Search

Aims and objectives: To examine documentation of medication administration in medical and surgical patients. Study objectives: (1) Determine the point prevalence of non-therapeutic medication omissions; (2) identify documented reasons for non-therapeutic medication omissions; (3) examine the relationship between length of stay and medication omissions; and (4) explore the impact of outlier status (e.g. medical patients managed on surgical wards) on medication administration. Background: Acutely ill patients are particularly sensitive to health care errors. We previously identified a 26% rate of non-therapeutic medication omissions in patients admitted unexpectedly to intensive care unit (ICU) from medical and surgical wards. Design: A point prevalence survey of 162 medical and surgical patients across four sites in the South West of England. Method: Data collected included: all instances of, and reasons for, non-therapeutic medication omission. We also recorded whether the patient was an 'outlier' and examined nursing documentation where no reason for medication omission was given on the drug chart. Results: The number of patients who missed at least one medication was high across all sites ( n = 129/162; 79.6%, range 60-88%), with a total of 1077 doses omitted. Patients who were outliers (e.g. surgical patients on a medical ward) were more likely to miss medications (100% versus 74%, p < 0.001). The most common missed medications were analgesia and anti-inflammatory drugs (28%, 299/1077); 203 of these were due to patient refusal. Conclusions: The extent of medications omitted for non-therapeutic reasons in medical and surgical patients is of concern. None were recorded as an adverse drug event; however, the extent of omitted or refused medications suggests the need for a review of prescribing and drug administration processes. These findings have important implications for the role of ICU outreach and liaison services, for example, including medication management in the monitoring of patients pre/post-ICU admission and support/education provided for ward staff. Relevance to clinical practice: Detailed analysis of medication records suggests a number of areas of medication administration that would benefit from review. [ABSTRACT FROM AUTHOR]

Aim. This paper is a report of a study to identify experienced rural nurses' perceptions of key issues related to the provision of effective psychosocial care for people with cancer in rural settings. Background. A cancer diagnosis has a major impact on psychological and emotional wellbeing, and psychosocial support provided by nurses is an integral part of ensuring that people with cancer have positive outcomes. Although, ideally, people with cancer should be managed in specialist settings, significant numbers are cared for in rural areas. Methods. Using a qualitative descriptive approach, three focus groups were conducted in 2005 with 19 nurses in three hospitals in rural Victoria, Australia. Findings. Participants indicated that a key issue in providing psychosocial care to patients with cancer in the rural setting was their own 'emotional toil'. This Global Theme encapsulated three Organizing Themes - task vs. care, dual relationships and supportive networks - reflective of the unique nature of the rural environment. Nurses in rural Australia are multi-skilled generalists and they provide care to patients with cancer without necessarily having specialist knowledge or skill. The fatigue and emotional exhaustion that the nurses described often has a major impact on their own well-being. Conclusion. In the rural context, it is proposed that clinical supervision may be an important strategy to support clinicians who face emotional exhaustion as part of their cancer nursing role. [ABSTRACT FROM AUTHOR]

Consumer participation has been heralded as the integration of consumer perspectives into standard mental health care. Using a qualitative descriptive method, this study had two broad aims. First, the study aimed to explore the perceptions of consumer advocates and clinicians regarding consumer participation in two new regional mental health services. Second, the study aimed to explore how broad policy initiatives, related to consumer participation, are enacted at a service delivery level. In-depth interviews were conducted with 10 participants, recruited from the steering committees of both services. Although all participants uniformly commended consumer participation as a reality in mental health services, its breadth and depth of influence was not enacted. A systemic change to the way consumer participation is funded and incorporated into mental health services is required. The incorporation of consumers as stakeholders within mental health services requires commitment to the idea, the establishment of clear purposes and roles, and commensurate funding to enable consumers to be stakeholders with similar resources to other stakeholder groups. [ABSTRACT FROM AUTHOR]

Triage processes are commonly used to manage the interface between demand for, and supply of, health services. This dimension of service provision is particularly pertinent for mental health services in Australia, where demand outweighs services available. This paper draws on the experiences of using participant observation to explore mental health triage processes. Findings highlight the complexities of the researcher role and benefits of using an ethnographic approach to explore mental health triage patterns. Insider participant observation brings many challenges but also, in this study, enabled the researcher to uncover some roles and processes underpinning triage decisions in mental health services. [ABSTRACT FROM AUTHOR]

This article reports on the clinical phase of a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting to evaluate the effectiveness of educational preparation for critical care nursing [Scholes & Endacott (2002) Evaluation of the Effectiveness of Educational Preparation for Critical Care Nursing. ENB, London]. The authors draw on observation and interview data from clinical settings (general and paediatric intensive care units; operating theatre departments; accident and emergency departments and coronary care units), focusing specifically on the way in which curricular intentions were made a reality in clinical practice. The reality of learning in practice is examined, with evidence from the data to illustrate the real world of clinical practice.Different models of support and supervision are identified, alongside strategies used to create different learning opportunities. The majority of students remained in their own workplace when undertaking the English National Board for Nursing, Midwifery and Health Visiting clinical course. This raised a number of issues for the students and their colleagues which we have labelled the practitioner:student gap. The authors discuss the impact this has on supernumerary status, perceptions of learning and opportunities to undertake placements. [ABSTRACT FROM AUTHOR]

This paper reports the findings from a study commissioned by the English National Board for Nursing, Midwifery and Health Visiting (ENB), entitled Evaluation of the Effectiveness of Educational Preparation for Critical Care Nursing. One aim of the study was to generate evidence that incorporated the national perspective on the priorities for core competencies and a national threshold standard of the ENB critical care clinical awards. Although these courses are no longer validated by the professional statutory body, the findings illuminate some key insights into the current challenges facing providers and consumers of critical care education as well as into implications for all post-registration education provision. The paper outlines how the study data were collected, how the core competendes were generated and the national consultation exercise and the levers and barriers that affect the introduction of core competencies. Other aspects of the study data are reported elsewhere (Scholes and Endacott, 2002). [ABSTRACT FROM AUTHOR]

Meeting needs is the aim of health care frequently espoused in textbooks, policy documents and reports of research studies; provision of health care is also now described as 'needs-based', rather than 'service-based'. The purpose of this paper is to explore the concept of need, using concept analysis, with the aim of providing greater clarity. Two approaches to concept analysis are compared: the linear model proposed by Walker and Avant and Rodgers' cyclical model. On both a philosophical and practical level, Rodgers' model was felt to be more appropriate for analysis of the concept of need. The rigid divisions which the Walker and Avant model seeks to establish (particularly in relation to the construction of additional cases) were felt to restrict, rather than clarify the concept. The attributes, antecedents, consequences and references of need are described, following stratified random sampling of the available literature, and a model case is presented. The themes of priority and perception of need arose consistently within the literature, highlighting the value-laden nature of the concept and the importance of achieving a common understanding to enable purchasers, providers and consumers to better satisfy health care needs. [ABSTRACT FROM AUTHOR]