Provision Of Nursing Care Research Articles

Better health and ambient assisted living (AAL) from a global, regional and local economic perspective

A high degree of social and economic relevance has been attributed to the technologies of assistance, and to information and communication systems, by scientists and politicians alike, particularly in connection with the development, promotion, and organisation of so-called senior-friendly environments and with ambient assisted living (AAL). Assisting technologies aim to provide more support to meet daily needs and preserve autonomy and quality of life. The focus of this paper is on the aged of the future, their specific demands and resources, which these technologies should be able to serve while adhering to their individual requirements. These technologies can make a considerable difference to the way people are able to live together and may represent new opportunities to the providers of outpatient and inpatient nursing and medical care.

Assessors find checklist for care open to interpretation

IN JULY this year the Department of Health (DH) released an updated version of its 2007 framework for the provision of NHS-funded nursing care for people with continuing health needs (see panel).

Peritoneal and Pleural Ports for Management of Refractory Ascites and Pleural Effusions: Assessment of Impact on Patient Quality of Life and Hospice/Home Nursing Care

Patients with end-stage malignancies often have refractory ascites or pleural effusions requiring repeated paracenteses or thoracenteses. Subcutaneous peritoneal and pleural port catheters are an alternative therapeutic option. We evaluate the clinical utility of this approach and the impact on quality of life (QOL) and home/hospice care. Thirty ports were placed, 16 peritoneal and 14 pleural, in patients with a mean age of 62 years. Retrospective chart review and interviews were held with patients and nursing care providers. Mean follow-up was 59 days. On a 10-point scale, QOL improvement, compared to that prior to port placement, was rated a mean of 9.5 by patients and 9.0 by the nursing staff. Both patients and nurses reported a high degree of convenience (rated at 9.7 and 9.6, respectively) and improvement of symptoms and comfort (9.6 and 9.3, respectively). Nursing staff reported a high degree of comfort (9.9) using the aspiration ports. Six of 14 pleural ports were removed following pleurodesis. One pleural port was removed due to patient discomfort and another due to pneumothorax. Two patients with pleural ports developed tumor seeding in the subcutaneous tissues. Of 14 peritoneal ports, 3 required removal for leaking and probable chemical cellulitis. Four became temporarily occluded with patency restored using tissue plasminogen activator (TPA) infusion. Peritoneal and pleural ports offer a convenient and relatively safe alternative to frequent paracenteses/thoracenteses in the management of refractory ascites and pleural effusions. This approach can improve the QOL for patients with end-stage disease.

Boundaries: The Nurse Scientist and Care Provider

Boundaries: The Nurse Scientist and Care Provider

Improving the oral health of older people in long‐term residential care: a review of the literature

Background. Unrefutable evidence now links poor oral health with the development of preventable systemic illnesses and debilitating conditions that threaten quality of life and life itself. This is especially significant for an increasing older population who are dependent on others for care. Aims and objectives. The majority of studies analysing the oral health of older dependent people in long-term residential care have been undertaken by dental professionals. This critical literature review examines the issue from a nursing perspective because nursing care providers have a fundamental role in daily oral health provision for dependent residents. Conclusions. Multiple barriers were found to negatively impact on daily oral healthcare provision, including lack of care provider education, oral health values, availability of resources, implementation of supportive policies, documentation and oral health assessment tools. Relevance to clinical practice. The nursing profession, at all levels, must become pro-active in removing financial, political and workforce barriers that impact negatively on oral health outcomes. A multi-faceted approach is required to address these barriers, including development and implementation of oral health education programmes, assessment screening tools, care plans, documentation, supply of oral hygiene aids and the appointment of oral care 'champions'.

Cuidados de enfermería al paciente sometido a técnicas de neurointervencionismo endovascular

Vascular interventional radiology (VIR) procedures have increased markedly, partly due to the current healthcare context, which encourages the use of less invasive procedures that reduce pressure on surgery departments and decrease hospital stays. In most patients, these techniques can be carried out in a single intervention. VIR procedures are based on the possibility of gaining access to vascular structures through a catheter inserted percutaneously without the need for open surgery. Due to the complexity of these procedures, hospitalization is required before and after the technique is performed but length of stay is short compared with that associated with surgery. As the health workers closest to patients, nurses must respond to their information needs. The provision of comprehensive nursing care should include all the care required before, during and after the procedure and all aspects related to the quality of the healthcare process. Knowledge of how diagnostic and therapeutic VIR techniques are performed in the neurovascular section is essential. Based on the authors' experience, the present article aims to provide nurses with knowledge of some neurointerventional procedures (cerebral angiography and embolization of intracranial aneurysms) and of the care provided in RVI rooms.

From substantive theory towards a family nursing scale

Introduction This paper describes the process of developing and testing a family nursing scale called Family Care during Child’s Illness (FCCI). The scale is based on Maijala’s (2004) substantive interaction theory. The empirical focus is on the provision of interactive nursing care for families of children aged one to three who require acute hospital care primarily for somatic reasons. The scale is intended for the purpose of measuring caregivers’ assessments of care provision in families where the child is potentially in a very serious and precarious situation and where there is much uncertainty (Meiers and Tomlinson 2003, Gedaly-Duff et al 2005). Typically, the need for acute hospital care is due to an accident, the onset of diabetes, cancer or an infectious disease.

Bed-to-nurse ratios, provision of basic nursing care, and in-hospital and 30-day mortality among acute stroke patients admitted to an intensive care unit: Cross-sectional analysis of survey and administrative data

Background The literature reports inconsistent evidence of the effects of nurse staffing on mortality despite continuing examination of this association. Objective To examine differences in provision of basic nursing care and in-hospital and 30-day mortality by nurse staffing of ICUs and general wards among acute stroke patients admitted to ICUs during hospitalization. Design A cross-sectional design that included survey and administrative data. Settings and participants The study included 6957 patients with hemorrhagic and ischemic stroke who were admitted to ICUs of 185 Korean hospitals. Methods Nurse staffing of ICUs and general wards was graded based on the bed-to-nurse ratios of each hospital. Provision of basic care was measured by whether five activities, such as bathing and feeding assistance, were fully provided by ICU nursing staff without delegation to patient families. Hospitals were categorized into low, middle, and high mortality groups for in-hospital and 30-day mortality based on z-scores that indicated standardized difference between observed and expected mortality after controlling for patient characteristics. Results In 83.8% of hospitals, basic care was provided fully by ICU nursing staff. The overall in-hospital and 30-day mortality rates were 21.9 and 25.4%, respectively. Hospitals with higher ICU staffing were more likely to fully provide basic care. Better ICU and general staffing tended to be associated with lower in-hospital and 30-day mortality. Compared with in-hospital mortality, 30-day mortality had a more distinct increase as nurse staffing became worse. Conclusion The findings provide evidence that nurse staffing may impact provision of basic care and patient mortality and suggest the need for policies for providing adequate nurse staffing.

Current Knowledge Related to Intelligence and Thinking With Implications for the Development and Use of Case Studies

This paper reviews current knowledge regarding intelligence and thinking, and relates this knowledge to learning to diagnose human responses and to select health outcomes and nursing interventions. Knowledge from relevant literature sources was summarized. The provision of high-quality nursing care requires use of critical thinking with three elements of nursing care: nursing diagnosis, health outcomes, and nursing interventions. Metacognition (thinking about thinking) should be used with knowledge of the subject matter and repeated practice in using the knowledge. Because there are limited clinical opportunities to practice using metacognition and knowledge of these nursing care elements, case studies can be used to foster nurses' expertise. Simulations of clinical cases are needed that illustrate application of the nursing knowledge represented in NANDA International, Nursing Outcomes Classification, and Nursing Interventions Classification. The International Journal of Nursing Terminologies and Classifications will promote the dispersion of case studies as a means of facilitating the implementation and use of nursing languages and classifications.

Responding to the shifting demographics and expectations of older people

AbstractSince their birth, members of the baby boomer generation have caused major changes in society, whether it is the way they were educated, the music they listened to, their politics or the homes in which they lived. As more of them now reach retirement age, the baby boomers are now turning their attentions to changing the way in which old age is viewed. As England's biggest not-for-profit provider of residential and nursing care, Anchor Trust is responding to this generation's ever-increasing demands. This paper sets out how many people will be of retirement age by 2020, their changing expectations and how Anchor has strategies in place to meet the demands of this ground-breaking generation.

Figuring it Out in the Moment: A Theory of Unregulated Care Providers' Knowledge Utilization in Dementia Care Settings

Within the context of knowledge translation, the disconnect between the results of research and the practice patterns of nursing care providers has not been reported in the context of institutional dementia care practice. Therefore, little is known about how knowledge about best dementia care practice, defined broadly as the person-centered approach, gets used by institutional nursing care providers. Unregulated care providers provide the majority of nursing care for older people with Alzheimer's disease and related disorders living in long-term care facilities. The purpose of this grounded theory study was to explore the process whereby these workers use knowledge about person-centered care in their dementia care practice. Transcribed data from tape-recorded interviews with 20 unregulated care providers among eight long-term care facilities in Ontario, Canada, were coded and categorized at progressively more abstract levels until concepts and the relationships among them were integrated in a middle-range theory of knowledge utilization. The theory of Figuring it Out in the Moment illustrates how unregulated care providers in dementia care settings practice in the context of unpredictability, variability, and personal threat. Their use of knowledge about person-centered care is dependent on the existence of certain individual and relational conditions that interrelate with four separate, but interconnected, phases of clinical decision-making and action. As a middle-range theory, Figuring it Out in the Moment is concrete and pragmatic information for promoting evidence-based dementia care not included in existing overarching knowledge utilization frameworks. Areas for further investigation include how knowledge utilization is conceptualized, as well as the influences of practitioners' clinical decision-making, the nature of caregiving with particular client populations, and the characteristics of individuals alone and in relationship on the utilization of best practice knowledge.

Jordanian nurses' job stressors and social support

This study describes stressors of Jordanian nurses and the social support they received to decrease the influence of these stressors. The relationships between the two concepts, and each with the sample's demographics were assessed. Predictors of nurses' stressors as well as social supportive behaviours were also studied. A descriptive correlational research design was used. The Nursing Stress Scale and the Inventory of Social Supportive Behaviours were used to collect data from a convenience sample of 464 Jordanian nurses who were working in 13 Jordanian hospitals. Workload and dealing with issues of death and dying were the most prevalent stressors among Jordanian nurses. Emotional support was the most supportive social behaviour Jordanian nurses reported that they usually receive. Significant correlations were found between nurses' stressors and social supportive behaviours, as well as between nurses' stressors and shift worked, level of education, and model of nursing care provision. Additionally, significant correlations were found between social supportive behaviours and commitment for work and units' decision-making style. Shift worked, nurses' educational level and model of nursing care provision were the best predictors of the nurses' stressors. Shift worked, model of the nursing care provision, marital status and unit's organizational structure were the best predictors of the social supportive behaviour. Nursing interventions are needed to decrease nurses' stressors; these will help nurses to perform safely their jobs. Various types of social support are needed, particularly emotional support.

Influenza Vaccination and Decisional Conflict among Regulated and Unregulated Direct Nursing Care Providers in Long-Term–Care Homes

The purpose of this study was to determine whether direct nursing care providers have decisional conflict about receiving influenza vaccinations and characteristics associated with decisional conflict. The researchers used a self-administered questionnaire mailed to direct nursing care providers in two long-term-care organizations. Most direct nursing care providers in both organizations (80% and 93%, respectively) intended to get the influenza vaccine. Unregulated direct nursing care providers had more decisional conflict than regulated providers, especially related to feeling uninformed about the pros and cons of influenza vaccination. Unclear valuing of the pros and cons of influenza vaccination was related to the age of the direct care providers in both organizations. Decisional conflict and influenza vaccination practices may be determined, in part, by age and by the culture of a health care organization. A decision aid to improve knowledge and clarify values may improve decision quality and increase influenza vaccination rates.

The Impact of PPS on Hospital-Sponsored Post-Acute Services: A Case Study of Delaware Medicare Providers

Hospitals were the first providers to experience the change in Medicare reimbursement from a cost basis to the prospective payment system (PPS). In the 1980s, this switch was accomplished through the development of diagnosis-related groups, a unique formula for Medicare reimbursement of inpatient hospital services. During that time, the concern was that, with the anticipated reduced payments to hospitals, adverse impacts on Medicare beneficiaries were likely, including premature release of patients from hospital care resulting in medical complications, increased readmissions, prolonged episodes of recuperation, and preventable mortality. The Balanced Budget Act of 1997 (BBA) mandated the implementation of the PPS for Medicare providers of skilled nursing home care and home health care. This change from cost-based reimbursement to PPS raised concerns that these providers would react as hospitals had done-that is, skilled nursing homes might limit their admission of Medicare patients and home health agencies might cut back on visits. As a result of that, hospitals might be faced with providing care for these post-acute patients without receiving additional reimbursement, and these changes in utilization patterns would be of critical importance to both providers and Medicare beneficiaries. This article examines the decisions that providers made in response to the perceived impact of the BBA. Qualitative data were derived from provider interviews. The article concludes with a discussion of how changes in Medicare reimbursement policy have influenced providers of post-acute care services to alter their level of participation in Medicare and the impact this may have on the general public as well as on Medicare beneficiaries.

Geographical and structural change in nursing care provision for older people in England, 1993–2001

This paper offers an investigation of the geographical and structural contexts of change in the provision of independent nursing care home resources in England between 1993 and 2001. This period: (i) immediately follows the implementation of the community care provisions of the 1990 National Health Service (NHS) and Community Care Act in 1993, and (ii) concludes immediately prior to the implementation of the main provisions of the 2000 Care Standards Act and the 2001 Health and Social Care Act. While the first half of the period witnessed the continued growth of nursing care home resources, the second half was characterized by absolute losses due mainly to closures of homes. The data of this study are elicited from Department of Health (DoH) sources relating to national, regional (DoH regions), and intra-regional (Health Authority areas) levels of resolution. The analytical methods comprise a variety of descriptive and spatial statistical methods that include the location quotient and the coefficient of variation. At the national scale, the findings reveal that the increasing importance of the dual-registered care homes partly cushioned the effect of home closures during the second half of the study period. At both the regional and intra-regional scales, structural changes and declining resource provision resulted in a trend towards a more geographically equitable distribution of nursing home beds. The findings are evaluated in light of current government policy that is committed to the provision of an increasingly flexible and seamless range of care services for older people.

Dying at home or in an institution: perspectives of Dutch physicians and bereaved relatives

IntroductionPrevious studies have shown that most people prefer to die at their own home. We investigated whether physicians or bereaved relatives in retrospect differently appreciate the dying of patients in an institution or at home.Materials and methodsOf 128 patients with incurable cancer who were followed in the last phase of their lives, 103 passed away during follow-up. After death, physicians filled out a written questionnaire for 102 of these patients, and 63 bereaved relatives were personally interviewed.ResultsOf 103 patients, 49 died in an institution (mostly a hospital), and 54 died at home (or in two cases in a home-like situation). Patients who had been living with a partner relatively often died at home. Bereaved relatives knew of the patient’s wish to die at home in 25 out of 63 cases; 20 of these patients actually died at home. Thirty-one patients had no known preference concerning their place of dying. Most symptoms and the care provided to address them were equally prevalent in patients dying in an institution and patients dying at home. Bereaved relatives were in general quite satisfied about the provision of medical and nursing care in both settings.ConclusionWe conclude that most patients’ preferences concerning the place of dying can be met. In about half of all cases, patients do not seem to have a clear preference concerning their place of dying, which is apparently not a major concern for many people. We found no indication that dying in an institution or at home involves major differences in the process and quality of dying.

Giving Birth

To gain an understanding of the meaning of childbirth to women living in St. Petersburg, the Russian Federation. Twenty-four Russian women who had given birth in the past 6 months participated in this phenomenological study and were interviewed and audio-taped about the meaning of childbirth. Data collection and analysis occurred concurrently. The Russian sociocultural context of childbirth was identified in specific themes: (1) adhering to cultural traditions, (2) accessing information, (3) maintaining a healthy lifestyle, (4) articulating the spiritual and emotional meaning of giving birth, and (5) transforming as a mother and a person. Study participants reported reading extensively during pregnancy as well as accessing Web-based information about childbirth. Women chose to give their newborns traditional Slavic names and have their infants christened. The findings of qualitative studies can be used to guide clinical practice, because they provide rich data about essential life events and reactions associated with them. Women from Russia are emigrating to countries all over the world, and thus, their cultural views of childbirth are essential knowledge for the provision of appropriate nursing care. With dramatic socioeconomic and political changes occurring over the past 15 years, along with major changes in healthcare delivery systems, listening to the voices of Russian childbearing women giving birth is vital information for nurses working in maternal-child health settings.

Nursing care provision for people with intellectual disabilities in institutions: A Taiwanese perspective

Background Little attention has been paid to the healthcare workforce in determining healthcare management for people with intellectual disability (ID) in institutions in Taiwan. This paper investigated the profile of the healthcare workforce among institutions caring for people with ID, and examined differences, particularly in relation to nursing staff numbers, between the various types of settings providing care.Method Data were provided by 121 institutions caring for people with ID in Taiwan. Structured questionnaires were completed at these institutions, providing a cross‐sectional survey.Results Nurses were the main health professionals employed in institutions. Even so, more than half the institutions (52.1%) did not have a nurse on their staff. The larger the size of the institution, the more likely it was that nursing staff were employed there. With regard to the relationship between institutional operating structure and the employment of nursing personnel, public institutions were more likely to employ nurses than private institutions or privately operated state‐owned institutions (POSOE). However there was no statistically significant difference among the various operating structures in terms of the ratio of nurses to people with ID.Conclusions The results highlight the importance of examining the regulation of an appropriate ratio of nurses: people with ID in institutions.

Distance Education: A Strategy for Leadership Development

ACROSS THE CONTINENTS, countries are embracing distance education as a means of upgrading large cadres of nursing care providers - from aide to auxiliary, general or technical to professional, baccalaureate to master's, and master's to doctorate - in a timely manner without disrupting their usual employment. This strategy is in response to the many challenges confronting the profession of nursing in a global context. Geopolitical changes such as regionalism, decentralization, deregulation, and privatization have an impact on the delivery of health services. Relationships among the health care professions have been changed by factors such as the adoption of primary health care strategies, economics, and workforce trends and demands. Nursing is challenged to meet evolving health care needs, while at the same time maintaining the standards and integrity of the profession. These needs arise from the requirements of society - nationally, regionally, and globally. As countries report on their nursing situation, almost invariably, the need for well-prepared nursing leaders surfaces. Therefore, it is possible to conclude that diverse countries have some needs and expectations in common when it comes to nurses, nursing, and nursing education. And, according to Smith, one must ask, What are the societal costs of nurses who cannot meet expectations? (1, p. 11). As the profession moves into the 21st century, a major role transition for nursing is occurring worldwide. This transition arises from a view of the future where the nursing role will be interdependent, focused more on health care, with clearly specified independent functions and flexible boundaries. The responsibility of the nurse will change from that of solely providing cure and safety for patients in an institutional setting to that of developing health prescriptions in community-based institutions as well as in tertiary care environments. In the past, the major function of the nurse has been providing patient care under the direction of the physician, controlled by institutional policies set by others. In the future, nurses will not only provide direct care but will be involved in legislation, definition of standards, and policy determination as part of an interactive, multidisciplinary team. The focus of care provided will include prevention of illness as well as health maintenance and restoration. is described as the ability to envision and communicate a changed future and to foster a dynamic that mobilizes and catalyzes the efforts of many toward that end (2). In his global analysis of trends, Naisbitt (3) predicts that the new leadership will be younger and more female, and power will shift from the state to the individual, and the structure will he less hierarchical with more networking. in nursing must be broader than it has been traditionally, and nursing leaders must look at nursing practice in the wider sense of health care and confront issues within a political, social, policy, and economic context. development should not be limited to preparing persons for the top of an organization. Rather, it should include preparation of persons with leadership potential at all levels of the system. In the next decades, the quality of the contributions of nurses toward improving health care delivery will expand as never before. Without a commitment to leadership development by policy makers in government, education, and health care service institutions, change cannot be initiated and societal needs go unaddressed. Distance Education as a Strategy of Nurturing Leaders One of the keys to leadership development is education. As John F. Kennedy said, Leadership and learning are indispensable to each other. The power of specialized knowledge and the ability to communicate and translate knowledge into action is assuming increasing importance in all nations and societies. Nursing, like mam other disciplines, must move from the concepts of the industrial age to the new age of information, and efforts directed toward leadership development must be responsive to the challenges of the information age. …

Work System Analysis of Home Nursing Care and Implications for Medication Errors

The purpose of this study was to examine the context of the provision of home nursing care for patients with congestive heart failure. A modified macroergonomic analysis and design work system analysis was undertaken in two phases with fourteen nurse participants: I) field observations of eight nurses for the collection of data on work elements and II) follow-up telephone interviews with six home care nurses. Open-ended questions were asked after the observations to identify clinical knowledge, policies, and procedures that influenced care decisions and practices. The telephone interviews focused on four different aspects of home health care delivery and were conducted using semi-structured questions. Results of the observations were translated into flowcharts and a summary report. The baseline findings described aspects of home medication management and its relevance to safety, quality of care, communication, and self-management.