Current Issue : April - June Volume : 2015 Issue Number : 2 Articles : 7 Articles
Background: Quality in nursing documentation facilitates continuity of care and patient safety. Lack of\ncommunication between healthcare providers is associated with errors and adverse events. Shortcomings are\nidentified in nursing documentation in several clinical specialties, but very little is known about the quality of how\nnurses document in the field of psychiatry. Therefore, the aim of this study was to assess the quality of the written\nnursing documentation in a psychiatric hospital.\nMethod: A cross-sectional, retrospective patient record review was conducted using the N-Catch audit instrument.\nIn 2011 the nursing documentation from 21 persons admitted to a psychiatric department from September to\nDecember 2010 was assessed. The N-Catch instrument was used to audit the record structure, admission notes,\nnursing care plans, progress and outcome reports, discharge notes and information about the patientsââ?¬â?¢ personal\ndetails. The items of N-Catch were scored for quantity and/or quality (0ââ?¬â??3 points).\nResults: The item ââ?¬Ë?quantity of progress and evaluation notesââ?¬â?¢ had the lowest score: in 86% of the records progress\nand outcome were evaluated only sporadically. The items ââ?¬Ë?the patientsââ?¬â?¢ personal detailsââ?¬â?¢ and ââ?¬Ë?quantity of record\nstructureââ?¬â?¢ had the highest scores: respectively 100% and 71% of the records achieved the highest score of these\nitems.\nConclusions: Deficiencies in nursing documentation identified in other clinical specialties also apply to the clinical\nfield of psychiatry. The quality of electronic written nursing documentation in psychiatric nursing needs\nimprovements to ensure continuity and patient safety. This study shows the importance of the existence of a\nvalidated tool, readily available to assess local levels of nursing documentation quality...
Background: Canadian Community health nurses (CHNs) work in diverse urban, rural, and remote settings such as:\npublic health units/departments, home health, community health facilities, family practices, and other community-based\nsettings. Research into specific learning needs of practicing CHNs is sparsely reported. This paper examines\nCanadian CHNs learning needs in relation to the 2008 Canadian Community Health Nursing Standards of Practice\n(CCHN Standards). It answers: What are the learning needs of CHNs in Canada in relation to the CCHN Standards?\nWhat are differences in CHNsââ?¬â?¢ learning needs by: province and territory in Canada, work setting (home health,\npublic health and other community health settings) and years of nursing practice?\nMethods: Between late 2008 and early 2009 a national survey was conducted to identify learning needs of CHNs\nbased on the CCHN Standards using a validated tool.\nResults: Results indicated that CHNs had learning needs on 25 of 88 items (28.4%), suggesting CHNs have confidence in\nmost CCHN Standards. Three items had the highest learning needs with mean scores > 0.60: two related to\nepidemiology (means 0.62 and 0.75); and one to informatics (application of information and communication technology)\n(mean = 0.73). Public health nurses had a greater need to know about ââ?¬Å?ââ?¬Â¦evaluating population health promotion\nprograms systematicallyââ?¬Â compared to home health nurses (mean 0.66 vs. 0.39, p <0.010). Nurses with under two years\nexperience had a greater need to learn ââ?¬Å?ââ?¬Â¦ advocating for healthy public policyââ?¬Â¦Ã¢â?¬Â than their more experienced peers\n(p = 0.0029). Also, NPs had a greater need to learn about ââ?¬Å?ââ?¬Â¦using community development principles when engaging\nthe individual/community in a consultative processââ?¬Â compared to RNs (p = 0.05). Many nurses were unsure if they\napplied foundational theoretical frameworks (i.e., the Ottawa Charter of Health Promotion, the Jakarta Declaration, and\nthe Population Health Promotion Model) in practice.\nConclusions: CHN educators and practice leaders need to consider these results in determining where to strengthen\ncontent in graduate and undergraduate nursing programs, as well as professional development programs. For practicing\nCHNs educational content should be tailored based on learnerââ?¬â?¢s years of experience in the community and their\nemployment sector....
Background: Patient care models have been implemented and documented worldwide. Many studies have\nfocused on features that hinder and facilitate the shift to such models, including the implementation process, staff\ninvolvement, resistance to new models and cultural dimensions. However, few studies have identified the potential\neffects of such new care models from a patient perspective. The aim of the present study was to investigate\nwhether patients did in fact perceive the intentions of partnership in the new care model 1 year after its\nimplementation.\nMethods: Sixteen participants were interviewed, selected from two wards in a medical department where a new\ncare model had been implemented 1 year earlier. A directed deductive content analysis was selected. The aim of\nthe directed approach to content analysis was to investigate to what extent the new care model had been\nimplemented, using patients� perspectives to describe the level of implementation. A coding framework was\ndeveloped based on a theoretical paper that described the key features of the new care model.\nResults: The implementation of person-centred care had clearly occurred to a large degree, even if some patients\nappeared not to have been exposed to the model at all. Aspects of the newly implemented care model were\nobvious; however, it was also clear that implementation was not complete. The analysis showed that patients felt\nlistened to and that their own perception of the situation had been noted. Patients spontaneously expressed that\nthey felt that the staff saw them as persons and did not solely focus on their disease. It was also stated that not\nevery ailment or aspect of a patient�s illness needed to be addressed or resolved for open listening to be perceived\nas a positive experience.\nConclusions: The findings indicate that even though some patients were not interested in participating and\nplaying an active role in their own care, this might relate to a lack of understanding on how to invite them to do\nso and to increase their confidence. To change healthcare from a paternalistic system to care where patients are\nseen as partners may require pedagogical skills....
Background: Implicit rationing of nursing care is the withholding of or failure to carry out all necessary nursing\nmeasures due to lack of resources. There is evidence supporting a link between rationing of nursing care, nursesââ?¬â?¢\nperceptions of their professional environment, negative patient outcomes, and placing patient safety at risk.\nThe aims of the study were:\na) To explore whether patient satisfaction is linked to nurse-reported rationing of nursing care and to nursesââ?¬â?¢\nperceptions of their practice environment while adjusting for patient and nurse characteristics.\nb) To identify the threshold score of rationing by comparing the level of patient satisfaction factors across\nrationing levels.\nMethods: A descriptive, correlational design was employed. Participants in this study included 352 patients and\n318 nurses from ten medical and surgical units of five general hospitals. Three measurement instruments were\nused: the BERNCA scale for rationing of care, the RPPE scale to explore nursesââ?¬â?¢ perceptions of their work\nenvironment and the Patient Satisfaction scale to assess the level of patient satisfaction with nursing care. The\nstatistical analysis included the use of Kendallââ?¬â?¢s correlation coefficient to explore a possible relationship between\nthe variables and multiple regression analysis to assess the effects of implicit rationing of nursing care together\nwith organizational characteristics on patient satisfaction.\nResults: The mean score of implicit rationing of nursing care was 0.83 (SD = 0.52, range = 0ââ?¬â??3), the overall mean\nof RPPE was 2.76 (SD = 0.32, range = 1.28 ââ?¬â?? 3.69) and the two scales were significantly correlated (? = ?0.234, p < 0.001).\nThe regression analysis showed that care rationing and work environment were related to patient satisfaction, even\nafter controlling for nurse and patient characteristics. The results from the adjusted regression models showed that\neven at the lowest level of rationing (i.e. 0.5) patients indicated low satisfaction.\nConclusions: The results support the relationships between organizational and environmental variables, care rationing\nand patient satisfaction. The identification of thresholds at which rationing starts to influence patient outcomes in a\nnegative way may allow nurse managers to introduce interventions so as to keep rationing at a level at which patient\nsafety is not jeopardized....
Background: Although the occurrence of malnutrition in hospitals is a growing concern, little is known about how\nhospital staff understand the care that nurses provide to patients with malnutrition. The purpose of this study was\nto explore nursesââ?¬â?¢ views and experiences of caring for malnourished patients in Saudi Arabia (KSA).\nMethods: Using a qualitative explorative design, fifteen nurses were interviewed as part of a purposive sample\nhospital staff. The transcripts were analyzed using latent content analysis.\nResults: The nurses spontaneously and consistently linked malnutrition with physical inactivity. The two main\ncategories, which emerged, were: ââ?¬Ë?Potentials for nurses to provide good nutrition and physical activityââ?¬â?¢, and ââ?¬Ë?Having\nthe ability but not the power to promote proper nutrition and physical activityââ?¬â?¢. These arose from the\nsubcategories: Good nursing implies providing appropriate health education; Acknowledging the Mourafiq (sitter) as\na potential resource for the nursing, but also as a burden; Inadequate control and lack of influence; Cultural\ndiversity and lack of dialog; and Views of womenââ?¬â?¢s weight gain in KSA society.\nConclusions: The nurses felt they have the capacity and passion to further improve the nutrition and activity of\ntheir patients, but obstacles in the health care system are impeding these ambitions. The implications for nursing\npractice could be acknowledgement of the nursesââ?¬â?¢ views in the clinical practice; culturally adjusted care, improved\ncommunication and enhanced language skills....
Background: Health care systems in Finland, Norway and Sweden share many similarities, e.g. full-coverage and\ntax-financed, with predominately public sector hospitals. Despite similarities, there are differences in the working\nsituations for RNs within these Nordic countries. The aim of this study was to analyze associations between RNs�\npatient workload and level of involvement in direct patient care, their job satisfaction and intention to leave in\nthese countries.\nMethods: A workforce survey was conducted through RN4CAST, an EU 7th framework project. The survey included\n118 items derived from validated instruments or tested in prior research. Responses from 1133 RNs at 32 Finnish\nhospitals, 3752 RNs at 35 Norwegian hospitals, and 11 015 RNs at 71 Swedish hospitals comprise the database,\nwhich was analyzed using logistic and odds ratio regressions analyses.\nResults: We found statistically significant differences in RNs� level of involvement in direct patient care (p < 0.001,\nSweden compared to Norway and Finland), in patient workload and in number of patients needing ADL assistance\nand surveillance. A U-formed relationship was found between level of involvement in direct patient care and\nintention to leave in Sweden, and more satisfaction among RNs in roles with more direct patient care (OR = 1.16,\n1.02 ? CI95% ? 1.32). Nearly half the Finnish sample report intention to leave, with significantly lower levels in Norway\nand Sweden (p < 0.001). Patient workload is associated with job satisfaction and intention to leave to some degree\nin all countries, i.e. greater patient workload, less job satisfaction and greater intention to leave.\nConclusions: This study suggests that more attention paid to patient mix, workload and role of RNs in patient care\nmight potentially diminish intention to leave and increase job satisfaction in these Nordic countries...
Background: The advanced practice role of the Nurse Consultant is unique in its capacity to provide clinical\nleadership across a range of contexts. However, the Nurse Consultant role has been plagued with confusion due to\nlack of clarity over function and appropriateness for purpose within health organisations across contexts. Changing\nhealth service delivery models are driving the emergence of new nursing roles, further clouding the waters related\nto role positioning and purpose. There is an urgent need for evidence of impact and demonstration of how Nurse\nConsultants contribute to health care outcomes. This study aims to gain a clearer understanding of the Nurse\nConsultant role and its impact in metropolitan and rural New South Wales (NSW) Australia.\nDesign: The proposed study employs a sequential mixed method design, underpinned by Realistic Evaluation, to\nexplore how Nurse Consultants contribute to organisational outcomes. The ââ?¬Ë?context ââ?¬â?? mechanism ââ?¬â?? outcomeââ?¬â?¢\napproach of realistic evaluation provides a sound framework to examine the complex, diverse and multifaceted\nnature of the Nurse Consultantââ?¬â?¢s role.\nMethod: Participants will be stakeholders, recruited across a large Local Health District in NSW, comprising rural\nand metropolitan services. A modified and previously validated survey will be used providing information related to\nrole characteristics, patterns and differences across health context. Focus groups with Nurse Consultantââ?¬â?¢s explore\nissues highlighted in the survey data. Focus groups with other clinicians, policy makers and managers will help to\nachieve understanding of how the role is viewed and enacted across a range of groups and contexts.\nDiscussion: Lack of role clarity is highlighted extensively in international and Australian studies examining the role\nof the Nurse Consultant. Previous studies failed to adequately examine the role in the context of integrated and\ncomplex health services or to examine the role in detail. Such examination is critical in order to understand the\nsignificance of the role and to ascertain how Nurse Consultants can be most effective as members of the health\ncare team. This is the first Australian study to include extensive stakeholder perspectives in order to understand the\nrelational and integrated nature and impact of the role across metropolitan and rural context....
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