Basic Nursing Care Research Articles

The utility of the records medical: factors associated with the medication errors in chronic disease.

ABSTRACTObjective:This study describes the development of the medication history of the medical records to measure factors associated with medication errors among chronic diseases patients in Diamantina, Minas Gerais. Methods:retrospective, descriptive observational study of secondary data, through the review of medical records of hypertensive and diabetic patients, from March to October 2016. Results:The patients the mean age of patient was 62.1 ± 14.3 years. The number of basic nursing care (95.5%) prevailed and physician consultations were 82.6%. Polypharmacy was recorded in 54% of sample, and review of the medication lists by a pharmacist revealed that 67.0% drug included at least one risk. The most common risks were: drug-drug interaction (57.8%), renal risk (29.8%), risk of falling (12.9%) and duplicate therapies (11.9%). Factors associated with medications errors history were chronic diseases and polypharmacy, that persisted in multivariate analysis, with adjusted RP chronic diseases, diabetes RP 1.55 (95%IC 1.04-1.94), diabetes/hypertension RP 1.6 (95%CI 1.09-1.23) and polypharmacy RP 1.61 (95%IC 1.41-1.85), respectively. Conclusion:Medication errors are known to compromise patient safety. This has led to the suggestion that medication reconciliation an entry point into the systems health, ongoing care coordination and a person focused approach for people and their families.

Don't prescribe on the cheap.

Newly qualified nurses should not be allowed to prescribe (Readers' panel, 5 April). And band 5 nurses should not be expected to prescribe until we get paid more. Are they pre-empting the lower number of junior doctors the NHS will see in the years to come and using nurses as a cheaper alternative? Nurses' responsibilities have evolved so much that doing basic nursing care is a distant memory to some, and what thanks have we got? A pay cut!

Impact of continuous in‐home rehabilitation on quality of life and activities of daily living in elderly clients over 1 year

To verify the effect of in-home rehabilitation on quality of life and activities of daily living in elderly clients. In this non-randomized controlled intervention trial, elderly participants were separated into a rehabilitation or a non-rehabilitation group (n = 100 each). The non-rehabilitation group received basic in-home nursing care, including assistance with cooking, cleaning, toileting, meals and medication. The rehabilitation group received a physical treatment program provided by a licensed professional once a week and basic nursing care in the home. For each group, quality of life and activities of daily living were assessed approximately every 3 months over a 1-year period. Quality of life was evaluated using the Philadelphia Geriatric Center Morale Scale, and activities of daily living were evaluated based on the Functional Independence Measure. The rehabilitation group showed statistically significant improvements in both quality of life and activities of daily living. In contrast, the non-rehabilitation group, although showing slight improvement in quality of life at 9 months, showed almost no effects at the other time-points and no significant changes in activities of daily living over the course of the study. The results of the present study suggest that long-term continuous in-home rehabilitation might improve quality of life and activities of daily living in elderly clients. Geriatr Gerontol Int 2017; 17: 1866-1872.

A return to the basics; nurses’ practices and knowledge about interventional patient hygiene in critical care units

BackgroundThe Nursing profession is struggling to return to basic nursing care to maintain patients’ safety. “Interventional patient hygiene” (IPH) is a measurement model for reducing the bioburden of both the patient and health care worker, and its components are hand hygiene, oral care, skin care/antisepsis, and catheter site care. ObjectivesTo identify the level of nurses’ practice and knowledge about interventional patient hygiene and identify barriers for implementing interventional patient hygiene in critical care units. MethodologyA descriptive research design was used and three tools were applied in this study: “The Interventional Patient Hygiene Observational Checklist”, “The Interventional Patient Hygiene Knowledge Questionnaire” and “The Barriers for Implementing Interventional Patient Hygiene in Critical Care Units”. ResultsThe mean percentage nurses’ knowledge score is higher than the mean percentage practice score in all items (hand hygiene (71.28±25.46, compared with 46.15±17.87), oral care (100.0±0.0, compared with 25.32±24.25), catheter care (75.76±9.40, compared with 8.97±24.14) and skin care (47.80±6.79, compared with 26.28±16.57). Barriers for implementing hand hygiene are workload (71.79%), insufficient resources (61.53%), and lack of knowledge (10.25%). ConclusionThe mean percentage IPH knowledge score is higher than the mean percentage IPH practice score of all IPH items. Barriers for implementing IPH include workload, insufficient resources, and lack of knowledge/training.

Perception knowledge and attitude of nursing students towards the care of older patients

The objectives of the study were to assess the perception, knowledge, and attitude of nursing students towards old age and care of the older adults and to examine personal characteristics that could predict their attitude.Two hundred and eighty students were systematically selected from learning institutions for nursing in Ile-Ife, Nigeria. Data on perception, knowledge, and attitude were collected with the aid of a validated self-administered questionnaire. Descriptive analysis and inferential statistics were done using Statistical Package for Social Sciences.Results showed that 66.1% and 71.8% of respondents had a positive perception and attitudes towards the care of older people, respectively. It further revealed that respondents believed that nurses should be patient, cheerful and sensitive (97.2%); as well as empathetic (91.4%) when caring for the older patients. The respondents also expressed that caring for the older patients goes beyond the basic nursing care (66.1%) and 90% supported the need for a geriatric unit in the hospital. Furthermore, 60% of respondents demonstrated good knowledge of essential clinical practice in the care of older patients. There was a statistically significant association between attitude and perception (OR=1.11; p=0.002) and age category 20–25 (OR=0.45; p=0.04). However, there was no significant association between the attitude of the respondents and knowledge (χ2=4.16; df=2; p=0.125).The study concluded that the respondents have positive perception and attitude as well as good knowledge towards the care of the older adults. These should be reinforced to enhance a better clinical outcome in the care of the older adults.

‘Failure to Maintain’: A theoretical proposition for a new quality indicator of nurse care rationing for complex older people in hospital

Complex older patients represent about half of all acute public hospital admissions in Australia. People with dementia are a classic example of complex older patients, and have been identified to have higher rates of hospital-acquired complications. Complications contribute to poorer patient outcomes, and increase length of stay and cost to hospitals. The care for older people with dementia is complex, and this has been attributed to: their cognitive response to being hospitalised; their limited ability to self-care; and lack of nursing engagement with the family caregiver. Registered nurses can offer simultaneous assessment and intervention to prevent or mitigate hospital-acquired complications. However, it is known that when demand for nursing care exceeds supply, care is prioritised according to acute medical need. Consequently some basic but essential nursing care activities such as patient mobility, communication, skin care, hydration and nutrition are implicitly rationed.This paper offers a theoretical proposition of ‘Failure to Maintain’ as a conceptual framework to indicate implicit care rationing by nurses. Care rationing contributes to functional and cognitive decline of complex older patients, which then contributes to higher rates of hospital acquired complications. Four key hospital acquired complications: pressure injuries, pneumonia, urinary tract infections and delirium are proposed as measurable indicators of ‘Failure to Maintain’.Hospital focus on throughput constrains nurses to privilege predictable, solvable and medically-related procedures and processes that will lead to efficient discharge over patient mobility, communication, skin care, hydration and nutrition. This privileging, also known as implicit rationing, is theoretically and physiologically associated with a rise in the incidence of complications such as pressure injuries, pneumonia, urinary tract infection, and delirium. Complex older patients, including those with dementia, are at higher risk of the complications, therefore should have higher delivery of prophylactic intervention (ie have higher care needs). ‘Failure to Maintain’ offers a conceptual framework that is inclusive of, and sensitive to, this vulnerable population.Implicit rationing is occurring and it likely contributes to functional and cognitive decline in complex older patients and hospital-acquired complications. However, the lack of patient functional ability data at admission and discharge for hospitalised patients, and lack of usable ward and hospital level nurse staffing and workload data makes it difficult to monitor, understand and improve quality of care. Current research in the fields of acute geriatrics and nursing work environments show promise through enabling multidisciplinary team communication, and facilitating clinical autonomy to provide patient focussed care, and avoid ‘Failing to Maintain’.The research field of acute geriatrics can understand and act on the risk modification role of nurses, including controlling for nurse staffing and work environment variables in intervention studies. The research field of nurse sensitive outcomes should incorporate the different profile of complex older patients, by including age brackets and functional ability as variables in their studies. Clinically, nursing work environments can be designed to recognise the different profile of complex older patients by adapting practices to privilege mobility, hydration, nutrition, skin care and communication in the midst of acute care interventions.

Developing Postoperative Nursing Care Standards for Patients Undergoing High Tibial Osteotomy Surgery

High tibial osteotomy an osteotomy is an operation where a bone is cut and re-positioned . The aim of this study explores and developing postoperative nursing care standards for patients undergoing high tibial osteotomy surgery. Subject and methods: Descriptive exploratory research design was utilized. The study was carried out in the department of orthopedic surgery at Assiut University Hospital. The study sample of all available nurses working in orthopedic department and who are willing to participate in this study (30).Tools utilized for data collections were Nurse's questionnaire sheet, Observation nursing practice checklist sheet and post-operative basic competencies Opinionnaire sheet. Results showed the knowledge about standards of post operative interventions for high tibial osteotomy patients, more than half of nurses (53.3%) had good knowledge regarding standards of post operative interventions for high tibial osteotomy patients. Nurses showed inadequacy in their practice about standards of post operative interventions for high tibial osteotomy patients .majority of nurses agree with basic post-operative nursing care standards. Conclusion: Formulation of standards is the first step toward evaluating nursing care delivery. Recommendation: an In-service training program for nurses is important in orthopedic surgery department. Application of the nursing care standards for post-operative high tibial osteotomy patients.

Application of nursing job satisfaction questionnaire in quality of nursing service in inpatients

Objective To study hospitalized patients for the application methods and effects of nursing work satisfaction on high quality nursing service. Methods In Shaanxi Province People′s Hospital, the inpatients were selected as the research objects, adopted the self-designed hospitalized patients to nursing job satisfaction questionnaire including basic nursing, nursing safety, service and humanistic care. Results Inpatients had high satisfaction for overall nursing job, and the top three were the explanation for nurse operation, name and wristbamd check, and nurses′ kind attitude, clean clothes, polite and civilized language, and nurse′s operation level. By this survey, it could effectively evaluate nursing quality and proposal advice. Conclusions The new design hospitalized patients to nursing job satisfaction is used to provide quality services for patients, and is helpful to improve the quality of nursing. Key words: Inpatients; Patient′s satisfaction; Quality nursing service

Role confusion as a barrier to effective carer involvement for people with intellectual disabilities in acute hospitals: findings from a mixed-method study.

To understand issues around carer roles that affect carer involvement for people with intellectual disabilities in acute hospitals. There is evidence that a lack of effective carer involvement can lead to poorer health outcomes for people with intellectual disabilities, but there is a lack of insight into the reasons for poor carer involvement in acute hospitals. Mixed methods in six acute hospital trusts in England (2011-2013). Electronic hospital staff survey (n=990), carer questionnaires (n=88), semi-structured interviews with hospital staff (n=68) and carers (n=37). Data were triangulated and analysed using a conceptual framework. There was strong support for carer involvement among hospital staff, and most carers indicated that they felt welcomed and supported. However, an investigation of negative experiences showed that there were discrepancies in the perspectives of hospital staff and carers on the scope of 'carer involvement'. An important contributory factor to the effectiveness of carer involvement was the degree to which staff understood the importance of carer expertise (rather than simply carer work) and welcomed it. Carers' contributions to basic nursing care tasks could be taken for granted by hospital staff, sometimes erroneously. The roles and contributions of carers should be clarified on an individual basis by hospital staff. The authors propose a new model to support this clarification. Further research is needed to assess the suitability of the model for patients with intellectual disabilities and other vulnerable patient groups.

English

Home based care (HBC) is a key component of care and support for people infected with human immunodeficiency virus (HIV). Understanding the pattern of HBC needs in a population is beneficial in planning and providing optimal HBC services for the people. This retrospective study assessed the pattern of home based care needs and services in patients of the adult antiretroviral therapy (ART) clinic of Jos University Teaching Hospital (JUTH), Jos, Nigeria. All documented home based care visits to patients of the clinic from September 2008 to December 2013 were reviewed. Relevant information was obtained from the patients’ clinical and home visit records. Data was analysed using Epi info version 7 statistical software. A total of 152 patients with 542 home visits were reviewed. There were 112 (73.7%) females and 40 (26.3%) males, with a mean age of 34±8.9 years at the time of initial home visits. The three commonest primary reasons for home visits were psychological counselling (22.7%), adherence counselling (15.5%) and ill-health (12.4%), while follow up visits accounted for 32.5% of the home visits. The 3 most frequent services provided during home visits were counselling on clients medication for adherence (77.5%), basic nursing care (61.6%), and psychological counselling (41.5%). By December 2013, out of 152 patients reviewed, 61.8% were alive, 15.1% had died and 23.1% were lost to follow up. The services provided during home visits extended beyond the patients’ perceived needs (primary reasons for visit). Home based care brings to light some patient needs that may not be evident or catered for at the facility level of care. This supports the endorsement of home based care as a useful strategy to complement facility care towards achieving an overall patient well-being. Key words: Home based care, human immunodeficiency virus (HIV), adult, Nigeria.

Nurses' perceptions of the impact of the aged care reform on services for residents in multi-purpose services and residential aged care facilities in rural Australia.

To understand nurses' perceptions of the impact of the aged care reform on care and services for residents in multi-purpose services (MPS) and residential aged care facilities (RACF) in rural South Australia. An interpretative study using semi-structured interviews. Participants comprised registered and enrolled nurses working with aged care residents in rural South Australia. Eleven nurses were interviewed, of these seven worked in MPS and four in RACF. Data were analysed for similarities and differences in participants' experiences of care delivery between MPS and RACF. Common issues were identified relating to funding and resource shortfalls, staffing levels, skill mix and knowledge deficits. Funding and staffing shortfalls in MPS were related by participants to the lower priority given to aged care in allocating resources within MPS. Nurses in these services identified limited specialist knowledge of aged care and care deficits around basic nursing care. Nurses in RACF identified funding and staffing shortfalls arising from empty beds due to the introduction of the accommodation payment. Dependence upon care workers was associated with care deficits in complex care such as pain management, medication review and wound care. Further research is needed into the impact of recent reforms on the capacity to deliver quality aged care in rural regions.

Why Do We Need to Study the Fundamentals of Care?

This paper makes the case for revisiting our understanding and valuing of basic or fundamental nursing care. Despite the interest in movements such as the person-centred or patient-centred care agenda, there continues to be concern about patient safety, quality of experience and getting the simple things right. Part of this debate is around whether meeting patients' fundamental care needs (such as personal hygiene, elimination and eating and drinking) within acute care settings constitutes legitimate nursing responsibilities or whether these needs ought to become part of "hotel services" executed by care assistants with elementary training or, as in many lower-income health systems, undertaken by relatives.

The Hidden Curriculum: What Are We Actually Teaching about the Fundamentals of Care?

The issues of missed or inadequately provided basic nursing care and related complications are being identified as worldwide phenomena of interest. Without being aware of it, educators and practicing nurses may be teaching nursing students that fundamental nursing care is unimportant, uncomplicated and not really nursing's responsibility. This paper explores the concept of the "hidden curriculum" in nursing education, as it relates to fundamental nursing care and calls for greater partnerships between education and service to uncover the hidden curriculum; to effectively shape it to achieve alignment between classroom and practice; and, ultimately, to improve care processes and patient outcomes through collaboration. A renewed focus on the vital importance of what is considered "basics" to patient outcomes is required in nursing education.

Effects of restrictive protection according to related legal regulations among inpatients with mental diseases

Objective To investigate the effects of the implementation of Mental Health Law of the People′s Republic of China and the of the tertiary mental on the quality of restrictive regulations among inpatients with mental diseases, in order to provide references for the further standardization and management using retrospective investigation of the clinical data. Methods The patients of control group received the normal restrictive protective nursing and the patients of intervention group was strictly carried out the restrictive protective care in accordance with the mental health law and the of the tertiary mental . The effects were compared between the two groups including: qualified rate of proper practice following doctor′s advice, the application of nursing procedures, nursing records, basic nursing care, incidence of the adverse event, patients′ restraint rate, average restraint time per person, and average restraint frequency per person. Results The differences of the qualified rate of proper practice following doctor′s advice, the application of nursing procedures, nursing records, basic nursing care, and the incidence rate of the adverse event had statistical significance between the two groups (P<0.05). The restraint rate were statistical different (χ2=10.11, P<0.05), as well as the average restraint time and frequency per person (t=7.92, 47.88; P<0.05). Conclusions The implementation of mental health law and the standard of review of the tertiary mental can significantly improve the quality of clinical restrictive protective nursing management, and reduce the restraint rate as well as the average restraint time and frequency per person. Key words: Mental disorder; Restrictive protection; Mental Health Law; Review of review of the tertiary mental hospitals

At Your Defense

At Your Defense

Study on nursing service needs among elderly people lived in nursing institutions in Fuzhou

Objective To investigate nursing care needs of elderly nursing homes residents in Fuzhou, to help to improve nursing care quality provided by elderly nursing homes. Methods A total of 120 elderly residents from 10 elderly nursing homes in Fuzhou were investigated with a self-developed questionnaire focusing on nursing care needs of elderly nursing home residents. The questionnaire included the following two parts: the general information of the elderly residents and the needs of disease care, basic nursing care, daily life care as well as psychological care. Results The retrieving rate was 95.8%(115/120). The overall nursing care needs of elderly nursing home residents was at the middle level (2.59 ±0.80), the highest demand for nursing care was disease care (3.34±1.07), followed by psychological care (2.56±0.93), basic nursing care (2.20±1.15) and daily life care (2.23±0.97). The single living elderly residents got lower scores than the couple living elderly residents in disease care, basic nursing care 3.19±1.07, 2.06±1.10 vs. 3.78±0.96, 2.62±1.20 (t=2.656,t=2.311,P <0.05). Over 90 years old age groups got lower scores than the other age groups in the disease care, 2.25±0.69, 3.80±0.72, 3.35±1.09, which showed significant difference (F=7.10,P <0.05). The elderly suffering from hypertension, diabetes, cardiovascular disease varied in the demand for different care. Conclusions The overall nursing care needs of elderly nursing home residents was at the middle level. Staying with spouse, age, disease state are the influencing factors of nursing care needs of elderly nursing home residents. Key words: Nursing care; Pension institutions; Elderly nursing home residents; Nursing care needs

Effectiveness of Designed Educational Programme for Nurse&apos;s Regarding Using the Braden Scale to Predict Pressure Ulcer Risk

<i>Introduction: </i>Pressure ulcer prevention and management is an important approach of basic nursing care. Pressure sores affect people who are unable to change position regularly. Sustained pressure on those areas which support the body leads to reduced blood supply and eventually death of the skin and underlying muscles (a pressure sore). <i>Aim: </i>This study was conducted to evaluate the effectiveness of designed educational programme for nurse's regarding using the Braden Scale to Predict Pressure Ulcer Risk. <i>Subjects and method: </i>A quasi- experimental research design was used. Convenience samplings were selected from available nurses worked in the selected setting as following and met selected criteria. It included 99 nurse in port said city at governmental hospitals from ICU and CCU, orthopedics, and medical units at pot said general hospital, Elzohour, Port-fouad hospitals. Data were collected through using one tool contains 3 main parts developed by the researchers based on literature review & modificated tool from <i>Registered Nurses’ Association of Ontario (2006) and Ayello, 2004</i> as follows: <i>Part I: </i>includes Sociodemographic data of nurses; <i>Part II: </i>includes nurse's knowledge regarding Braden scale and <i>Part III: </i>contains Observational checklist in using Braden scale. <i>Results: </i>The study revealeda highly statistically significant difference were found between pre educational programme phase and post educational programme phase in relation to nurse's total scores of knowledge and practice of Braden scale as a predictive risk assessment of pressure ulcer. <i>Conclusion & recommendations: </i>The present study concluded that there are obvious needs for educational programme to increase nurse's awareness of Braden Scale as predictive risk assessment of pressure ulcer.

English

Most critical care units in private healthcare in South Africa are staffed below maximum workload levels and additional staff is supplemented when needed. The additional staff often consists of enrolled nurses. In South African context, the enrolled nurse is a person who is trained to perform basic nursing care and works under direct or indirect supervision of the registered nurse. The aim of this study was to explore the experiences of critical care nurses regarding the utilization of enrolled nurses from a general ward as relief staff in critical care units. A descriptive design with a qualitative approach was applied. A sample size of n=15 was drawn from a total population of N=377, using purposive sampling technique. The findings demonstrated that some enrolled nurses perceived the critical care units as frightening whereas others viewed the distribution of the workload among themselves and the critical care nurse as unfair with the enrolled nurse feeling exploited. The critical care nurses perceived the experienced enrolled nurses as supportive and those with little or no experience in the critical care unit as a burden. Staff development for enrolled nurses who work in critical care units occasionally was found to be minimal and subsequently some critical care nurses disapprove their presence. However, nursing management encourage the use of enrolled nurses in the critical care unit to contain cost pertaining to labour. Enrolled nurses, who assist occasionally in the critical care unit to limit expenditure pertaining to labour, require supervision as well as ongoing development to ensure safe and quality patient care. Key words: Critical care unit, patient-nurse ratio, staff management.

A comparison of nurses’ knowledge of nursing care for central vascular catheters

The aim of the research was to compare the knowledge of nursing care for central vascular catheters (which hereinafter will be referred to as CVC) among general nurses from intensive care units and standard departments. In general, we can say that the aim was also to map the extent of nurses’ knowledge on infections associated with providing care in healthcare-associated infections (which hereinafter will be referred to as HAI), and aseptic care for central vascular catheters, including catheter sepsis. Part of the research was a content analysis and a comparison of standards of nursing care in three medical facilities concerning the issue of central vascular catheters (with an emphasis on HAI).The quantitative research was conducted in four medical facilities: Regional Hospital Liberec, Masaryk Municipal Hospital in Jilemnice, Hospital České Budějovice, and Hospital Semily. The chosen research method was a standard questionnaire, which used different kinds of questions and assessment scales. The respondents were selected by purposive sampling. The statistical processing was drawn from 290 completed questionnaires. The statistical methods used were the χ2 test and the two-sided Student's t-test.The research identified various and serious information deficits in nurses (both in intensive care units and standard units). One example might be underestimating the issue of HAI; the majority of respondents perceived the term HAI as an abbreviation for infections arising only in connection with the hospitalization of patients. Staff who are unaware of the risk of HAI in connection with outpatient or basic nursing care in social institutions will hardly be able to apply preventive procedures. Several serious deficiencies were detected in the knowledge of nurses regarding the aseptic approach to nursing care for central vascular catheters, such as a poor description of the procedure of disinfecting the injection site, non-complex tools for dressing the CVC and a very problematic thinning of heparin plugs.

Hygiene: basic care that promotes comfort in critically ill patients

&lt;br /&gt;Los pacientes hospitalizados en entornos críticos requieren la provisión de cuidados de enfermería para satisfacer sus necesidades básicas. Las intervenciones encaminadas a satisfacer las necesidades de higiene son cuidados de enfermería, inherentes al rol profesional y que actualmente se omiten o delegan por considerarlas de poco valor, sin tener en cuenta que constituyen indicadores de resultado en los pacientes y de la calidad de atención en las unidades de cuidado crítico. &lt;br /&gt;&lt;br /&gt;Objetivo: Analizar la importancia social, disciplinar y teórica de la higiene como un cuidado básico de enfermería requerido por los pacientes críticos y su relación con la comodidad a la luz de la teoría propuesta por Kolcaba.&lt;br /&gt;&lt;br /&gt;Método: Revisión de la literatura y selección de artículos en las bases de datos ISI -Web of Knowledge, Scopus, Science Direct, Proquest, Ebsco, Medline, Ovid, Scielo y de otras fuentes como documentos no publicados y páginas web. La revisión incluyó 3 estudios cualitativos, 27 cuantitativos, 1 estudio mixto, 40 piezas documentales y 4 editoriales publicados por profesionales de enfermería y otras áreas de la salud. &lt;br /&gt;&lt;br /&gt;Resultados: Los resultados se organizaron en 4 categorías así, cuidados básicos de enfermería en entornos críticos, higiene como cuidado básico para los pacientes críticos, higiene y comodidad y necesidades de investigación.&lt;br /&gt;Importancia clínica: Es indispensable que el profesional de enfermería asegure la satisfacción de las necesidades de higiene de los pacientes, así se proporciona seguridad, comodidad y bienestar. Durante la provisión de los cuidados de enfermería se presenta una oportunidad para que el profesional de enfermería se comunique con el paciente, evalúe el estado físico y psicológico, identifique posibles ansiedades y temores, planifique los cuidados y brinde una atención individualizada&lt;br /&gt;&lt;br /&gt;