Current Issue : July - September Volume : 2016 Issue Number : 3 Articles : 6 Articles
Malaysia is a heterogenous, multi-ethnic society with a population of 30 million, of which 74% reside\nin urban areas. Since gaining independence, the main priority of health policy makers is to\nprovide and enhance the delivery of health care for the disadvantaged communities, namely the\nrural populations: women, children and the disabled. The Ministry of Health is the main healthcare\nprovider in Malaysia. There has been much development in the healthcare system of Malaysia\nfrom the time of independence; starting from the development of the two-tier system and its subsequent\ntransformation to a three-tier system, as well as the extension of healthcare delivery into\nrural areas in Sabah and Sarawak through the implementation of mobile teams and the Flying\nDoctor Service (FDS). The improvement in health status of the general population, particularly in\nrural settings is remarkable and in line with the Tenth Malaysian Plan on the road to Vision 2020.\nHowever, the current shift in disease burden from communicable to chronic non-communicable\nconditions continues to undermine these efforts. As a result, deficiencies in healthcare delivery\nand the health status of populations still exist, albeit more rampant in rural populations. We propose\nthe implementation of Advanced Practice Nursing (APN) in the community as a solution to\nbridge gaps in health care provision in rural areas in line with Vision 2020. An advanced practice\nnurse is a specialty-specific registered nurse with an expert knowledge base and clinical competencies\nfor extended practice. Modelled on Australian and Norwegian systems, advanced practice\nnurses are recruited directly from rural communities, with a better understanding of the population,\nand access to the local cultural norms, such as traditional healers. APN training is still in its\ninfancy in many developing countries. Evidence from other similar models has proven that the\ncare provided by specialised nurses results in higher patient satisfaction, greater access to health\ncare, improved outcomes and cost effectiveness. APN compliment the care provided by physicians;\nreducing doctors� workload, patient waiting times and providing care in the convenience of the\npatients� homes. To succeed in improving health care outcomes by APN, the utilisation of evidence\nbased practice, audits, guidelines, and escalation of specialist care at hospitals and continuous\nmedical education are essential....
Background: While the relationship between nursesââ?¬â?¢ job satisfaction and their work in hospital environments is\nwell known, it remains unclear, which factors are most influential in the nursing home setting. The purpose of this\nstudy was to describe job satisfaction among care workers in Swiss nursing homes and to examine its associations\nwith work environment factors, work stressors, and health issues.\nMethods: This cross-sectional study used data from a representative national sample of 162 Swiss nursing homes\nincluding 4,145 care workers from all educational levels (registered nurses, licensed practical nurses, nursing\nassistants and aides). Care worker-reported job satisfaction was measured with a single item. Explanatory variables\nwere assessed with established scales, as e.g. the Practice Environment Scale ââ?¬â?? Nursing Work Index. Generalized\nEstimating Equation (GEE) models were used to examine factors related to job satisfaction.\nResults: Overall, 36.2 % of respondents reported high satisfaction with their workplace, while another 50.4 %\nwere rather satisfied. Factors significantly associated with high job satisfaction were supportive leadership (OR = 3.\n76), better teamwork and resident safety climate (OR = 2.60), a resonant nursing home administrator (OR = 2.30),\nadequate staffing resources (OR = 1.40), fewer workplace conflicts (OR = .61), less sense of depletion after work\n(OR = .88), and fewer physical health problems (OR = .91).\nConclusions: The quality of nursing home leadershipââ?¬â??at both the unit supervisor and the executive administrator\nlevelââ?¬â??was strongly associated with care workersââ?¬â?¢ job satisfaction. Therefore, recruitment strategies addressing\nspecific profiles for nursing home leaders are needed, followed by ongoing leadership training. Future studies\nshould examine the effects of interventions designed to improve nursing home leadership and work\nenvironments on outcomes both for care staff and for residents....
Background: Individualized care is a cornerstone of patient-centered nursing care. To foster individualized care,\ninfluencing factors should be known. The aim of this study was to identify the individual and organizational factors\ninfluencing hospitalized patients� perception of individualized care.\nMethods: A cross-sectional study was conducted of 606 patients from 20 wards from five hospitals across\nGermany. Individualized care and potential influencing factors were assessed via structured questionnaires. To\nidentify influencing factors, we applied a hierarchical linear model with two levels.\nResults: Self-rated health, length of ward stay, educational level and shared decision-making process about nursing\ncare were perceived to influence individualized care. A higher rating of health and longer ward stay correlated with\nimproved perceptions of individualized nursing care. In addition, an educational level of nine or fewer years and a\nperceived shared decision-making process about nursing care positively influenced the perception of nursing care\nas being tailored to individual needs.\nConclusions: Several factors influence patients� perception of individualized care. However, only the decision-making\nprocess can be actively influenced by nurses. Therefore, nurses should be encouraged to promote shared\ndecision-making regarding patients� nursing care....
Objective: The objective is to correlate the nursing diagnoses of the domain Safety/Protection of\nNANDA-I in critically ill patients with sociodemographic and clinical data. Method: A cross-sectional\nstudy with 86 individuals was conducted, from October 2013 to May 2014 in the Intensive Care Unit\nof a university hospital in northeastern Brazil, through a formal interview and physical examination.\nResults: It was possible to identify a total of 20 significant statistical associations, and 15 were clinically\njustified by the literature, namely: risk for aspiration and reason for admission; impaired dentition\nand age; risk for peripheral neurovascular dysfunction and sex and comorbidity; skin integrity\nand comorbidity; risk for impaired skin integrity and gender and reason for admission; impaired\ntissue integrity and gender and reason for admission; risk for perioperative positioning injury and\nreason for admission; risk for thermal injury and age and comorbidity; delayed surgical recovery\nand reason for admission; risk for poisoning and years of schooling; and risk for imbalanced body\ntemperature and age. Conclusions: By understanding the relationship between customers� answers\nand the sociodemographic and clinical profile, positive health outcomes can be achieved in particular\nin the prevention of risks facing vulnerability characteristics, providing greater safety and protection\nfor the critical customer....
Background: Delirium is an acute cognitive impairment among older hospitalized patients. It can persist until\ndischarge and for months after that. Despite proof that evidence-based nursing interventions are effective in\npreventing delirium in acute hospitals, interventions among home-dwelling older patients is lacking. The aim\nwas to assess feasibility and acceptability of a nursing intervention designed to detect and reduce delirium in\nolder adults after discharge from hospital.\nMethods: Randomized clinical pilot trial with a before/after design was used. One hundred and three older\nadults were recruited in a home healthcare service in French-speaking Switzerland and randomized into an\nexperimental group (EG, n = 51) and a control group (CG, n = 52). The CG received usual homecare. The EG\nreceived usual homecare plus five additional nursing interventions at 48 and 72 h and at 7, 14 and 21 days\nafter discharge. These interventions were tailored for detecting and reducing delirium and were conducted by\na geriatric clinical nurse (GCN). All patients were monitored at the start of the study (M1) and throughout the\nmonth for symptoms of delirium (M2). This was documented in patients� records after usual homecare using\nthe Confusion Assessment Method (CAM). At one month (M2), symptoms of delirium were measured using\nthe CAM, cognitive status was measured using the Mini-Mental State Examination (MMSE), and functional\nstatus was measured using Katz and Lawton Index of activities of daily living (ADL/IADL). At the end of the\nstudy, participants in the EG and homecare nurses were interviewed about the acceptability of the nursing\ninterventions and the study itself.\nResults: Feasibility and acceptability indicators reported excellent results. Recruitment, retention, randomization, and\nother procedures were efficient, although some potentially issues were identified. Participants and nurses considered\norganizational procedures, data collection, intervention content, the dose-effect of the interventions, and methodology\nall to be feasible. Duration, patient adherence and fidelity were judged acceptable. Nurses, participants and informal\ncaregivers were satisfied with the relevance and safety of the interventions.\nConclusions: Nursing interventions to detect/improve delirium at home are feasible and acceptable. These results\nconfirm that developing a large-scale randomized controlled trial would be appropriate....
Background: Earlier studies in developed and a few developing countries have documented experiences of family\nmembers with critically-ill patients. However, in Tanzania no documented studies could be found in this study area.\nThe aim of this study was therefore to explore the Tanzanian family members� perceived needs and level of\nsatisfaction with care of their critically-ill patients, in the intensive care units in the Muhimbili National Hospital.\nMethods: A descriptive cross-sectional study was undertaken, using a quantitative approach. A semi-structured\nquestionnaire was used to collect data. The sample size was 110 respondents, comprised of individuals who visited\ncritically-ill patients in the intensive care unit. Data were analyzed using SPSS Version 14.\nResults: The study revealed that 72 % of the family members perceived having a specific person to call at the\nhospital when a related family member was not available at the hospital as a very important need. Only 23 % of\nthe respondents perceived the need of talking about the possibility of their patients� death as very important. The\nnurses� provision of care to the patients of the family members was found to be satisfactory.\nConclusion: The perceived needs and level of satisfaction of family members of critically-ill patients calls for nurses\nto improve the quality of care to patients� family members, which in return will enhance the patient�s recovery....
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