimal assumptions about concepts and concept possession. The argument has a descriptive and a normative dimension. It is descriptive in the sense that it seeks to use concepts from philosophy of mind to explain how many nurses succeed in talking about illness without applying the concept of illness. It is normative in the sense that it provides a philosophical justification for this practice. [ABSTRACT FROM AUTHOR]

Nurses in the United Kingdom spend much time attempting to fit British nursing practice into the theoretical framework of American nursing models. This is often a manipulative process in that it seeks to establish positive links with a care delivery system totally unlike our own. In the present paper the authors detail the process of establishing a new nursing model which integrates nursing curricula, education and practice to meet the needs of patients, staff and students within their own health district. An over-emphasis on lower levels of human need is common within nursing practice, which, although often blamed upon lack of human and financial resources, is also due to practitioners' misconceptions. The latter are invariably the result of a lack of an adequate or overt, practice orientated, conceptual framework. The Human Needs Model of Nursing adapts Maslow's concept of human needs to create such a conceptual framework for practice. It places equal emphasis on those patient problems which arise as the result of unmet needs at higher levels as well as those at lower levels, thereby acknowledging the holistic and dynamic nature of man. [ABSTRACT FROM AUTHOR]

This paper shows how female, ambulant, geriatric patients in a long-stay psychiatric ward, many of whom had become institutionalized and had lost much of their self-identity and initiative, could be encouraged to become more spontaneous and individualistic. This study utilized a programme which did not involve any great financial expenditure nor extra nursing staff, and enhanced, rather than interfered with, the daily functioning of the ward. Data are presented to show that sociability and spontaneity improved on the ward concerned and that the programme proved so flexible that it has since been extended to other wards. [ABSTRACT FROM AUTHOR]

The necessity, timing and benefits of follow-up after rectal cancer surgery remain controversial, with two years traditionally considered adequate to detect most local recurrences. This unit has a policy of lifetime follow-up, and this paper investigates, at 23 years, the value of prolonged surveillance.Six hundred and sixty consecutive patients undergoing surgery for rectal cancer were prospectively followed-up between 1978 and 2002, and local or systemic recurrence recorded. This analysis was performed on the 509/660 (76%) patients who underwent potentially curative surgery.Total mesorectal excision (TME) was performed in 422/509 (83%) patients, mesorectal transection in 78 (15%), and local excision in 9 (2%). Follow-up ranged from 1 to 23 years (mean = 9.7). Seven (1.4%) patients had local recurrence alone, 11 (2.2%) local plus systemic, and 86 (17%) systemic recurrence alone. Of the local recurrences 3 (17%) became evident within 1 year, 9 (50%) within 2 years, 16 (89%) within 5 years, and 2 (11%) presented after 5 years, at 5.6 and 5.8 years. Of the systemic recurrences 26 (27%) became evident within 1 year, 57 (59%) within 2 years, 93 (96%) within 5 years, and 4 (4%) presented after 5 years at 5.3, 5.3, 5.4 and 7.9 years.This long-term surveillance of patients undergoing curative surgery for rectal cancer demonstrates that most local and systemic recurrences occur within 5 years. Almost half occurred more than 2 years after surgery. However, those centres wishing to set standards of care, or evaluate current or new therapies in rectal cancer treatment, should be aware that unexpected late recurrences occasionally develop. [ABSTRACT FROM AUTHOR]

Please cite this paper as: Kitchener H, Paraskevaidis E. Patient's preference: a sound basis for policy? BJOG 2012;119:5-6. [ABSTRACT FROM AUTHOR]

In two samples of over 200 consecutive referrals each from a psychiatric hospital to community agencies, client characteristics were generally unrelated to referral success but three staff interventions were related to completing referrals. It was concluded that known interventions are stronger predictors of successful referrals than patient characteristics. Staff telephone contacts with ethnic minorities were more successful in effecting referrals than with majority patients. [ABSTRACT FROM AUTHOR]

The article focuses on the study on the HIV patients' preference and experiences about the quality of care. The study is supported by the assessment of quality of care received by patients with HIV from nurse specialists, nurse consultants and general practitioners. The questionnaire method used in the study is called QUOTE-HIV. It is a modified version of a scale that is designed to measure patient perceptions of care quality. There were 23 scale items used in the study.

Responds to a comment on three studies concerning caregivers' interactions with persons with dementia showing aggressiveness. Interviews of caregivers concerning their feelings and experiences from interacting with residents with dementia; Basis of the selection of the units; Perception of being able to interact effectively with the persons showing aggressiveness or not; Limitations of the study.

The article focuses on the study concerning the alternative forms of patient and nurse consultations. The study aims to investigate ways of improving access for patients to practice nurse appointments. The researchers found out that there had been no support for the use of phone or e-mail as alternative to consultation in their general study setting.

Comments on the use of special surface devices for patients identified to be at risk and even for those with an identified pressure ulcer. Factors that influenced crude prevalence rates; Limitations of all risk assessment scales; Support surfaces for pressure ulcer prevention.

Cases of dementia present us with difficult ethical dilemmas as we strive to care for those unable to care for themselves. In this article, I review the relevant Islamic texts on caring for the ill, alleviating suffering, and feeding the hungry—all in light of the modern clinical environment. I find that the ethical appropriateness of tube feeding at the end of life is not as clear-cut as it may seem. My analysis, however, suggests that Muslim scholars ought to favor insertion of a feeding tube in patients who can no longer respond to assisted feeding. Nonetheless, several important issues require further clarification in this clinically important but neglected area of ethical inquiry. [ABSTRACT FROM AUTHOR]

Background The Redesigning Care initiative at Flinders Medical Centre aimed to improve access to timely, consistent, quality care. This led to the creation of an Acute Assessment Unit (AAU) where all patients are assessed by the Allied Health team on admission. This study aimed to: (i) determine the nutritional status of patients admitted to the AAU using the scored Patient Generated-Subjective Global Assessment (PG-SGA); and (ii) determine the association between nutritional status and length of stay (LOS). Methods A prospective, observational study was conducted in 64 patients (mean age 79.9 ± 11 years, 76% female). Nutritional status was assessed within 48 h of admission and LOS data were collected prospectively. Results According to PG-SGA global rating, 53% ( n = 34) of patients were malnourished. There was a weak association between PG-SGA score and LOS ( r = 0.250, P = 0.046). The malnourished patients had a longer LOS by 1 day compared to well-nourished patients, and while this did not reach statistical significance ( Z = −0.988, P = 0.323), it has implications for health care costs. LOS overall was short at a median of 4.5 days (range 1–24). Conclusions A significant proportion of patients admitted to the AAU is malnourished. There was a trend for these patients to have a longer LOS, indicating a critical need for nutritional management; however LOS as a whole was short. While nutrition support in hospital is useful in reinforcing dietary education, the short LOS emphasized the importance of discharge education and follow-up. [ABSTRACT FROM AUTHOR]

We examine how the information gathered about patient safety-related events is influenced by the interpretation and classification of these events in hospitals and by the context in which hospitals operate. Building on aviation safety studies, we developed research questions to guide a qualitative, interview-based study of three hospitals. We found that having a specific (or general) definition of an event was important for aviation safety information systems, but was not salient for hospitals. In these hospitals, event classification was influenced by professional perspectives, perceived professional responsibility, event contingencies, and surveillance technology. In both contexts, decision makers avoided reporting potentially dangerous events by classifying them in non-reportable categories. The importance of industry context for these results underscores the need for industry-specific midlevel conceptual frameworks. Healthcare policy-makers advocate standardizing event definitions to promote learning, but if organizational factors influence definitions and classification schemes, this may undermine the usefulness of centralized error reporting. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aims and objectives. The aim of this present study was to explore patients’ experiences of the meaning they attribute to hope and hoping a year after acute spinal cord injury. Background. Nursing literature is pointing towards the importance of having hope for a healthful living. However, the concept of hope has preliminarily been defined in an abstract and general way and is therefore difficult to grasp. Design and methods. This qualitative study has a longitudinal and descriptive–explorative design. Data were collected by personal interviews ( n = 10) one year after acute spinal cord injury. A phenomenological–hermeneutic approach, based on the philosophy of Ricoeur, was used to extract the essences of the patients’ experiences. Results. The findings resulted in one main interpretation: ‘The Power of Hope’, and two sub-themes: ‘Will, Faith and Hope’ and ‘Hoping, Struggling and Growing’. The power of hope was interpreted as the individual having experienced the meaning a year after the injury, mainly expressed through will power. Conclusions. This study shows that experiences of hope were important to all participants, providing energy and power to the process of struggling because hope is necessary for further progress and personal development. Relevance to clinical practice. Nursing interventions should be mainly directed towards emotional and motivational strategies to promote the will power and personal growth through learning experiences. [ABSTRACT FROM AUTHOR]

The purpose of this article is to critically review and synthesize the literature related to the general concepts and the process of diagnosing the client's condition, and the possible variables which influence diagnostic practise in nursing. It is suggested that statistical theories are capable of capturing the diagnostic process and offer an effective means to predict diagnostic decisions. Studies underpinned by information-processing theory argue that diagnosing a patient's condition follows a hypothetico-deductive model that consists of specific stages. Those who hold a phenomenological perspective remark that there is yet another form of diagnostic practise: intuitive reasoning, which plays an important role in diagnosing the patient's clinical condition. Other related studies suggest that diagnostic practise is contingent on some personal, psychosocial, and structural variables. Regrettably, these studies offer no conclusive explanation to delineate diagnostic practise in nursing. Based on the literature reviewed, a conceptual framework is suggested to help articulate the underlying structures and processes of diagnostic practise in nursing. [ABSTRACT FROM AUTHOR]

Nurses make mistakes in practice despite the culturally based expectation of perfection. Such a disparity between reality and expectation calls members of the profession to question the current attitudes toward mistakes in practice. Two explanatory models of the origin of mistakes are presented. The Perfectibility Model holds that any error or harm is caused by an individual practitioner's lack of knowledge or motivation. The Faulty Systems Model offers a broader explanation of human error. I conclude that a Faulty Systems Model is more comprehensive and more effective for managing mistakes. Integrating the Faulty Systems Model into practice and education can result in more ethically fitting responses to errors and ultimately better outcomes for nurses, institutions and patients. [ABSTRACT FROM AUTHOR]

Objectives. To assess whether adverse outcomes in Medicare patients can be used as a surrogate for measures from all patients in quality‐of‐care research using administrative datasets. Data Sources. Patient discharge abstracts from state data systems for 799 hospitals in 11 states. National MedPAR discharge data for Medicare patients from 3,357 hospitals. State hospital staffing surveys or financial reports. American Hospital Association Annual Survey. Study Design. We calculate rates for 10 adverse patient outcomes, examine the correlation between all‐patient and Medicare rates, and conduct negative binomial regressions of counts of adverse outcomes on expected counts, hospital nurse staffing, and other variables to compare results using all‐patient and Medicare patient data. Data Collection/Extraction. Coding rules were established for eight adverse outcomes applicable to medical and surgical patients plus two outcomes applicable only to surgical patients. The presence of these outcomes was coded for 3 samples: all patients in the 11‐state sample, Medicare patients in the 11‐state sample, and Medicare patients in the national Medicare MedPAR sample. Logistic regression models were used to construct estimates of expected counts of the outcomes for each hospital. Variables for teaching, metropolitan status, and bed size were obtained from the AHA Annual Survey. Principal Findings. For medical patients, Medicare rates were consistently higher than all‐patient rates, but the two were highly correlated. Results from regression analysis were consistent across the 11‐state all‐patient, 11‐state Medicare, and national Medicare samples. For surgery patients, Medicare rates were generally higher than all‐patient rates, but correlations of Medicare and all‐patient rates were lower, and regression results less consistent. Conclusions. Analyses of quality of care for medical patients using Medicare‐only and all‐patient data are likely to have similar findings. Measures applied to surgery patients must be used with more caution, as those tested only in Medicare patients may not provide results comparable to those from all‐patient samples or across different samples of Medicare patients. [ABSTRACT FROM AUTHOR]

The article focuses on the role of nurses. In a widely observed rule among nurses that when speaking to patients they just do not use the word 'cancer'. However much one may deplore this practice, the reason for it is understandable. It is simply that in some members of the general public the word 'cancer' produces a characteristic reaction, a kind of irrational panic. The reaction is dangerous because it creates an irrational pattern of behavior in which the victim is quite unable to think logically, to act rationally, or even to listen.

Presents a study that reviews one method implemented in an acute medical/surgical ward and discusses the use of a quality assurance project to ensure a consistent approach to the handover. Need for communicating high-quality patient information accurately, completely and in the most timely and effective way; Analysis of change of shift handovers between nurses; Problems encountered during handovers; Improvement in the communication between staff with less time wasted in accessing information as a result of the audit on the nursing handover.

The article provides information about a new scale to aid hospital staffs in the objective evaluation of the patient's adjustment. The large number of chronic disease patients has emphasized the need for a scale applicable to them. The scale is easy to administer and should give hospital staffs a fairly objective method of evaluating adjustment as well as changes in adjustment. Scores below 50 on this scale tend to indicate poor hospital adjustment and scores above 75 good hospital adjustments with the 50 to 75 ranges being average adjustment.

Reports on the completion of a study of nurses' judgment of patient distress derived from different cultures. Cooperation of the American Nurses Foundation, health professionals from the various countries studied; Confirmation of the difference of the judgment of patient distress by licensed practical nurses; Use of the standard Measure of Inference questionnaire in the study.