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Current guidelines for pain management recommend systematic assessment of pain. A few standardized tools exist for the daily assessment of pain intensity, for example the numeric rating scale or visual analogue scale, yet these instruments are rarely used by nurses. In the study reported in this paper, a numeric rating scale accompanied by an educational programme for nurses, was implemented in three hospitals. The paper describes the feasibility of daily pain assessment from the nurses' and patients' perspective in multiple settings. The outcomes studied were the professional compliance of nurses with daily pain assessment, and the value of daily pain assessment for both nurses and patients. The results show that nurses' compliance with daily pain assessment is high (73.9%) and that daily pain assessment is feasible and valued by nurses; however, differences between the three hospitals and two specialties (medical vs. surgical wards) were found. Although patients have difficulty with expressing their pain by use of a number, almost all patients are able to give a pain score and a majority is positive about daily pain assessment. From this study it can be concluded that daily pain assessment is practical and appreciated by nurses as well as patients, but attuning the implementation protocol to the needs of the specific setting is necessary. [ABSTRACT FROM AUTHOR]

Abstract Background The employment of physician assistants (PAs) is a strategy to improve access to care. Since the new millennium, a handful of countries have turned to PAs as a means to bridge the growing gap between the supply and demand of medical services. However, little is known about this new workforce entity from the patient’s perspective. The objective of this study was to assess the willingness of Dutch patients to be treated by a PA or a medical doctor (MD) under various time constraints and semi-urgent medical scenarios. Methods A total of 450 Dutch adults were recruited to act as surrogate patients. A convenience sample was drawn from patients in a medical office waiting room in a general hospital awaiting their appointments. Each participant was screened to be naive as to what a PA and a nurse practitioner are and then read a definition of a PA and an MD. One of three medical scenarios was assigned to the participants in a patterned 1-2-3 strategy. Patients were required to make a trade-off decision of being seen after 1 hour by a PA or after 4 hours by a doctor. This forced-choice method continued with the same patient two more times with 30 minutes and 4 hours and another one of 2 hours versus 4 hours for the PA and MD, respectively. Results Surrogate patients chose the PA over the MD 96 % to 98 % of the time (depending on the scenario). No differences emerged when analysed by gender, age, or parenthood status. Conclusion Willingness to be seen by a PA was tested a priori to determine whether surrogate Dutch patients would welcome this new health-care provider. The findings suggest that employing PAs, at least in concept, may be an acceptable strategy for improving access to care with this population.

Abstract Background This paper reports a study about the effect of knowledge sources, such as handbooks, an assessment format and a predefined record structure for diagnostic documentation, as well as the influence of knowledge, disposition toward critical thinking and reasoning skills, on the accuracy of nursing diagnoses. Knowledge sources can support nurses in deriving diagnoses. A nurse’s disposition toward critical thinking and reasoning skills is also thought to influence the accuracy of his or her nursing diagnoses. Method A randomised factorial design was used in 2008–2009 to determine the effect of knowledge sources. We used the following instruments to assess the influence of ready knowledge, disposition, and reasoning skills on the accuracy of diagnoses: (1) a knowledge inventory, (2) the California Critical Thinking Disposition Inventory, and (3) the Health Science Reasoning Test. Nurses (n = 249) were randomly assigned to one of four factorial groups, and were instructed to derive diagnoses based on an assessment interview with a simulated patient/actor. Results The use of a predefined record structure resulted in a significantly higher accuracy of nursing diagnoses. A regression analysis reveals that almost half of the variance in the accuracy of diagnoses is explained by the use of a predefined record structure, a nurse’s age and the reasoning skills of `deduction’ and `analysis’. Conclusions Improving nurses’ dispositions toward critical thinking and reasoning skills, and the use of a predefined record structure, improves accuracy of nursing diagnoses.

Background: Limited research has examined what is actually done in the process of care by nursing staff in long-term institutional care. The applied instruments employed different terminologies, and psychometric properties were inadequately described. This study aimed to develop and test an observational instrument to identify and examine the amount of time spent on nursing interventions in long-term institutional care using a standardized language., Methods: The Groningen Observational instrument for Long-Term Institutional Care (GO-LTIC) is based on the conceptual framework of the Nursing Interventions Classification. Developmental, validation, and reliability stages of the GO-LTIC included: 1) item generation to identify potential setting-specific interventions; 2) examining content validity with a Delphi panel resulting in relevant interventions by calculating the item content validity index; 3) testing feasibility with trained observers observing nursing assistants; and 4) calculating inter-rater reliability using (non) agreement and Cohen's kappa for the identification of interventions and an intraclass correlation coefficient for the amount of time spent on interventions. Bland-Altman plots were applied to visualize the agreement between observers. A one-sample student T-test verified if the difference between observers differed significantly from zero., Results: The final version of the GO-LTIC comprised 116 nursing interventions categorized into six domains. Substantial to almost perfect kappa's were found for interventions in the domains basic (0.67-0.92) and complex (0.70-0.94) physiological care. For the domains of behavioral, family, and health system interventions, the kappa's ranged from fair to almost perfect (0.30-1.00). Intraclass correlation coefficients for the amount of time spent on interventions ranged from fair to excellent for the physiological domains (0.48-0.99) and poor to excellent for the other domains (0.00-1.00). Bland Altman plots indicated that the clinical magnitude of differences in minutes was small. No statistical significant differences between observers (p > 0.05) were found., Conclusions: The GO-LTIC shows good content validity and acceptable inter-rater reliability to examine the amount of time spent on nursing interventions by nursing staff. This may provide managers with valuable information to make decisions about resource allocation, task allocation of nursing staff, and the examination of the costs of nursing services.

Purpose: The aim of this study was to determine how the use of diagnostic resources influences nurses' communication during admission interviews., Methods: A randomized controlled trial was performed. Actors simulated patients based on case studies. We analyzed transcriptions of 60 interviews and video recordings using the Roter Method of Interaction Process Analysis., Findings: Nurses mainly asked closed-ended questions. The use of knowledge sources, such as forms in the PES format or an assessment format, affected communication significantly in several aspects., Conclusion: Prestructured forms may promote comprehensive interviews, but nurses need to be aware that using certain kinds of diagnostic resources may hinder them from asking open-ended questions., Practice Implications: Nurses need to increase their use of open-ended questions., (© 2013, The Authors. International Journal of Nursing Knowledge © 2013, NANDA International.)

The purpose of this study was to determine how knowledge sources, ready knowledge, and disposition toward critical thinking and reasoning skills influence the accuracy of student nurses' diagnoses. A randomized controlled trial was conducted to determine the influence of knowledge sources. We used the following questionnaires: (a) knowledge inventory, (b) California Critical Thinking Disposition Inventory, and (c) Health Science Reasoning Test (HSRT). The use of knowledge sources had very little influence on the accuracy of nursing diagnoses. Accuracy was significantly related to the analysis domain of the HSRT. Students were unable to operationalize knowledge sources to derive accurate diagnoses and did not effectively use reasoning skills., (Copyright 2010 Elsevier Inc. All rights reserved.)

Objectives: To develop, validate and test the reliability of a measurement instrument that measures the extent to which records describe essential aspects of nursing care such as the admission report, nursing diagnoses, interventions, and progress and outcome evaluations., Method: A measurement instrument was developed based on the Cat-ch-Ing instrument and the Scale for Degrees of Accuracy in Nursing Diagnoses. A record screening was conducted in 7 hospitals in the Netherlands. Content validity was tested by using two Delphi panels. Each of the 250 records was assessed by two reviewers independently. The reliability of the instrument was tested by calculating Cohen's weighted Kappa inter-rater reliability coefficient of 250 records and 12 reviewers. Internal consistency was calculated by using Cronbach's alpha., Results: The new measurement instrument, named D-Catch, consists of six items. Quantity and quality variables were used to judge the accuracy of the nursing documentation. Internal consistency: Cronbach's Alpha 0.722. The inter-rater reliability coefficients were between 0.397-1.000., Conclusions and Implications: The D-Catch instrument was estimated to be a valid and reliable measurement instrument for nursing records in hospitals in the Netherlands. An adverse effect on the inter-rater reliability may have been that, specifically in long stay situations, documentation forms with diagnoses, interventions and outcomes were often unstructured and found to be repetitious.

As research continues to highlight the risks involved in handling antineoplastic drugs, the health services are giving increased attention to safety measures. In order to establish what protective measures nursing staff employ and what they know about antineoplastic drugs, a survey was carried out in The Netherlands. The questions were based on the self-study modules by Dunne and the (American) Oncology Nursing Society. A total of 1,373 questionnaires were distributed in 10 hospitals. Of these, 824 were returned, which represents a response rate of 60%. Over two-thirds (68%) of the nursing staff reported that they were involved, on a daily or weekly basis, in caring for patients being treated with antineoplastic drugs. In the view of 94% of the nurses, protective measures are effective. While administering antineoplastic drugs, 91% of the respondents said that they wore gloves, 21% said that they wore a gown, 18% wore a mask, and 3% used goggles. While handling excreta, fewer nurses applied safety measures. Thirty-nine percent of the respondents knew that latex gloves offer a greater degree of protection than PVC gloves. It appeared that there was not one Dutch hospital whose guidelines for the safe handling of antineoplastic material were completely up-to-date and that nurses do not always follow the guidelines established.