Acute Healthcare Settings Research Articles

P4.13 A Comprehensive Approach in Controlling MRSA in an Acute Health Care Setting

P4.13 A Comprehensive Approach in Controlling MRSA in an Acute Health Care Setting

Mapping nursing activity in acute inpatient mental healthcare settings

Background: The quality of care on acute inpatient mental health units is a matter of national and international concern. A major determinant of the quality of care experienced by service users is the use of nursing time.Aims: To map, classify and compare the patterns of activities for qualified and unqualified nursing staff in three acute inpatient mental health wards in three UK NHS-provider organizations, and to compare the proportions of time dedicated to user-centred and non user-centred activities.Method: Open interviews with staff undertaken hourly during five, three-day data collection periods per ward.Results: A total of 505 hours of nursing activity were assessed. Half of all activity reported was staff-user contact, however, the majority was during containment activities. Qualified staff were responsible for ward administration, unqualified staff for the majority of staff-user interaction. Unqualified staff reported higher satisfaction with their work, positively correlated with patient contact time.Conclusions: Working practices built on highly prescriptive nursing routines need to be reconfigured in order to allow qualified staff more time to engage with patients and unqualified staff to use their time with service users more constructively.Declaration of interest: This study was funded by three mental health trusts in the North West United Kingdom. We know of no financial relationship that may pose a conflict of interest.

Researchers’ experience of co‐operative inquiry in acute mental health care

The aim of this article is to reflect upon our experiences of using co-operative inquiry in an acute mental health care setting, with a focus on the methodology used in a 4-year intervention programme developed in Norway between 1999 and 2003. Action research plays a crucial role in assisting nurses to integrate theory and research with nursing practice. The central characteristic of this approach is the grounding of research in practice in collaboration with clinical practitioners. The research was a co-operative inquiry based on a hermeneutic-phenomenological approach. The research methods used were ethnographic, including participant observation and face-to-face interviews, questionnaires, focus group interviews, and our process notes. The different methods used in the co-operative inquiry design of the Project Teaching Ward (PTW) had both benefits and drawbacks. In particular, the focus group method proved useful due to its ability to stimulate participants' research interest, and thus motivating them to be actively involved in the development of knowledge. The particular knowledge development process used has been described as a local knowledge dialogue. This dialogue must incorporate critical subjectivity on the part of participants in order to ensure that the research has a reflective resistance, which is decisive for its validity and quality. The findings also highlight the importance of the different roles of project leader in lengthy action research collaboration. The PTW has illustrated that co-operative inquiry was well suited for developing knowledge relevant to practice, thus contributing to bridging the gap between practice and theory. In order for this to happen, the research collaboration should be characterized by patience, realism and engagement.

Cognitive behaviour therapy within acute mental health care: A critical appraisal

This paper examines the evidence for the use of cognitive behavioural therapy (CBT) within acute mental health-care settings. Through the provision of a literature review the authors critique the research into the effectiveness of CBT when delivered within acute mental health-care settings, to clients who are acutely psychotic. The review concludes with recommendations for future research to expand the current evidence base.

Oximetría de pulso en la asistencia neonatal en 2005. Revisión de los conocimientos actuales

INTRODUCTION Oxygen saturation monitors or pulse oximeters (SpO2) were entered into practice in the 1980s not only without randomized trials but also, and probably more importantly, without education of neonatal bedside care providers around the world (i. e.: nursing staff, respiratory therapists and also physicians). Education about some known physiological principles, such as the changing relation between O2 and hemoglobin, PaO2 and O2 saturation (O2Sat), did not accompany the routine implementation of SpO2 monitors. Preterm infants of all gestational ages and postnatal ages receiving supplemental oxygen have been treated in many places using targets of O2Sat seen in normal healthy infants breathing room air (i. e.: “physiological” or “normal” values). This was accepted and entered into practice in many cases without full understanding of the meaning of what O2Sat really is and without considering the changing relationship between PaO2 and O2Sat and the differences in SpO2 monitors used. In the past few years, the findings in a number of studies have shown that the long-accepted “physiological” targets of O2Sat by many may in fact be too high. However a “comfort zone” exists in routine clinical practice and it is assumed that if the O2Sat is “high” and the baby appears pink, the preterm baby is “doing well”. On the other hand, in many units, based on understanding of known and proven concepts, the targets of O2Sat were never 97-100 % for preterm infants receiving supplemental oxygen early in life. Oximetry monitors have become commonplace in acute healthcare setting over the last 10-12 years. It has been said blood oxygen can now be considered a “fifth vital sign”. By 1989 there were 29 manufacturers producing 45 different models of oximeters1. There are currently less manufacturers producing over 20 different models and recent technological advances have changed some important aspects of SpO2 performance. All SpO2 monitors have some variability between the measurements with the actual arterial O2Sat value measured by a cooximeter, but true new generation SpO2 monitors are much better than all others. As importantly, monitors are affected by noise, but the different SpO2 monitors handle noise in different ways, leading to differences in real measurements, speed in which a problem is detected, alarms and false alarms, and the presence or not of “holding periods”. In addition, newer technology offers measurements of perfusion index. It is our objective to describe all these factors and others in relation to SpO2 monitoring for neonates. The reliability, accuracy and therefore clinical utility of pulse oximetry remain problematic in some types of infants under certain conditions. As it will be described in this manuscript, improved signal processing technology has substantially improved the ability of some oximeters to work reliably under conditions of poor perfusion, motion artifact and noise from other sources such as bilirubin lights. Historically it was common teaching that if clinicians or bedside care providers were confronted with questionable oxygen saturation values, they should estimate the reliability of the monitor by correlating the pulse rate measured by the oximeter with the heart rate obtained by an electrocardiogram (ECG) monitor used simultaneously. As it will be shown later, accuracy in the recording of pulse rates is also a problem of many monitors.

Nursing attitudes towards acute mental health care: development of a measurement tool

This paper reports the development, piloting and validation of a tool to measure attitudes for use with nursing staff working in acute mental health care units. The quality of care provided for service users in acute mental health care has come under both scrutiny and severe criticism. The attitudes of staff working in these environments have been cited as a contributory factor in poor care. No measure of attitudes specific to acute mental health has been reported. A 64-question measure was constructed and distributed to a sample of qualified and unqualified nurses drawn from seven mental health care units in the North of England. Exploratory factor analysis and a number of other statistical tests were performed to validate the questionnaire. Preliminary analysis reduced the original 64 questions to 37. Five components were retained, accounting for 42% of the variance, and the five rotated factors were identified. The resultant 'Attitudes Towards Acute Mental Health Scale' (ATAMHS) achieved good internal reliability, with a Cronbach's alpha of 0.72. The construction and validation of the ATAMHS measure will enable improved understanding of the attitudes of nursing staff working in acute mental health care settings to occur. This measure is available for use in a clinical area of nursing in which attitude change is of fundamental importance for future development of care.

Ideal nurses: the social construction of emotional labour

This paper summarizes briefly the findings of my doctoral research study, which identified a range of types of emotional labour as a social construction of caring (Mazhindu 2002). Emotional labour as critique illuminates problems and issues surrounding the predominant educational paradigm of reflection on practice for health care professionals in higher education institutions (HEIs). Reflection on practice was used as a key to unlock the doors of professional practice in order to examine the working worlds of professional nursing. Emotional labour was identified as a social construction of caring inductively using grounded theory (Glaser 1992) from the perspective of trained nurses, who had been practising for a long time, in both acute and community health care settings. Feeling the emotional cost of being unable to act out the social construction of ‘ideal nurse’ was explored. In terms of emotional labour as critique, the implications for research into reflective learning in the context of professional practice and professional learning are discussed. The paper also explores the concepts of professional knowledge, professional competence and professional practice as perceived by practitioners. It also considers some of the limitations of the research and the implications of the social construction of emotional labour and ideal nurse, as perceived by practitioners, for future education, practice and research into emotional labour in health care.

A World Apart: How Occupational Therapists, Nurses and Care Managers Perceive Each other in Acute Health Care

Multidisciplinary teamwork is one of the key processes through which care is managed in the British National Health Service. Working in a multidisciplinary team requires many skills, which include understanding not only one's own role but also that of other professionals. The aim of this paper is to provide an understanding of occupational therapists', nurses' and care managers' perceptions of each other and how these influence interprofessional relationships. In total, nine occupational therapists, nine care managers and 19 nurses within an acute physical health care setting were interviewed using the critical incident approach. The findings revealed that the interprofessional relationships between nurses, care managers and occupational therapists were often problematic owing to role confusion and competing priorities, which influenced communication. To prevent role ambiguity, occupational therapists must define their role clearly. It is suggested that multidisciplinary team members need continuing interprofessional education in order to understand the changing roles in the National Health Service.

Nurses' perceptions of discharge planning in acute health care: a case study in one British teaching hospital.

To provide an in-depth understanding of nurses' perceptions of the hospital discharge process in a London teaching hospital. Discharging patients from hospital is a key component of the nurse's role in acute health care settings. It is remarkable that despite government legislation and research, which stretches back over 20 years in both Europe and North America, discharge planning remains problematic. Furthermore, it is an activity that requires collaboration between health and social care agencies. In the United Kingdom there is a new emphasis and incentive on managing acute hospital beds, which in turn results in shorter stays in hospital. In London, discharge planners face additional problems because of social, economic and environmental factors. Using a case study design, 19 nurses were interviewed using the critical incident approach to obtain their perceptions of the discharge process. Direct observation was conducted to record interactions between nurses and health care professionals in multidisciplinary teams. In total 14 meetings were attended in elder care and orthopaedics and 7 in acute medicine. Aspects of the discharge process were often ignored or neglected and assessments were rarely co-ordinated. The nursing ward handover was regarded as a process that hindered communication. Lack of time was reported to be the biggest barrier that affected interprofessional working and hence the co-ordination of assessments. The findings have important implications for nurses, managers and educational establishments. It is essential that social and medical diagnoses run parallel and that accurate information is collated and communicated within the multidisciplinary team. Further research into the impact of time pressures on communication, interprofessional working and the discharge process is needed.

OPINIONS OF HEALTHCARE PROFESSIONALS REGARDING THE MATERNITY EXPERIENCES OF INDIGENOUS WOMEN IN AN ACUTE CARE SETTING

ABSTRACT: This is the report of stage three of a three stage project. The aims of the overall project were to seek advice from expert Indigenous women on how to gather information from birthing Indigenous women while in hospital. Information was gathered from Indigenous women who gave birth in hospital or were admitted after the birth of their baby. The opinions of healthcare professionals on the care of these women were investigated. This paper describes the opinions and concerns of healthcare professionals regarding identified cultural, social and economical issues for Indigenous women at a large acute care hospital in the Northern Territory, Australia. The opinions of healthcare professionals are vital if the needs and concerns of Indigenous women are to be considered within the hospital setting.Stages one and two of this project have been presented previously. Stage three, reported here, describes a survey of 18 non‐Indigenous and one Indigenous healthcare professionals regarding their opinions of the maternity experiences of Indigenous women admitted to an acute care setting. The consultative process for designing the questionnaire and reflections on issues raised by Indigenous women during their interviews in the previous two stages is presented. The methodology of the survey, demographics and perceptions of healthcare professionals who participated in the project are examined and the similarities and differences between the issues raised by the healthcare professionals and the Indigenous women in stage two of the project are discussed. Suggestions made by the healthcare professionals regarding improving quality of care for Indigenous women when admitted to an acute healthcare setting are presented.

Opinions of healthcare professionals regarding the maternity experiences of indigenous women in an acute care setting

This is the report of stage three of a three stage project. The aims of the overall project were to seek advice from expert Indigenous women on how to gather information from birthing Indigenous women while in hospital. Information was gathered from Indigenous women who gave birth in hospital or were admitted after the birth of their baby. The opinions of healthcare professionals on the care of these women were investigated. This paper describes the opinions and concerns of healthcare professionals regarding identified cultural, social and economical issues for Indigenous women at a large acute care hospital in the Northern Territory, Australia. The opinions of healthcare professionals are vital if the needs and concerns of Indigenous women are to be considered within the hospital setting. Stages one and two of this project have been presented previously. Stage three, reported here, describes a survey of 18 non-Indigenous and one Indigenous healthcare professionals regarding their opinions of the maternity experiences of Indigenous women admitted to an acute care setting. The consultative process for designing the questionnaire and reflections on issues raised by Indigenous women during their interviews in the previous two stages is presented. The methodology of the survey, demographics and perceptions of healthcare professionals who participated in the project are examined and the similarities and differences between the issues raised by the healthcare professionals and the Indigenous women in stage two of the project are discussed. Suggestions made by the healthcare professionals regarding improving quality of care for Indigenous women when admitted to an acute healthcare setting are presented.

Systematic reviews of wound care management: (5) beds; (6) compression; (7) laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy.

Chronic wounds such as leg ulcers, diabetic foot ulcers and pressure sores are common in both acute and community healthcare settings. The prevention and treatment of these wounds involves many strategies: pressure-relieving beds, mattresses and cushions are universally used as measures for the prevention and treatment of pressure sores; compression therapy in a variety of forms is widely used for venous leg ulcer prevention and treatment; and a whole range of therapies involving laser, ultrasound and electricity is also applied to chronic wounds. This report covers the final three reviews from a series of seven. To assess the clinical effectiveness and cost- effectiveness of: (1) pressure-relieving beds, mattresses and cushions for pressure sore prevention and treatment; (2) compression therapy for the prevention and treatment of leg ulcers; (3) low-level laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy for the treatment of chronic wounds. METHODS - DATA SOURCES: Nineteen electronic databases, including MEDLINE, CINAHL, EMBASE and the Cochrane Controlled Trials Register (CENTRAL), were searched. Relevant journals, conference proceedings and bibliographies of retrieved papers were handsearched. An expert panel was also consulted. Randomised controlled trials (RCTs) which evaluated these interventions were eligible for inclusion in this review if they used objective measures of outcome such as wound incidence or healing rates. RESULTS - BEDS, MATTRESSES AND CUSHIONS FOR PRESSURE SORE PREVENTION AND TREATMENT: A total of 45 RCTs were identified, of which 40 compared different mattresses, mattress overlays and beds. Only two trials evaluated cushions, one evaluated the use of sheepskins, and two looked at turning beds/kinetic therapy. RESULTS - COMPRESSION FOR LEG ULCERS: A total of 24 trials reporting 26 comparisons were included (two of prevention and 24 of treatment strategies). RESULTS - LOW-LEVEL LASER THERAPY, THERAPEUTIC ULTRASOUND, ELECTROTHERAPY AND ELECTROMAGNETIC THERAPY: Four RCTs of laser (for venous leg ulcers), 10 of therapeutic ultrasound (for pressure sores and venous leg ulcers), 12 of electrotherapy (for ischaemic and diabetic ulcers, and chronic wounds generally) and five of electromagnetic therapy (for venous leg ulcers and pressure sores) were included. Studies were generally small, and of poor methodological quality. CONCLUSIONS (1) Foam alternatives to the standard hospital foam mattress can reduce the incidence of pressure sores in people at risk, as can pressure-relieving overlays on the operating table. One study suggests that air-fluidised therapy may increase pressure sore healing rates. (2) Compression is more effective in healing venous leg ulcers than is no compression, and multi-layered high compression is more effective than single-layer compression. High-compression hosiery was more effective than moderate compression in preventing ulcer recurrence. (3) There is generally insufficient reliable evidence to draw conclusions about the contribution of laser therapy, therapeutic ultrasound, electrotherapy and electromagnetic therapy to chronic wound healing.

Designing teams that work.

This paper describes the development of clinical improvement teams in a multi-disciplinary acute health care setting. The process included an information-gathering phase that enabled a match of team structure and leadership to staff skills and experience. It was found that an environment that supported collaborative practice and shared decision-making was critical to staff support of the teams and the outcomes achieved.

Effective Nursing Interventions for the Management of Alzheimerʼs Disease*

Alzheimer's disease (AD) is a progressive neurodegenerative disease that causes severe deterioration of functional and cognitive abilities. As the leading cause of dementia in adults, it affects one in every 10 people who are more than 65 years of age. There is a vital need for neuroscience nurses with knowledge of AD to provide high-quality care for the growing number of patients. The use of effective nursing interventions for the management of AD can help nurses promote independence and quality of life for AD patients. Nursing care must include interventions that focus on maintaining AD patients' functional and cognitive abilities as well as on preventing further disability and decline. Nurses can implement these measures in acute, long-term, and home healthcare settings.

Needleless intravenous systems: A review

Background: Needleless intravenous devices have now been implemented by many institutions worldwide. A rationale for their use has been a reduction in the number of needlestick injuries. Objective: The aim of this review is to outline the possible benefits and dangers of needleless intravenous systems. Review: Many early reports demonstrate a reduction in needlestick injuries after the implementation of a needleless intravenous device; however, not all such reductions are directly attributable to the device itself. Furthermore, good evidence suggests that needlestick accidents prevented by needleless intravenous devices pose little threat to health care workers. Finally, increasing reports associate bacteremias with the use of needleless intravenous devices. Early reports described devices used in the home care setting; however, recent reports are from acute health care settings, including intensive care units. Conclusion: Ongoing critical review of the benefits, risks, and costs of needleless intravenous devices is required. (AJIC Am J Infect Control 1999;27:431-4)

Nursing attire: indicators of professionalism?

The purpose of this qualitative research was to explore the effect that current nursing attire has on the image of the nursing profession. A number of nurses and a nonnurse were interviewed to determine how attire affected their perception of today's nurses. The two research questions were as follows: (1) is the changing dress of nurses projecting a negative image to the public? and (2) What components of a nurse's apparel indicate professionalism? Content analysis was performed on transcriptions from the tape-recorded responses of a purposeful sample of health care workers: 12 registered nurses, 1 bachelor of nursing student, and 1 layperson. The responses for the first research question were not directly addressed by the participants. However, one overall theme emerged, which was labeled "I can't tell you what it is, but I know it when I see it." The main theme that emerged for the second research question was labeled "total package," with role identification and competency being related themes. As a result of this research, nursing administrators and other health care professionals could gain an understanding of the importance of nursing attire as an indicator of nursing professionalism. Future research needs to examine the same research questions with health care consumers in a variety of acute and community-based health care settings.

Preceptors in long-term care. 1997 NGNA innovations in practice award winner.

A preceptor is an experienced and competent staff member who serves as a clinical role model and resource person to newly employed nursing personnel. Although this concept has been prominent since the late 1970s in acute health care settings, preceptors rarely are used in long-term care facilities. This article describes the overall effectiveness of the first long-term care preceptor program implemented at the Masonic Home of New Jersey in 1989. Conclusions will support the program as viable and beneficial to long-term care facilities by decreasing nursing turnover, providing continuity in the orientation process, promoting job satisfaction, and providing quality resident care.

Refinement of an Australian Pharmacy Casemix Classification for the Acute Healthcare Setting

PharmGroup was developed as a pharmacy specific, acute care, casemix classification system. This project aimed to refine the first version ofPharmGroup and develop a coding, nomenclature and cost weight structure for the PharmGroup categories. The refinement process also led to the description of critical data elements and high cost and severity indicators specific to pharmacy practice. Selection criteria for the identification and ratification of future indicators was also developed.

The acute care nurse practitioner and management of common health problems: a proposal

The acute care nurse practitioner, an emerging role in acute healthcare settings, is responsible for managing acutely ill patients with multiple acute and chronic health problems. There are variations in acute care nurse practitioner specialty practices but the complexity and potential progression of the acutely ill patient's status require the use of a multidisciplinary approach to patient care to include knowledge of common health problems. The acute care nurse practitioner curriculum should include course content on common health problems and/or physiological alterations, which should be prerequisites for specialty courses.

How nurses react to and cope with the uncertainty of unfamiliar technology: validation for continuing education.

Technological developments in healthcare continue, and nurses working in acute health care settings are assailed with new techniques. The focus of this qualitative study is methods nurses employ to stay current with new technological procedures. This article features nurses' verbatim responses regarding their use of technology and the facilitative role of continuing education.