Individual Nursing Care Research Articles

Investigating the relationship between individualized care, patient satisfaction and trust in nurses through structural equation modelling.

The aim of this study was to demonstrate the impact of individualized nursing care on patient satisfaction and trust in nurses through structural equation modelling in patients receiving treatment in internal clinics. The study is a descriptive, exploratory and cross-sectional research conducted with patients receiving treatment in the internal admission services of an educational research hospital between January and April 2023. According to sample calculations, it was determined that a minimum of 238 patients needed to be included in the study, and 286 patients who met the inclusion criteria and agreed to participate in the research formed the study sample. Data were collected using the 'Patient Identification Form', 'Individualized Care Scale-Patient Version', 'Newcastle Nursing Care Satisfaction Scale' and the 'Trust in Nurses Scale'. The level of awareness of nursing actions supporting individuality was found to be 2.71 ±0.99, the level of perceiving individuality was 2.88 ±0.99, the average level of nursing care satisfaction measured 77.17 ± 12.67 and the average level of trust in nurses was 21.92 ±3.04. It was determined that as patients' awareness of nursing actions supporting individuality and their perception of individuality in care increased, they remained more satisfied with their care and had greater trust in nurses. Patients who perceived receiving individualized care were found to have higher levels of patient satisfaction and trust in nurses. Additionally, it was observed that as participants' satisfaction with their care increased, their trust in nurses also increased.

Perceptions of Patients and Nurses about Bedside Nursing Handover: A Qualitative Systematic Review and Meta-Synthesis.

Bedside nursing handover is a recognized nursing practice that involves conducting shift change communication at the patient's bedside to enhance communication safety. Understanding the perceptions of both patients and nurses regarding bedside handover is crucial in identifying the key principles for developing and implementing effective bedside handover protocols. However, there is currently a lack of comprehensive evidence that summarizes and evaluates studies focused on qualitative approaches for gaining insights into the perceptions of both nurses and patients. This meta-synthesis review aims to identify, synthesize, and evaluate the quality of primary qualitative studies on the perceptions of patients and nurses about bedside nursing handover. A meta-synthesis review was conducted to identify qualitative studies that reported patients and nurses' perceptions about bedside handover using seven electronic databases, including CINAHL, PsycINFO, Embase, Education Database (ProQuest), Web of Science, The Cochrane Library, and PubMed, from January 2013 to November 2023. The authors independently selected reviews, extracted data, and evaluated the quality of included studies using the 10-item JBI Qualitative Assessment and Review Instrument tool. A total of 871 articles were retrieved, of which 13 met the inclusion and exclusion criteria. These studies identified three main themes: (1) facilitators of bedside nursing handover, (2) barriers to bedside nursing handover, and (3) strategies to maintain confidentiality during bedside handover. This study systematically reviewed and integrated the perceptions of patients and nurses about bedside handover. Based on nurses' perceptions, the combined findings highlight the facilitators of bedside handover, including developing partnership interaction between nurses and patients, promoting professionalism, and enhancing emotional communication among nurses. From the patients' viewpoint, the synthesized findings emphasize the facilitators of bedside handover, including acknowledging the expertise, professionalism, and humanity of the nursing profession, ensuring a sense of safety, satisfaction, and confidence in the care received, as well as promoting individualized nursing care. In the context of barriers to bedside handover, both nurses and patients perceive breaches of confidentiality and privacy violations as significant barriers. When it comes to maintaining confidentiality during bedside handovers, it is important to consider patients' preferences. Patients often prefer handovers to take place in a private setting. From the nurses' perspective, it is important to inquire with patients about their preference for the presence of caregivers, and to conduct private handovers for sensitive issues away from the bedside. Relevance to Clinical Practice. Clinicians should carefully evaluate the barriers and facilitators in this meta-synthesis prior to implementing bedside handover. Study Registration. This study is registered in PROSPERO with Protocol registration ID: CRD42024514615.

Application of Individual Nursing Care Software for Public Health Nurses at the Indramayu District Health Center

Public Health Nursing (Perkesmas) is one of the health centers' efforts that supports the improvement of public health status by integrating nursing knowledge/practice with public health through the support of active community participation. Perkesmas service activities can be carried out inside and outside the Puskesmas building. Nurses provide nursing care for individuals who come to the puskesmas, provide family nursing care and nursing care for special groups/health-prone groups in the Perkesmas target area (home visits to vulnerable families). The problem for partners who are appointed in this community service program is the Documentation of Individual Nursing Care in the Perkesmas program which is less than optimal. This program offers solutions that are expected to help solve partner problems. The method used is to develop an application system in the documentation of individual nursing care in the health care program. As a result of this community service program, partners have an application system that will make it easier for community health workers in documenting individual nursing care in the community health program. The results of this program will also be published in accredited national or international journals.

Nurse – patient communication: an exploration of nurses’ experiences

A good relationship between a nurse and a patient is considered particularly important in a nurse's professional path and one of the main components of good nursing. Effective relationships based on mutual understanding lead to patient satisfaction and the determination of individual nursing care measures. The patient tends to be more involved in his treatment process and to trust the health care professional.
 Aim. To assess the quality of communication between nurses and patients from the perspective of nurses.
 Methods. A quantitative study was conducted using an anonymous online questionnaire. Research participants are general practice nurses working in Lithuanian health care institutions (n - 231). The standardized questionnaire The Nurse Quality of Communication with Patient Questionnaire (NQCPQ) was used to collect research data.
 Results and conclusions. Nurses indicate that the higher quality of communication with the patient allows the patient to open up and speak more confidently about his illness (84.4%, n = 195) and at the same time the nurse can better understand the seriousness of the patient's health and communicate about it (84.0%, n = 194). High-quality communication between the nurse and the patient helps the specialist understand that the prescribed drug treatment is acceptable to the patient (80.1%, n = 185). Nurses can decide on the appropriateness of treatment for the patient based only on the patient's reactions (71.9%, n = 166) and nurses can only assess the patient's current state of health by observing the patient (68.4%, n = 158).The quality of communication between nurses and patients determines the ability of nurses to assess the patient's state of health, decide on the appropriateness of the prescribed treatment, and the quality of communication affects communication with the patient during procedures, hygiene and nutrition.

APLIKASI SOFTWARE ASUHAN KEPERAWATAN INDIVIDU BAGI PERAWAT PERKESMAS DI PUSKESMAS WILAYAH KABUPATEN INDRAMAYU

Public Health Nursing (Perkesmas) is one of the health centers' efforts that supports the improvement of public health status by integrating nursing knowledge/practice with public health through the support of active community participation. Perkesmas service activities can be carried out inside and outside the Puskesmas building. Nurses provide nursing care for individuals who come to the puskesmas, provide family nursing care and nursing care for special groups/health-prone groups in the Perkesmas target area (home visits to vulnerable families).
 The problem for partners who are appointed in this community service program is the Documentation of Individual Nursing Care in the Perkesmas program which is less than optimal.
 This program offers solutions that are expected to help solve partner problems. The method used is to develop an application system in the documentation of individual nursing care in the health care program.
 As a result of this community service program, partners have an application system that will make it easier for community health workers in documenting individual nursing care in the community health program. The results of this program will also be published in accredited national or international journals.
 

Effect Observation of Optimized Individualized Nursing Care Applied to ICU Patients with Severe Pneumonia.

This study aims to observe the effect of optimized individualized nursing care applied to intensive care unit (ICU) patients with severe pneumonia (SP). 440 patients with SP admitted to the ICU of our hospital from January 2019 to June 2020 were provided with routine nursing care (group A), and 550 patients with SP admitted from July 2020 to December 2021 were provided with optimized individualized nursing care (group B). The blood lactate index and acute physiology and chronic health evaluation (APACHE II) scores before and after care were compared between the two groups. The WBC count recovery time, mechanical ventilation time, antipyretic time, and length of hospital stay of the two groups were recorded. The complication rate of the two groups during the nursing care period was compared. The prognosis effect of the two groups after 6 and 12 months of discharge was followed up with the Seattle angina pectoris questionnaire (SAQ). After care, the lactate level and lactate clearance rate were higher in both groups than before care, and the lactate level in group B was lower than that in group A and the lactate clearance rate was higher than that in group A (P < 0.05). After care, APACHE II scores were lower in both groups than before care, and lower in group B than in group A (P < 0.05). After care, the WBC count recovery time, mechanical ventilation time, antipyretic time, and length of hospital stay were shorter in group B than in group A (P < 0.05). During the nursing care period, the complication rate was lower in group B (5.82%) than in group A (11.59%) (P < 0.05). 6 and 12 months after discharge, the SAQ scores were higher in group B than in group A (P < 0.05). Optimized individualized nursing care applied to ICU SP patients can effectively improve the patients' physiological indicators, reduce complications, improve the prognosis of quality of life, and have a positive effect on the patients' speedy recovery.

IMPACT OF HEALTH EDUCATION ON THE COMPLIANCE LEVEL OF LUNG TUBERCULOSIS PATIENTS TO PREVENT THE TRANSMISSION OF MYCOBACTERIA TUBERCULOSIS

Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) which most commonly attacks the lungs. Eight countries account for two-thirds of new TB cases in the world, namely India, China, Indonesia, the Philippines, Pakistan, Nigeria, Bangladesh, and South Africa. So for that it is very necessary to take precautions so as not to infect family members by increasing knowledge through health education. This study aims to analyze the impact of health education on compliance with pulmonary tuberculosis patients in preventing transmission of Mycobacteria Tuberculosis. This study uses the design used in this study is a quasi-experimental design method with the method of one group pre and post-test design. The sample size of this research is 30 people. The health education method used is the individual method as a requirement for conducting research during the COVID 19 pandemic and the media used to provide health education is a poster. The tool used to measure compliance is a questionnaire. The results of the analysis showed that there was a significant effect on health education on the level of pulmonary tuberculosis patients to prevent transmission of mycobacterium tuberculosis (p value was 0.000). Advise nursing arrangements in implementing community and individual nursing care to implement nursing interventions, especially health education by paying attention to the methods and media used so that the health education information delivered can be accepted and implemented by patients.

First and second cycle nursing students' perceptions of the clinical learning environment in acute care settings - A comparative crossectional study using the CLES+T scale

BackgroundResearch has shown that the clinical learning environment can both facilitate and hinder students' learning. Students' perceptions need to be evaluated, preferably using nationally and internationally validated instruments. In Sweden, there is a lack of research about students' evaluation in acute care settings and from the perspectives of different levels of students. ObjectivesThe aim was to explore and compare perceptions of the clinical learning environment of first- and second-cycle nursing students in an acute care setting using the Clinical Learning Environment, Supervision and Nurse Teacher scale (CLES+T). DesignThe design involves cross-sectional data collection with comparisons between groups. Setting and participantsData were collected from a convenience sample of first- and second-cycle students at the end of their clinical placements in an acute care setting at a university hospital. MethodsA paper version and a web version of the culturally adapted version of CLES+T was filled out by the students. An independent t-test was used to explore the differences between CLES+T scores and distribution methods and educational level. Internal consistency was evaluated using Cronbach's alpha. ResultsOverall, the students (N = 179) were satisfied with the clinical learning environment. There was no significant difference in the total score (m = 4.31, SD = 0.63) between first- and second-cycle students except for the subscale of “Premises of nursing on the ward” and the individual items “The ward's nursing philosophy was clearly defined” and “Patients received individual nursing care”, showing that the first-cycle students were more satisfied compared to the second-cycle students. The scale demonstrated high internal consistency (α = 0.97 vs. 0.96) for the paper survey and the web survey, respectively. ConclusionsOur findings provide initial support for the CLES+T as a useful instrument to evaluate the clinical learning environment at different levels of education and in different contexts regardless of distribution method.

The Most Commonly Determined Nursing Diagnoses According to NANDA-I Taxonomy and Difficulties Using the Nursing Process in COVID-19 Outbreak

The study was planned to determine the most common nursing diagnoses according to NANDA International (NANDA-I) taxonomy and difficulties experienced in using of nursing process in COVID-19 outbreak. The sample of the descriptive cross-sectional study consisted of nurses cared for patients with COVID-19 (n = 114). Average age of nurses is 26.86 ± 6.68. Commonly determined nursing diagnoses according to NANDA-I taxonomy in patients with COVID-19 were imbalanced nutrition (66.7%), impaired gas exchange (40.4%), insomnia (21.1%), acute confusion (31.6%), hopelessness (96.5%), difficulty playing caregiver (84.2%), anxiety (38.6%) willingness to strengthen religious bond (71.9%), risk for infection (64.9%), nausea (49.1%). Twenty-four-years old and younger, high school graduates, caring for intubated patients, and those who stated that they did not use nursing diagnosis had more difficulty in using nursing process (<0.05). The use of nursing diagnoses and process for patients with COVID-19 is extremely important in ensuring individual and qualified nursing care.

Improving Clinical Nurses’ Competency and Nursing Care Using the Research Process Model

Abstract Background Clinical nurses working in an acute neurosurgery ward and researchers conducted research using the research process model with the aim to improve nursing competency, nursing autonomy, work motivation, ethics, and actual nursing care content. The research clarified: (a) how clinical nurses in the neurosurgical ward changed and the process of improving nursing competence; (b) changes regarding clinical nurses’ patient care autonomy, work motivation, and ethics; (c) changes in nursing care (rate of medical restraint, rate of manual removal of faeces, etc.) and (d) changes in patients’ and families’ degree of nursing care satisfaction. Methods Participants were a purposive sample of 12 (50%) ward nurses from a neurosurgery ward in a 500-bed hospital that had emergency care. Qualitative and quantitative data were from descriptions of the research process model and interviews, with the use of professional autonomy scale, work motivation scale, ethical behaviour scale, implementation rates of medical restraints and manual removal of faeces to inpatients, and by changes in nursing care and patient satisfaction. Data were collected before, during and at the completion of research. Analyses for quantitative data was done by unpaired t-test and ANOVA, and thematic analysis for qualitative data. Significance was set at (p &lt; 0.05). Results Professional autonomy scores gradually increased after the start of research and were significantly higher at the midpoint. The ethical behaviour scores gradually increased from the starting point, but there was no significant difference. The work motivation scores gradually increased and had significantly increased at the end of the study period compared to the starting point. The rate of medical restraints on patients significantly decreased in the end compared to the beginning, while the rate of manual removal of faeces significantly decreased at the midpoint and in the end compared to the starting point. Families complained about nurses’ response and care during the three-year period prior to the start of the research, but a year after the start of this research, no complaints were observed. The nurses improved nursing competence from Stage 1 : realization of individual nursing care anew; Stage 2: collaborating with various medical professionals; Stage 3: pursuit of specialized nursing; and Stage 4: promote competence of leadership and team building ability for all nurses. The research process model in this study improved nursing competency of the nurses participating in the study. Conclusion Going through the four stages, the clinical nurses working in the acute neurosurgery ward were able to improve their actual nursing care and increased their nursing competency.

Body composition measures may help target fundamental nutritional nursing efforts in rehabilitating patients with acquired brain injury.

AimTo illuminate using body composition measurements for malnutrition measured by Bio Impedance Analysis (BIA), as opposed to body mass index (BMI), and discuss benefits and burdens for fundamental nursing care.DesignA second analysis of a prospective, descriptive cohort study, targeting fundamental nursing care elements.MethodsThis postevaluation study explored data from a prospective, descriptive cohort study, which consecutively included 92 patients admitted for neurorehabilitation care. Measures of nutritional status were BMI and FFMI. Chi‐Square test and Multivariable logistic regression were used.ResultsBody composition measures rather than BMI contributed to target individual nutritional nursing care as this measure detected more patients at potential risk of malnutrition and indicated minor changes in the nutritional state. Transitions from being malnourished to a normal nutritional status occurred in 29% using the BMI definition while it was the case in 40% of individuals with malnutrition defined by the body composition.

Nurse bias and nursing care disparities related to patient characteristics: A scoping review of the quantitative and qualitative evidence.

Investigations of healthcare workers' implicit attitudes about patient characteristics and differences in delivery of healthcare due to bias are increasingly common. However, there is a gap in our understanding of nurse-specific bias and care disparities. To identify (a) the types of available evidence, (b) key factors and relationships identified in the evidence and (c) knowledge gaps related to nurse bias (nurse attitudes or beliefs towards a patient characteristic) and nursing care disparities (healthcare disparities related specifically to nursing care). Authors completed a scoping review using the Joanne Briggs Institute method and PRISMA-SCR checklist. Five databases were searched. After screening, 215 research reports were included and examined. Data were extracted from research reports and assessed for thematic patterns and trends across multiple characteristics. Nurse bias and/or care disparity investigations have become increasingly common over the 38-year span of included reports. Multiple patient characteristics have been investigated, with the most common being race and/or ethnicity, gender and age. Twenty-nine of 215 studies identified a potential relationship between nurse bias regarding a characteristic and nursing care of individuals with that characteristic. Of these studies, 27 suggested the bias was associated with a negative disparate impact on nursing care. Only 12 reports included evaluating an intervention designed to reduce nurse bias or nursing care-related healthcare disparities. Despite increasing research focus on individual bias and disparities in healthcare, the accumulated knowledge regarding nurses has not significantly advanced past a descriptive, exploratory level. Nor has there been a consistent focus on the role of nurses, who represent the largest component of the professional healthcare workforce. National and international codes of ethics for nurses require provision of care according to individual, unique patient need, disregarding bias and incorporating patient characteristics into their plan of care.

Dementia and patient outcomes after hip surgery in older patients: A retrospective observational study using nationwide administrative data in Japan.

To investigate whether dementia is associated with incidence of adverse events and longer hospital stays in older adults who underwent hip surgery, after adjusting for individual social and nursing care environment. Retrospective observational study using the linked data between the Japanese Diagnosis Procedure Combination database and the reports of the medical functions of hospital beds database in Japan (April 2016-March 2017). A total of 48,797 individuals aged 65 and older who underwent hip surgery and were discharged during the study period. Outcomes included in-hospital death, in-hospital pneumonia, in-hospital fracture, and longer hospital stay. We performed two-level, multilevel models adjusting for individual and hospital characteristics. Among all participants, 20,638 individuals (42.3%) had dementia. The incidence of adverse events for those with and without dementia included in-hospital death: 2.11% and 1.11%, in-hospital pneumonia: 0.15% and 0.07%, and in-hospital fracture: 3.76% and 3.05%, respectively. The median (inter quartile range) length of hospital stay for those with and without dementia were 26 (19-39) and 25 (19-37) days, respectively. Overall, the odds ratios (95% confidence interval (CI)) of dementia for in-hospital death, in-hospital pneumonia, and in-hospital fracture were 1.12 (0.95-1.33), 0.95 (0.51-1.80), and 1.08 (0.92-1.25), respectively. Dementia was not associated with the length of hospital stay (% change) (-0.7%, 95% CI -1.6-0.3%). Admission from home, discharge to home, and lower nurse staffing were associated with prolonged hospital stays. Although adverse events are more likely to occur in older adults with dementia than in those without dementia after hip surgery, we found no evidence of an association between dementia and adverse events or the length of hospital stay after adjusting for individual social and nursing care environment.

Determining the effect of an intercultural nursing course on empathic skill and intercultural sensitivity levels: An intervention study

BackgroundProviding culturally sensitive healthcare services requires to command on content and concepts. Moreover, it is essential to train nurses who are sensitive toward cultural values and beliefs and who can provide holistic and individual nursing care in an increasingly diverse population. ObjectiveThis study determined the effect of the Intercultural Nursing Course on the empathic skill and intercultural sensitivity levels of nursing students in Turkey. DesignThis study was an interventional study that adopted a pretest–posttest design with a control group. ParticipantsThe participants of the study were 165 nursing students from a school of health; these students were completing their fourth year of studies and in the spring term of the 2017–2018 academic year. However, the sample group comprised 113 students who agreed to participate in the study and completely filled out the administered forms. The intervention group consisted of 84 students admitted to Intercultural Nursing Course, whereas the control group consisted of 29 students who were not admitted to Intercultural Nursing Course. MethodsIntercultural Nursing Course, one of the elective courses in the fourth grade of the nursing program, was a 14-week course that was conducted through two contact hours per week. Data from both the groups were collected at the beginning and at the end of the course by the researchers using the “Introductory Information Form,” the “Empathic Skill Scale”, and the “Intercultural Sensitivity Scale”. Data were analyzed through descriptive tests, t-test, the Mann–Whitney U test, and the Wilcoxon signed-rank test using statistical package software. In addition, the required approval was procured from the ethics committee of the relevant university and School of Health before the study was conducted. ResultsNo significant differences prevailed between the intervention and control groups in terms of total intragroup and intergroup Empathic Skill Scale and Intercultural Sensitivity Scale scores. However, a significant difference (Z = −4.000; p = 0.000) between the pretest and posttest scores was observed in the interaction confidence subdimension of the Intercultural Sensitivity Scale in the intervention group. ConclusionAlthough Intercultural Nursing Course did not lead to a significant change in students' empathic skills and cultural sensitivity levels, it enhanced their cultural sensitivity and self-confidence in intercultural communication and ensured maintenance of their empathic skills. Intercultural Nursing Course can thus valuably contribute to the understanding of cultural structure and values of society and to the development of techniques that can provide nursing care accordingly.

The Future of LTC: The Continuing Evolution of the SNF

The Future of LTC: The Continuing Evolution of the SNF

Monitoring the Changes of Upper Limb Water in Breast Cancer Patients by Segmental Multi-Frequency Bioelectrical Impedance Analysis.

BackgroundOur study aims to investigate the role of segmental multi-frequency bioelectrical impedance analysis (SMF-BIA) in the monitoring of upper limb water changes of patients with breast cancer before and after surgery to aid in establishing a new approach to preventing lymphedema.Material/MethodsThis study included 442 female patients with breast cancer. We used SMF-BIA to monitor changes in body composition. Data were collected 1 day before surgery and 7 days and 3 months after surgery.ResultsThe average body mass index (BMI) of patients was normal but, in 22.8% of patients, the percentage of body fat exceeded the average, which is known as invisible obesity. Moreover, the weight, BMI, basal metabolic rate, inorganic salt content, muscle content, total body water, and extracellular water of patients increased 7 days after surgery (P<0.05), but recovered to preoperative levels within 3 months. In addition, protein content, skeletal muscle content, and intracellular water increased 7 days after surgery, but decreased within 3 months to even lower levels than before surgery (P<0.05). The extracellular water and total body water ratios increased continuously within the 3 months after surgery. Finally, the segmental water ratio of the healthy and affected upper limbs increased, while the bioelectrical impedance value decreased; however, they were still within the normal range.ConclusionsSMF-BIA monitoring may provide more detailed information for making individual nursing care plans in patients with breast cancer. Further studies with long-term follow-up are urgently needed to establishment a lymphedema risk predictive model.

FAKTOR-FAKTOR YANG BERHUBUNGAN DENGAN KELENGKAPAN DOKUMENTASI PENGKAJIAN RAWAT JALAN DI RUMAH SAKIT AWAL BROS BATAM TAHUN 2016

Documentation is as a communication tool where documentation in providing nursing care will be coordinated to avoid or prevent repetitive information. Documentation as a mechanism of accountability which contains documentation standard rules or provisions on the implementation of documentation, therefore the quality of the documentation truth will easily be justified and can be used as a protector of the lawsuit because it has a legal standard. Document as individual nursing care facilities, as a means of evaluation, and as a means to enhance cooperation between the health care team. This study aims to determine the factors that related to the documentation completeness. This type of research is descriptive analytic approach of Cross Sectional study. Sampling using total sampling technique. Respondents in this study were 51 people. Data retrieved by distributing questionnaires and observasi, there was significant relationship between motivation and completeness of documentation with the value (p = 0.002). There is a significant relationship workloads with complete documentation with a value (p = 0.039). there is a significant relationship between supervision with the completeness of the documentation with the value (p = 0.003). It can be concluded that the completeness of the documentation associated with motivation, workload and supervision. Agencies are expected to hospital in order to improve the support and teaching to nurses in order to obtain complete documentation, and for further research in order to add a variable that supports the completeness of the documentation

The nurse-patient relationship in the New Public Management era, in public home care: A focused ethnography.

The aim of this study was to gain deeper understandings of nurse-patient relationships in the New Public Management era, by exploring beliefs and practices of nurses and patients in Norwegian public home care. Organization of Norwegian home care services is based on New Public Management-ideologies, which have led to a rigidly formalized and task-oriented nursing practice that may jeopardize individual nursing care. Nurse-patient relationships have several positive effects on patients' health and well-being, but organizational boundaries and time pressure affect the quality of relationships. Focused ethnography. Data were collected between November 2015-July 2016 using participant observation and semi-structured interviews with 10 nurses and eight patients in six different home care areas, in two Norwegian municipalities. Data analysis was based on Roper and Shapiras framework. Findings demonstrate the continued importance of nurse-patient relationships in contemporary home care, while identifying extensive variations in the degree of closeness and emotional involvement. Organizational boundaries, time constraints, high workload, and disharmony between nurses "competence and patients" complex illnesses, influence practice in ways that reduce the significance of nurse-patient relationships and affect conditions under which they develop and evolve. Facing a system nurses perceive to function suboptimal, they govern practices based on their own professional assessments, and findings indicate cultural patterns in the way both nurses and patients prioritize to safeguard nurse-patient relationships. Home care cultures based on traditional nursing values continue, despite New Public Management influences, but a transition into New Public Management culture may, over time, influence the quality of nurse-patient relationships and meanings attributed to them.

Nursing care of double flap repair of free tissue for patients with multiple sites defect in head and neck tumors

Objective To analyze and summarize the perioperative care of double flap repair of free tissue for head and neck tumors patients with multiple sites defect. Methods From January 2014 to March 2017, 8 head and neck tumors patients with multiple sites defect who underwent the double flap repair of free tissue were selected as the research objected. We established the medical and nursing integrated management group care in perioperative period to care the patient including preoperative scientific and systematic evaluation, careful preoperative preparation, intraoperative cooperation and postoperative target nutrition management, fine management, special oral management, diverse tube nursing, individual nursing care, functional exercise and observation in disease. Results Through meticulous nursing management, 8 patients were successfully discharged from hospital. Conclusions Patients with multiple site defects in head and neck tumors are rare. The features of this kind of patient included high risk of surgery, serious traums, more complications, long time for healing. Targeted perioperative care is the key to successful recovery of patients. Key words: Perioperative nursing care; Head and neck neoplasms; Complex defect; Free flap

Infusing Social Justice in Undergraduate Nursing Education: Fostering Praxis Through Simulation.

Forensic clinical experiences are often inconsistent in undergraduate nursing education. Nursing students are not included in the process of forensic evidence collection, often because of the sensitive nature of the situation. Unfortunately, nursing students are forced to rely on theoretical knowledge provided by the nurse educator to understand the complexities of forensic nursing care. Nursing students must be able to identify and provide appropriate nursing care for individuals in all forensic situations. Comprehensive clinical laboratory experiences should be provided through active teaching-learning strategies, which replicate nursing care of the forensic patient. Simulated patient experiences provide a unique opportunity to explore the sensitive nature of sexual trauma in a safe learning environment. This strategy facilitates the application of theoretical forensic principles by utilizing live actors or high-fidelity manikins in laboratory settings. The application of theory to each simulated patient infuses conceptual knowledge at the point of care. Change in social consciousness begins at the bedside. The moral imperative of nursing continues to be the preparation of socially responsible, professional nurses who strive to end social injustices.