Current Issue : July - September Volume : 2015 Issue Number : 3 Articles : 7 Articles
The role of the Australian Nurse Practitioner (NP) is in its infancy and at a crossroads where extensive research demonstrates\neffective quality care and yet the role remains underrecognised and underutilised.The translation of practice into ââ?¬Å?valueââ?¬Â is critical\nfor the sustainability of NP roles and requires the practitioner to adopt a systematic method of inquiry. Kimââ?¬â?¢s (1999) ââ?¬Å?Critical\nReflective Inquiryââ?¬Â (CRI) method was adapted by two Australian NPs who specialise in diabetes and chronic disease management.\nKim highlights the intent of CRI as understanding the meaning of practice, delivering improvements to practice through selfreflection,\nand the critique of practice that can lead to practice changes and development of new models of care translated to\nââ?¬Å?productsââ?¬Â of value. Based on the thematically analysis of 3 years of CRI application, the authors formed 5 headings that represented\nthe NPââ?¬â?¢s practice as Specialised Care Access, Complications and Diagnostics Interventions, Pharmaceutical Treatment, Vulnerable\nPopulations, and Leadership. The utility of CRI demonstrates how NP practice is integral to a continuous cycle of addressing health\ncare services gaps, and the conversion of ââ?¬Å?productsââ?¬Â into ââ?¬Å?valueââ?¬Â and positions the NP to assimilate the role of the practitionerresearcher....
This paper describes the changes in transformational leadership and quality outcomes that occurred between 2008 and 2011 in\na Finnish university hospital that is aiming to meet the Magnet standards. Measurements were conducted in 2008-2009 and\nsubsequently in 2010-2011 by surveying nursing staff and patients. Nursing staff were surveyed using web-based surveys to collect\ndata on transformational leadership (n1= 499, n2= 498) and patient safety culture (n1= 234, n2= 512) and using both postal and web-based surveys to gather information on job satisfaction (n1= 1176, n2= 779). Questionnaires were used to collect dataon care satisfaction from patients (n1= 678, n\n2= 867). Transformational leadership was measured using the 54-item TLS, job satisfaction with the 37-item KUHJSS, patient safety culture with the 42-item HSPSC, and patient satisfaction using the 42-item RHCS questionnaire. Transformational leadership, which was the weakest area, was at the same level between the two measurement occasions. Job satisfaction scores increased between 2008 and 2010, although they were generally excellent in 2008. The scores for nonpunitive responses to errors and events reported were also higher in the 2010-2011 surveys. The highest empirical outcome scores related to patient satisfaction. The project and the development initiatives undertaken since 2008 seem to have had positive effects on empirical quality outcomes....
Background. A 2010 evaluation found generally poor outcomes among HIV patients on antiretroviral therapy in Nicaragua. We\nevaluated an intervention to improve HIV nursing services in hospital outpatient departments to improve patient treatment and\nretention in care. The intervention included improving patient tracking, extending clinic hours, caring for children of HIV+\nmothers, ensuring medication availability, promoting self-help groups and family involvement, and coordinatingmultidisciplinary\ncare. Methods. This pre/postintervention study examined opportunistic infections and clinical status of HIV patients before and\nafter implementation of changes to the system of nursing care. Hospital expenditure data were collected by auditors and hospital\nteams tracked intervention expenses. Decision tree analysis determined incremental cost-effectiveness from the implementersââ?¬â?¢\nperspective. Results.Opportunistic infections decreased by 24%(95%CI: 14%ââ?¬â??34%) and 11.3% of patients improved in CDC clinical\nstage. Average per-patient costs decreased by $133/patient/year (95% CI: $29ââ?¬â??$249). The intervention, compared to business-asusual\nstrategy, saved money while improving outcomes. Conclusions. Improved efficiency of services can allow more ART-eligible\npatients to receive therapy.We recommended the intervention be implemented in all HIV service facilities in Nicaragua....
Background: Educational advantages of simulation have been widely reported. Pre-briefing and debriefing support simulation\nmethods. However, few detailed accounts of how the learning activities surrounding simulation are implemented exist.\nObjectives: This case example provides a detailed description of learning activities surrounding a simulation experience with a\ndeteriorating cardiac patient. The educational sequence integrates Benner et al.ââ?¬â?¢s goals for transforming nursing education. The\nstudy objectives were to design and evaluate an educational sequence using narrative, games, and simulation to teach students\nhow to manage and anticipate the care of a deteriorating patient.\nDesign: A case example with descriptive quantitative and qualitative evaluation is presented. Setting: The study took place on\nmultiple days in a university simulation laboratory. Participants: All study participants (n = 43) were senior students enrolled in\na Bachelor of Science in Nursing program.\nMethods: Students experienced an educational sequence and then rated and ranked educational activities. Results are reported\nwith descriptive statistics. Students and faculty responded to the question, ââ?¬Å?What will you take from this experience?ââ?¬Â Their\nresponses were evaluated using constant comparison and expert review for themes.\nResults: Students identified ââ?¬Ë?knowing howââ?¬â?¢, ââ?¬Ë?increasing confidenceââ?¬â?¢ and ââ?¬Ë?understanding rolesââ?¬â?¢ as what they took from the\nexperience. Students ranked the simulation itself as the most helpful.\nConclusions: Incorporating Benner et al.ââ?¬â?¢s transformational educational goals informed the educational sequence and engaged\nstudents in the learning experience. This paper adds uniquely to the nursing literature by providing detailed accounts of the\nactivities surrounding simulation that support student learning in multiple domains....
Background. Organizing and performing patient transfers in the continuum of care is part of the work of nurses and other\nstaff of a multiprofessional healthcare team. An understanding of discharge practices is needed in order to ultimate patients�\ntransfers from high technological intensive care units (ICU) to general wards. Aim. To describe, as experienced by intensive\ncare and general ward staff, what strategies could be used when organizing patient�s care before, during, and after transfer from\nintensive care. Method. Interviews of 15 participants were conducted, audio-taped, transcribed verbatim, and analyzed using\nqualitative content analysis. Results. The results showed that the categories secure, encourage, and collaborate are strategies used\nin the three phases of the ICU transitional care process. The main category; a safe, interactive rehabilitation process, illustrated\nhow all strategies were characterized by an intention to create and maintain safety during the process. A three-way interaction\nwas described: between staff and patient/families, between team members and involved units, and between patient/family and\nenvironment.Discussion/Conclusions.The findings highlight that ICUtransitional care implies critical care rehabilitation. Discharge\nprocedures need to be safe and structured and involve collaboration, encouraging support, optimal timing, earlymobilization, and\na multidiscipline approach....
This paper discusses the challenges encountered by researchers while conducting a randomized controlled trial (RCT) testing\nthe efficacy of a healthy lifestyle educational and exercise intervention for people with serious mental illness. RCTs, even though\nconsidered the ââ?¬Å?gold standardââ?¬Â of research designs, are still prone to risks of potential bias and threats to their validity. Based on\nresearcher reflexivity, the combination of reflection and action, during the conduct of the study, this paper outlines a number of\nchallenges faced by the researchers. These included managing the need of participants to tell their story and be heard, reluctance of\nparticipants to remain in allocated groups, participant literacy, dual role of the nurse nurse-researcher, and reporting the benefits of\nnonstatistical results of a quantitative research project. Recommendations for conducting future behaviour intervention studies of\nthis type include the incorporation of a reflexive component for the nurse nurse-researcher, highlighting the importance of taking\na reflexive stance in both qualitative and quantitative research designs....
Older patients are vulnerable to adverse hospital events related to frailty. SPICES, a common screening protocol to identify risk\nfactors in older patients, alerts nurses to initiate care plans to reduce the probability of patient harm.However, there is little published\nvalidating the association between SPICES and measures of frailty and adverse outcomes. This paper used data from a prospective\ncohort study on frailty among 174 older adult inpatients to validate SPICES. Almost all patients met one ormore SPICES criteria.The\nsum of SPICES was significantly correlated with age and other well-validated assessments for vulnerability, comorbid conditions,\nand depression. Individuals meeting two or more SPICES criteria had a risk of adverse hospital events three times greater than\nindividuals with either no or one criterion. Results suggest that as a screening tool used within 24 hours of admission, SPICES is\nboth valid and predictive of adverse events....
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