Good Nursing Care Research Articles

Patterns of Neonatal Admission and Outcome in Neonatal Intensive Care Unit of a Tertiary Care Hospital

Introduction: Analyzing the neonatal admission pattern helps the policymakers to make better strategies for healthcare provider to deliver better service.
 Objective: To demonstrate the admission pattern and outcome of patients in the Neonatal Intensive Care Unit (NICU) in a tertiary care hospital of Bangladesh.
 Materials and Methods: This retrospective descriptive study was conducted on all neonates admitted to the NICU of Combined Military Hospital (CMH), Dhaka from January to December 2015. Data were collected from file records of the patients regarding age, gender, mode of delivery, working diagnosis, length of stay in NICU and immediate outcome.
 Results: A total of 502 neonates were admitted during the study period. Majority of the patients (77.3%) were admitted on the 1st day of life. There were 279(55.6%) males with a male to female ratio 1.2:1. The major cause of admission was prematurity (23.1%) and other leading causes were birth asphyxia (BA)14.9%, infant of a diabetic mother (IDM) 13.5%, neonatal sepsis 12.5%. Most of the neonates (82.7%) were delivered by caesarean section. About 84.1% were discharged after improvement, 65(12.94%) died and 15(3%) were referred to other specialties for further management. Within the first 24 hours of admission, 9.4% deaths occurred and two common causes of neonatal death were preterm (49.18%) and birth asphyxia (23%).
 Conclusion: Good outcome of a neonate depends on adequate management, monitoring and good nursing care in an intensive care unit. By paying good attention to perinatal services and improving the facilities in the unit, morbidity and mortality in neonates can be reduced.
 Journal of Armed Forces Medical College Bangladesh Vol.13(2) 2017: 49-53

Perceived quality of nursing care and patient education: a cross-sectional study of hospitalised surgical patients in Finland

ObjectivesThis study aims to analyse the relationship between patient education and the quality of surgical nursing care as perceived by patients. The background of the study lies in the importance...

The qualitative dimension of Nursing workload: a measurement proposal.

Objective:construct and test a proposal to measure the qualitative dimension of nursing workload; identify the workload cut-off point and its indicator as predictors of the good and optimal nursing care product score.Method:this is a descriptive study conducted in four inpatient units and four intensive care units of a Brazilian teaching hospital, considering 308 evaluations performed by 19 nurses. Four measurement instruments were used: three to assess the care demand in relation to nursing and the other to classify the care product delivered at the end of the shift. The workload was calculated and its indicator was constructed.Results:a weak and inverse correlation was found between the care product score, workload and the workload indicator and the workload indicator in the units and moderate and inverse between Nursing care planning and Care needs assistance with the number of hospitalized patients.Conclusion:it is possible to associate workload and its indicator with the care product. Nursing workload ≤ 173 hours (24 hours) and indicator ≤ 12.3 hours / professional were associated with a higher probability of obtaining a “good” and “optimal” score in the care product in the inpatient units.

Combining and complementing technology with good nursing care

Combining and complementing technology with good nursing care

PENGGUNAAN GLASGOW OUTCOME SCALE DALAM PENILAIAN KONDISI PASIEN PASCA CEDERA KEPALA

The incidence of disability as outcomes in head injury patients reaches 5.3 million people per year. Disability occurring is 1 year after injury. Glasgow Outcome Scale or GOS is a scoring or instrument used to assess patients ranging from 1 to 12 months after head injury. GOS was first created in 1975 by Bryan Jennett and Michael Bond, who have over 40,000 citations and is the most widely cited article in research on head injuries. GOS is also further developed into GOS-E or Glasgow Outcome Scale - Extended and GODS or Glasgow Outcome Discharge Scale. The purpose of this study was to determine the level of validity and reliability of GOS in assessing the condition of head injury patients. This study was a descriptive observation of 112 head injury patients measured using GOS for 6 months post injury. The result of the research showed that the characteristics of respondents with the average age of 18-40 years were 58.9% productive), male was 75.8%, the last level of senior high school was 35.7%, farmers, traders and laborers were 39.2% of 65.1% and GCS 3-8 value of 49.1%. The level of validity with the value of count> 0.195 with 95% CI and reliability is very high with correlation coefficient value> 0.8. Therefore, GOS is a scoring that can be used to assess the outcome of head injury patients by maintaining good clinical and nursing care at home or rehabilitation phase well.Key word : Glasgow Outcome Scale, Head Injury, Reliability, Validity

The theory of a co-creative process in advanced palliative home care nursing encounters: A qualitative deductive approach over time.

Aims and objectivesThe aim of this study was to test the theoretical conceptualization of the co‐creative process in home care nursing encounters over time.Method and designThis was a multiple case study with a deductive analysis of qualitative data over time, using interviews and observations collected from three cases.ResultsThe co‐creative process was complex and contained main, sub‐ and micro‐processes. Time was important and valuable, giving the patient and relatives space to adjust the process to their own pace. Some processes were worked on more intensively in accordance with the patients’ and relatives’ needs, and these are considered the main‐process. The further developed theory of the co‐creative process and its main, sub‐ and microprocesses can be understood as a concretization of how good nursing care can be performed within caring relationships in the context of advanced palliative home care.

Evaluation of the delivery of long-term at-home nursing care: An example of good practice.

To evaluate the influence of long-term at-home nursing care (LTHNC) on patient functional status. The specific aims were as follows: (1) to analyse the influence of LTHNC on patient functional status in terms of activities of daily living; (2) to evaluate the risk of pressure sores and pressure sore prevention in patients receiving LTHNC. LTHNC is a form of care for chronically ill persons staying at home who do not need hospitalisation, but due to their health problems they require regular nursing care that can be provided at home. A retrospective descriptive study. A document research method was used. We collected data from the medical records of 1,058 patients receiving LTHNC at the Non-Public Health Care Centre OMNI-MED in Bialystok (Poland) for the years 2005-2012. Detailed analysis of scores on the Barthel Activities of Daily Living Index revealed significant improvement in patient functional status as a result of LTHNC. In patients aged 65-80, the Barthel score increased by 8.83 points, and in patients aged 64years and younger, the score increased by 6.58 points (p<0.001). In the oldest patients (>80years), functional status improved the least, gaining a mean of 4.97 points on the Barthel scale. Overall, the demonstrated improvement of patient functional status and reduced risk of pressure sore development provide evidence that LTHNC is an effective form of care for elderly and chronically ill persons staying at home. The findings of our study represent a positive example of the way good nursing care can benefit patients while promoting the autonomous nature of nursing. The results add to our understanding of the functioning of LTHNC by providing relevant scientific evidence which may contribute to the development of community nursing.

Expert in nursing care but sometimes disrespected-Telenurses' reflections on their work environment and nursing care.

To describe telenurses' reflections on their work environment and how it impacts on their nursing care. Telenursing is one of the largest healthcare settings in Sweden today; approximately 5.5 million care-seekers call the designated number-1177-each year. Telenursing is regarded as highly qualified nursing care, and providing care over the telephone is considered a complex form of nursing. Within other fields of nursing, the work environment has been shown to affect the outcome of care, patient safety, nurse job satisfaction and burnout. The study used a descriptive design and followed the COREQ checklist. Twenty-four interviews were performed and analysed using qualitative content analysis. The main theme concerned "feeling like a nursing care expert but sometimes being disrespected." The telenurses reported that their work environment supported their work as nursing care experts via the telephone in some respects, but also hindered them. Appreciation and respect they received from the vast majority of callers positively impacted the work environment and contributed to work satisfaction. However, they also felt disrespected by both their employers and healthcare staff; they sometimes felt like a dumping ground. Receiving support from colleagues seemed invaluable in helping them feel like and be a nursing care expert. Work was perceived as cognitively demanding and sometimes exhausting, but appreciation from care-seekers and the feeling of being able to provide qualified nursing care made working as a telenurse worthwhile. If telenurses are to perform good nursing care over the telephone, managers must provide them with resources, for example, support, education and opportunities for recovery during shifts. It seems that the role of the 1177 service has not been properly implemented and accepted within the healthcare system, and politicians need to anchor its mission within the healthcare organisation.

Understanding the complexity of working under time pressure in oncology nursing: A grounded theory study

BackgroundThe international nursing shortage has implications for the quality and safety of patient care. Various studies report that nurses do not have time to complete all necessary nursing care tasks, potentially resulting in nurse-perceived time pressure. Providing good care in the current nursing environment often poses a real ethical challenge for nurses. How nurses experience caring for cancer patients under time pressure and how they deal with the limited time available in achieving an ethical nursing practice remains unclear. ObjectivesTo report qualitative research grounded in oncology nurses’ experiences with time pressure, its perceived impact on nursing care and the ways in which they deal with it. DesignA qualitative study design with a grounded theory approach was conducted to explore and explain oncology nurses’ experiences with time pressure and its underlying dynamics. Setting and participantsPurposive and theoretical sampling led to the inclusion of 14 nurses with diverse characteristics from five inpatient oncology nursing wards in one academic hospital. MethodsIndividual, semi-structured, in-depth interviews were conducted over a six-month period in 2015 and 2016. Data collection and analysis occurred simultaneously. The interview data was analysed using the Qualitative Analysis Guide of Leuven and NVivo software. ResultsThe conceptualised phenomenon of time pressure, grounded in empirical data, illuminated its complexity and helped us to explicate and describe what nurses felt when working under time pressure. The interviewed nurses described time pressure as a shared yet nuanced reality. We uncovered that nurses dealt with time pressure in varied ways, with a broad range of proactive and ‘ad hoc’ strategies. According to our interviewees, time pressure was a significant barrier in providing good nursing care. They illustrated how time pressure particularly affected the interactional aspects of care, which most nurses considered as essential in an oncology setting. Underlying personal, cultural and context-related factors seemed to play a key role in nurses’ individual experiences with time pressure. ConclusionTime pressure is a widely recognised and experienced phenomenon among nurses which has substantial negative implications for the quality and safety of patient care. Our findings reinforce the need to establish better support for nurses and to reduce the circumstances in which nurses are ethically challenged to provide good care due to time pressure. Based on our findings, we recommend investing more in the nursing culture and nurses’ personal development, in addition to optimising nurse staffing levels.

Sepsis and Nursing Care in Pediatric Patients

Sepsis is an issue that process serious problems for years in terms of treatment and care. In addition to seen common it has always been associated with significant mortality. Sepsis is one of the frequent cases among child patients. For years, sepsis occupies the pediatric intensive care units. Treatment is very long, complicated, costly and challenging. During the treatment and care period and also during the follow-up period, it affects many systems mainly due to accompanying of other systemic problems. A good nursing care is very important in sepsis children. Sepsis requires a multidisciplinary approach.

&lt;i&gt;Babesia caballi&lt;/i&gt; infection in a 6-month-old colt

On the 15 th of August 2016, a 6-month-old colt weighing 118 kg was presented to the large animal clinic of Veterinary Teaching Hospital, Michael Okpara University of Agriculture, Umudike. The colt showed clinical signs including fever, weakness, inappetence, anaemia, tachycardia, dyspnoea, rough hair coat, pale mucus membranes, lacrimation, ataxia and edematous swelling of distal limbs. Rhipicephalus eversti eversti ticks were detected on different parts of the colt’s body. Examination of peripheral blood smear showed Babesia caballi within the erythrocytes. Haematological analysis showed a decrease in red blood cell count, packed cell volume and haemoglobin concentration. Administration of imidocarb dipropionate and good nursing care yielded a successful result after two weeks of treatment. It is necessary to control ticks by regular use of acaricide and timely treatment of affected horses in order to reduce the devastating effects of this protozoan disease. Keywords: Babesia caballi , Colt, Imidocarb dipropionate, Rhipicephalus eversti eversti

Treatment of feline pyothorax: A report of two spontaneous cases

Two cases of feline pyothorax, presented in severe respiratory distress, were treated successfully by applying intermittent drainage and daily lavage of the pleural space with warm normal saline. Before that an indwelling thoracostomy tube had been fixed on the thoracic wall and left in place from 5 to 10 days. The only complication noticed was a symptomatic pneumothorax due to either tube malpositioning or damage to the tube wall. In both instances, the inspiratory dyspnea decreased or disappeared as soon as the tube was removed. Systemic and long term (6-9 weeks) treatment with antibiotics, combined with supportive measures and good nursing care, had a positive effect to the successful outcome in both cases.

Taking a cervical sample: A reflection on good practice

Cervical sample taking is an important role for the practice nurse. Valerie McMunn describes a personal experience and reflects on what constitutes good practice This article is a reflection of a cervical sample taking experience highlighting the importance of communication, information collection and correct techniques when taking a cervical sample. It explores the negative outcomes of failure to follow the national guidelines, provide good basic nursing care and communicate effectively, and the impact this may have on the woman both in terms of outcomes and her wish to have another sample taken in the future.

Nursing Work in Long-Term Care: An Integrative Review.

Evidence suggests that delivery of good nursing care in long-term care (LTC) facilities is reflected in nurses' descriptions of the factors and structures that affect their work. Understanding the contemporary nature of nursing work in aged care will influence policies for improving current work structures in this practice setting. The current review aims to present a contemporary perspective of RNs' work in LTC facilities. A comprehensive search and purposeful selection of the literature was conducted using CINAHL, PubMed, Medline, Scopus, and Google Scholar databases. Nine studies were eligible for review. Common themes revealed that nursing work in aged care settings is characterized by RNs providing indirect care tasks-primarily care coordination, engaging in non-nursing activities, and having an expanded and overlapping role. As care providers, aged care RNs do not always provide direct care as part of their nursing work. The scope of RN work beyond its clinical nature or performance of non-nursing tasks adds complexity in clarifying RN work roles in aged care. [Journal of Gerontological Nursing, 43(11), 41-49.].

Model of An Increasing Quality of Nursing Service (Satisfaction) for Poor Patient in Public Health Center Indonesia

Introduction: Nursing care Quality in a health center was one form of services that had to be considered and adjusted based on customer perception. The purpose of this study was to analyse the model of quality nursing service based on the customer perspective using the theory of Service Quality (SERVQUAL) for Poor patient in Public Health Center in Indonesia. Method: The study was a descriptive survey design. The respondents were all patients at Puskesmas Ngletih- Kediri. There were 46 respondents who had been chosen by simple random sampling. Research variables were the recommendation of others, customer needs, past experiences and the quality of nursing care. Data were collected using a questionnaire that was modified from the theory of service quality by Parasuraman and analyzed using binary logistic regression test with a significance level of p &lt; 0.05.Results: The results showed that the recommendation from others (p = 0.011), customer requirements (p = 0.033), and past experiences (p = 0.009) were related to the quality of nursing care. Past experience variables had the greatest chance to determine the quality of nursing care at Puskesmas Ngletih to be good. Three variables had a chance of 78.26% to form a customer’s perception of good service quality all at once.Discussion: It can be concluded that thecustomers get the recommendation of others, can fulfill their needs, and have good experiences because of a good nursing care quality in the health center. On the other hand, if the customers get bad experiences and their needs are not met, they will not recommend to others to use the services of nursing services at the health center and customers’ perceptionabout the good quality of nursing care will not be formed.

Nursing actions that create a sense of good nursing care in patients with wet age-related macular degeneration.

To identify and describe nursing actions performed by nurses that create a sense of good nursing care in patients with wet age-related macular degeneration. People who suffer from wet age-related macular degeneration risk central vision loss. Treatment with antivascular endothelial growth factor is the only available option at present that preserves vision and no definitive cure currently exists. Patients feel that they are compelled to accept this treatment because they might otherwise become blind. An explorative and descriptive design based on the critical incident technique was used. Interviews with 16 Swedish patients who all had received intravitreal treatment for wet age-related macular degeneration. Two main areas of good nursing care were identified: 'Being perceived as an individual' and 'Being empowered'. The first area was divided into two categories: being respectful and being engaged. Being respectful was observed when nurses had a benevolent attitude towards their patients and answered questions kindly and politely. Patients saw themselves as individuals when nurses were available for conversation and focused on them. The second area was divided into two categories: encouraging participation and creating confidence. Encouraging participation refers to when nurses provided information continuously. Nurses instilled confidence and trust in their patients by keeping promises and by being honest. A respectful interaction between patients and caregivers is necessary for patients to obtain beneficial health care. Patient interviews revealed important information about nursing actions that created a sense of good nursing care in patients with wet age-related macular degeneration. Nurses acknowledged people as individuals and created trust by building partnerships and sharing decision-making. To address each patient's concerns, nurses need to prioritise each patient's narrative and participation by documenting agreements in their medical record.

The importance of medical and nursing care of the open prostatectomy‐related vesico‐cutaneous fistula

ABSTRACTObstruction of the Foley catheter following open prostatectomy occurs frequently and can lead to the development of vesiculo‐cutaneous fistula unless recognized and managed effectively. Vesico‐cutaneous fistula reduces the patient's quality of life and increases overall health care costs. In this case report, we explore how ineffective medical and nursing care could lead to the development of vesico‐cutaneous fistula and outline what good medical and nursing care should consist of in order to prevent this condition. As far as we know, there is no case report of open prostatectomy‐related vesico‐cutaneous fistula in the literature to date.

Prioritising patient care: The different views of clinicians and managers.

There is little research comparing clinicians' and managers' views on priority settings in the healthcare services. During research on two different qualitative research projects on healthcare prioritisations, we found a striking difference on how hospital executive managers and clinical healthcare professionals talked about and understood prioritisations. The purpose of this study is to explore how healthcare professionals in mental healthcare and somatic medicine prioritise their care, to compare different ways of setting priorities among managers and clinicians and to explore how moral dilemmas are balanced and reconciled. Research design and participants: We conducted qualitative observations, interviews and focus groups with medical doctors, nurses and other clinical members of the interdisciplinary team in both somatic medical and mental health wards in hospitals in Norway. The interviews were recorded and transcribed verbatim. Ethical considerations: Basic ethical principles for research ethics were followed. The respondents signed an informed consent for participation. They were assured anonymity and confidentiality. The studies were approved by relevant ethics committees in line with the Helsinki Convention. Our findings showed a widening gap between the views of clinicians on one hand and managers on the other. Clinicians experienced a threat to their autonomy, to their professional ideals and to their desire to perform their job in a professional way. Prioritisations were a cause of constant concern and problematic decisions. Even though several managers understood and empathised with the clinicians, the ideals of patient flow and keeping budgets balanced were perceived as more important. We discuss our findings in light of the moral challenges of patient-centred individual healthcare versus demands of distributive justice from healthcare management. The clinicians' ideals of autonomy and good medical and nursing care for the individual patients were perceived as endangered.

Nursing care documentation practice: The unfinished task of nursing care in the University of Gondar Hospital

ABSTRACTIntroduction: Even though nursing care documentation is an important part of nursing practice, it is commonly left undone. The objective of this study was to assess nursing care documentation practice and the associated factors among nurses who are working at the University of Gondar Hospital. Methods: An institution-based cross-sectional study was conducted among 220 nurses working at the University of Gondar Hospital inpatient wards from March 20 to April 30, 2014. Data were collected using a structured and pre-tested self-administered questionnaire. Data were entered into Epi Info version 7 and analyzed with SPSS version 20. Descriptive statistics, bivariate, and multivariate logistic regression analyses were carried out. Results: Two hundred and six nurses returned the questionnaire. Good nursing care documentation practice among nurses was 37.4%. A low nurse-to-patient ratio AOR = 2.15 (95%CI [1.155, 4.020]), in-service training on standard nursing process AOR = 2.6 (95%CI[1.326, 5.052]), good knowledge AOR = 2.156(95% CI [1.092, 4.254]), and good attitude toward nursing care documentation AOR = 2.22 (95% CI [1.105, 4.471] were significantly associated with nursing care documentation practice. Conclusion: Most of the nursing care provided remains undocumented. Nurse-to-patient ratio, in-service training, knowledge, and attitude of nurses toward nursing care documentation were factors associated with nursing care documentation practice.

Editorial: Don't despair, be inspired

I recently had the privilege of attending the 2016 Robert Burns Humanitarian Awards. At the awards ceremony, a Scottish government minister spoke of the very real potential of a collective sense of despair in the light of recent and current global events. The shortlisted candidates, he said, demonstrated that when humanity seems to be at its lowest point, the true potential of the human condition most often shines through. The humanitarian acts of the three men shortlisted for the 2016 award demonstrated just that. The message from the minister was, essentially, don’t despair, be inspired. It was indeed both humbling to learn of the personal sacrifice and commitment of each of the shortlisted candidates and it was inspiring to hear of the impact of their endeavours. The winner of the 2016 award was David Nott, a UK surgeon who for over 20 years has practised surgery in conflict and natural disaster zones including Bosnia, Afghanistan, Pakistan, Iraq, Syria, Yemen, Liberia, Chad, Ivory Coast, Libya, Sierra Leone, Central African Republic, Democratic Republic of the Congo and Haiti, very often at great personal risk. Clearly a man with exceptional skills and intellect, nevertheless his acceptance speech was tinged with humility. I could only imagine the Scottish poet Robert Burns, in whose name the awards are made, would have been impressed. The egalitarian Burns would expect no less, that each and every one of us use our skills and talents for our collective wellbeing ‘A man’s a man for a’ that’. In my experience as a nurse, I have been humbled and inspired almost every day of my career by colleagues who presume their extraordinary acts of human kindness and compassion to be nothing more than ordinary. They are not, and we should do much much more to acknowledge the contribution of nursing, not just in the face of conflict and natural disasters, but in the mundane messiness of everyday practice. The trouble is’ ‘though that good nursing care is often only visible to the untrained eye when it is set against poor care (or indeed no care). Arguably this can make it something of a challenge to defend the value of nursing if it is only recognised or valued when it is suboptimal. And it is ironic that it is the most expert of nurses, whose impact on the lives of individuals in their care is arguably the most profound, whose contribution is most poorly understood, or valued, by those who hold the purse strings.