Provision Of Nursing Care Research Articles

Perioperative mortality and major cardio-pulmonary complications after lung surgery for non-small cell carcinoma.

A database of patients operated of lung cancer was analyzed to evaluate the predictive risk factors of operative deaths and life-threatening cardiopulmonary complications. From 1990 to 1997, data were collected concerning 634 consecutive patients undergoing lung resection for non-small cell carcinoma in an academic medical centre and a regional hospital. Operations were managed by a team of experienced surgeons, anaesthesiologists and chest physicians. Operative mortality was defined as death within 30 days of operation and/or intra-hospital death. Respiratory failure, myocardial infarct, heart failure, pulmonary embolism and stroke were considered as major non-fatal complications. Preoperative risk factors, extent of surgery, pTNM staging, perioperative mortality and major cardiopulmonary complications were recorded and evaluated using chi-square statistics and multivariate logistic regression. Complete data were obtained in 621 cases. The overall operative mortality was 3.2% (n = 19). Cardiovascular complications (n = 10), haemorrhage (n = 4) and sepsis or acute lung injury (n = 5) were incriminated as the main causative factors. In addition, there were 13 life-threatening complications (2.1%) consisting in strokes (n = 4), myocardial infarcts (n = 5), pulmonary embolisms (n = 1), acute lung injury (n = 1) and respiratory failure (n = 2). Four independent predictors of operative death were identified: pneumonectomy, evidence of coronary artery disease (CAD), ASA class 3 or 4 and period 1990-93. In addition, the risk of major complications was increased in hypertensive patients and in those belonging to ASA class 3 or 4. A trend towards improved outcome was observed during the second period, from 1994 to 97. Our data demonstrate that perioperative mortality is mainly dependent on the extent of surgery, the presence of CAD and provision of adequate medical and nursing care. Preoperative testing and interventions to reduce the cardiovascular risk factors may help to further improve perioperative outcome.

The healing process, the road to recovery and positive mental health.

This paper is designed to explore and examine the experience of loss following a hysterectomy. The painful aftermath of the ordeal and the work involved in the healing process are outlined and discussed from both a personal and professional perspective. The manuscript highlights a number of inner struggles that had to negotiated before an equilibrium in mental health and wellbeing was successfully achieved. The forces that move the dialogue forward from one theme to the other are complex in their simplicity. The enigmatic dimensions of physical pain and emotional torment are expressed and worked through in a sensitive and intimate manner. The mysteries of internalized, conflicting messages on socialization issues, such as gender roles and living in and identifying with only one culture are discussed and debated. In addition, the disharmony between spiritual ideals, the meaning and purpose of life, the process of self-actualizing and the physical realities involved in living are identified and elaborated upon. Embroidered within the tapestry of the text is the need to revisit the curriculum for the education and training of mental health nurses to enhance the quality and provision of effective, humane and therapeutic nursing care.

The behaviors of aids patients toward their nurses

The purpose of this study is to identify the behavioral responses of hospitalized patients with HIV⧹AIDS to nursing care providers. The critical incident technique, developed by Flanagan, 1954was used to obtain a listing of the behavioral responses. Patients were asked to recall brief descriptions of caregiving events. A purposive sample included 118 men and women with HIV⧹AIDS from broad socioeconomic and cultural backgrounds. A total of 273 critical incidents yielded a listing of 393 behaviors. The analysis of data was facilitated by a computer program which allowed for the creation of coding systems and refinement of coded items into behavioral response categories. The inductive content analysis yielded 10 major response categories: participate, anger, appreciate, come close, stay away, match respect, match disrespect, dependent, complaint, and self care. In the largest category, 41% of the patients described ways in which they participate actively in their nursing care. These behavioral responses sharply contrast with current literature which continues to place a negative emphasis on the attitudes and behaviors of nurses. One third of the patients listed angry behaviors which were directed at nurses. Behavioral descriptions of anger reflected increased irritability with advancing illness, intense psychological responses toward an AIDS diagnosis, or a violent and angry style of relating to others in street settings. Two of the response categories describe the reciprocal nature of nurse–patient interactions. By becoming aware of patient responses, nurses will obtain a greater understanding of what changes would influence outcomes in patient behavior.

Trends in community care and patient participation: implications for the roles of informal carers and community nurses in the United Kingdom.

This paper argues that the interfaces between formal and informal care-giving are changing as a result of two current trends; the increased scope of home-based nursing care and the emphasis on participation both within nursing and in the wider health and social care arenas. These various changes are explored in relation to the provision of intensive and complex nursing care in the home. It will be argued that the changing interfaces between formal and informal care have important implications for the respective roles of nurses and informal carers which hitherto have been relatively overlooked. These implications urgently need addressing in research, policy and public debate if professional nurses are to provide appropriate help and support to informal carers.

Hospice nursing

To provide an overview of hospice services provided, and hospices affiliated with home health agencies. Published articles, book chapters, and organizational standards. Hospice programs recognize that dying is a part of life that requires a redirection of goals from cure to palliation. Hospice nursing practice is the provision of palliative nursing care for terminally ill patients and their families, with emphasis on addressing physical, psychosocial, emotional, and spiritual needs. Hospice nurses must expand their scope of practice beyond the walls of the hospital and home to provide holistic nursing care in collaboration with staff from many disciplines. Hospice nurses need to provide support to the patient and family in achieving the quality of life of their choosing.

Meeting Societal Needs for CNS Competencies

The purpose of this paper is to contribute to the debate on whether or not the roles of the clinical nurse specialist (CNS) and nurse practitioner (NP) should be blended. In this paper I argue that the two roles should not be blended in masters degree programs for two reasons. First, societal needs for the advancement of nursing practice through the generation and utilization of nursing science and the provision of expert nursing care for highly complex problems have never been greater. Secondly, the two roles should not be blended because the competencies required for the two roles are more different than alike; hence the development of important competencies for one or both roles is lost in time-limited masters programs. Each of these reasons are discussed below.

Establishing a community health focus in perinatal nursing practice within a capitated environment.

In this article, a model of care delivery is proposed that establishes a framework for meeting the health care needs of urban-dwelling women and children by organizing nursing care providers in a variety of delivery systems to balance access, quality, and cost. The program, intended as a component of an integrated health care network, illustrates the potential for nursing to assume a dominant role in providing health care services to a high-risk, high-cost population within a capitated environment.

All for one and one for all: team building and nursing.

Nursing care provision has become increasingly complex with the growth of health care systems in recent years. This has resulted in a greater emphasis upon the use of team approaches to providing care. This paper explores the nature of teams within nursing and how they can be developed. The membership of nursing teams and the differences between the type of teams is also examined. The process of team building in nursing teams and the way that induction programmes can play a part in this team building process is also discussed.

Reawakening spirit in clinical practice.

This article describes processes for incorporating spirituality into clinical nursing practice. Spirituality is viewed as a unifying force manifested in the Self, which is expressed and experienced in the context of caring connections with oneself, others, nature, and God/life force. Spirituality relates to an inner knowing and source of strength reflected in one's being, one's knowing, and one's doing. The nurse's intentional, caring presence with clients makes possible the speaking and hearing of spiritual concerns. Such concerns are revealed in the context of one's life story. Nurturing the nurse's own spirit is essential for responding to the spirit in any interaction. Nurses frequently deal with issues of spirituality but may not label them as such. This article suggests processes through which nurses may more clearly identify spiritual issues. Spirit is understood to be both the source of and a manifestation of one's spirituality. By reawakening spirit in clinical practice, nurses will be more effective providers of holistic nursing care.

PREP hindering nurse advancement?

While our profession recognises that the provision of high-quality nursing care to the general practice population is essential, the UKCC’s recent Post- Education registration and Practice (PREP) proposals seem to hinder practice nurses from attaining specialist and advance-level qualifications.

HIV INFECTION IN TRADITIONAL RURAL COMMUNITIES

The challenge to rural nurses to deliver knowledgeable and skilled nursing and health care to individuals with HIV infection and AIDS is indeed tremendous. Isolation of rural communities and health care facilities coupled with limited resources, financial concerns, conservative values of many traditional rural communities, and the tendency to exclude those who do not conform to community norms make it difficult to integrate the individual with HIV disease into the rural health care delivery system fully. Issues of particular concern to the rural nurse include maintenance of client confidentiality, obtaining and maintaining current knowledge and skills necessary to the provision of quality HIV nursing care, management of complex client health care problems, and provision of appropriate support services. Rural nurses must be innovative and creative in developing mechanisms to deal with these concerns. In addition, because rural nurses are well respected by the community and viewed as possessing a great deal of expertise in the delivery of health care, they are well positioned to provide leadership to the community in developing educational and care strategies to more effectively provide HIV care. Indeed, the delivery of high-quality HIV care in rural areas across the United States will likely depend on the expertise and leadership provided by rural nurses.

Abortion

Management of abortion personnel within a hospital setting involves a number of rights: the patient's rights to privacy and to the provision of competent, compassionate, and understanding nursing care; the right of nurses to refrain from abortion procedures due to conscience; and the right of hospitals to hire employees who will fulfill their contractual obligations. The US Supreme Court has held that the decision to abort is protected under the right to privacy; no one may interfere with a woman's decision. Public institutions do not have an obligation to fund abortion. If the Court had made abortion a right, then society would be obliged to provide abortion. The discussion of abortion rights focuses on the following topics: the legal duties of health professionals, the legal and moral rights and obligations of nurses, the legal rights and obligations of hospitals, and the rights of abortion patients. A case study is provided of a head nurse and staff in the gynecology ward of a large metropolitan hospital in 1974 who objected to the performance of saline abortion on the ward, to disposing of the fetuses, and to the validity of patients' consent. Their concern was for the health and safety of patients and the rights of patients to informed consent. The hospital did not have a right to force the nurses to comply with the directive on saline abortion procedures, because the hospital did not have the right to violate the conscience of an individual citizen. In another example of a transfer of a nurse to another area of the hospital, the hospital was exercising its prerogative to expect fulfillment of contractual obligations in a way that did not interfere with health care workers' objections to abortion. Roe v. Wade and Doe v. Bolton were the 2 cases that established the existence of institutional conscience. Health care workers have an obligation to inform hospitals in writing if they have objections to participation in abortion procedures. Nurses have an obligation to respect the legal right to privacy in making or carrying out an abortion decision, and to provide competent nursing care to all who receive their services. Nurses should not make judgments about their approval or disapproval of abortion or the patient's reasons for abortion. Patients have a right to be protected from emotional and physical harm from objecting nurses; nurses may withdraw their services only if there are other qualified professionals available to provide care.

Initial Management of a Patient with Extensive Burn Injury

During the resuscitation period, a knowledge of burn pathophysiology assists the nurse in conducting thorough assessments and providing effective nursing interventions in the acutely ill patient. The many variables associated with the burn injury contribute to the presentation of each burn patient as one with a unique injury that requires the most vigilant nursing care and expertise. The total dedication required of health care workers as members of a multidisciplinary burn team provides a significant professional challenge. Meeting that challenge appreciably strengthens the chances of burn patient survival.

Primary nursing and the role of the nurse preceptor in changing long‐term mental health care: an evaluation

The main aims of this action research study were to implement primary nursing in two long-term psychiatric rehabilitation/continuing-care wards and to investigate the effects of the intervention of the quality of nursing care provision. This evaluation took the form of a quasi-experimental time series analysis. A package of measures together with a number of peripheral indicators was used before primary nursing was introduced on each ward and again after primary nursing had become established. The results showed that the implementation of primary nursing led to nurses being more accountable for care, resident who were seen to be more self-sufficient and independent and wards which had an improved environment for care and rehabilitation.

Nonpunitive Discipline

Absenteeism affects healthcare by reducing the work force during a time of crisis in availability of skilled nursing care providers. An absent worker is a loss to the employer both financially and emotionally. By understanding and using the concept of nonpunitive discipline, nurse administrators can effectively reduce absenteeism and increase the availability of professional nursing resources.

'Dear old mother Levy's': the Jewish maternity home and Sick Room Helps Society, 1895-1939.

Historians have tended to neglect the issue of ethnicity and religion in the provision of health-care in Britain in the late nineteenth and early twentieth centuries. This question particularly needs to be addressed given the dominant role played by religious institutions in the provision of district and hospital nursing care in this period. Tracing the foundation of the Sick Room Helps Society and later the Jewish Maternity Home, this paper shows how religion and ethnicity played a vital role in shaping the form of health-care afforded to Jewish mothers in East London. These issues were critically important at a time when comprehensive medical care and maternity services were minimal and not provided along secular lines. Living in a predominantly Protestant society Jewish patients had specific requirements which were not always catered for by the outside community. This paper examines the experience Jewish mothers had with East London maternity services and how their special needs spurred the Jewish community to establish an innovative form of aid for mothers through its home-helps scheme. Evidence strongly suggests that the Jewish poor had much lower rates of infant mortality than their neighbours. One contributory factor to this low rate of infant mortality could have been the access Jewish mothers and their infants had to Jewish communal support.

Twice in need of care: a transcultural nursing analysis of elderly Mexican Americans.

In sum, elderly Mexican Americans residing in an urban area were identified as a population at high risk for chronic conditions associated with age and were also at risk for health problems related to migrant status, poverty-level incomes, and low levels of education and nutrition. They are in need of care, i.e. assistance, succorance, nurturance, stress alleviation, and support in a stressful urban environment in which they encounter barriers of language, transportation, eligibility requirements, and self-perceptions of inferior ethnic identify. The family and kin groups are most important but are not exhaustive of the sources of emotional support and bonds of social obligations for elderly Mexican Americans. Networks of informal relationships and culturally sanctioned groups also involve the individual in emotionally supportive bonds (Cuellar, 1977; Nall & Speilberg, 1967; Valle & Mendoza, 1978). As transculturally prepared nurses, we need to assess individuals and families to establish what roles we should assume as relief caregivers or as providers of professional nursing care, in addition to the care provided by the family and other significant others. This analysis of the social factors and values of elderly Mexican Americans focuses on a social structural theory to explain the health status and behavior of Mexican Americans related to health and illness. The relevance of such a preliminary analysis is that it provides the framework for interpretation of patients' behavior so the nurse may better understand and predict patient behavior related to health and illness.(ABSTRACT TRUNCATED AT 250 WORDS)

The willingness of nursing personnel to care for patients with acquired immune deficiency syndrome: a survey study and recommendations.

This study investigated the degree of association between willingness to work with patients with acquired immune deficiency syndrome (AIDS) and attitudes toward homosexuals. Subjects were all the nursing care providers employed by an urban hospital in Northern California; 472 received a mail survey that was returned by 208 (44 per cent). A significant and substantial relationship between the main variables existed (r = .50, P < .01). Twenty-five per cent of respondents agreed with a statement that patients with AIDS should be quarantined. The study concluded with a number of recommendations for nursing managers and educators, as well as implications for future research.

Recruitment … the graduate nurse

The author expresses concern for the future of nursing if a reduction in the educational entrance requirements to the profession is adopted as one of the means to broaden the entrance gate to nursing. The legacy of such a move is examined. The author suggests consideration of the role and responsibilities of existing nursing care providers, and recommends consideration be given to determining a specific role for the graduate nurse.

Nursing the immobile: a preliminary study

Permanent loss of mobility has profound physical and mental consequences for both sufferers and carers, and is a major challenge to the National Health Service. A recent study has shown that 42% of beds in departments of Geriatric Medicine are occupied by people with longstanding immobility. These people are highly dependent on nursing staff for their daily activities and quality of life. The assessment of mobility, as a single parameter of dependency, and the measurement of allocated nursing hours are both rapidly and easily performed on geriatric wards. It is felt that a simple correlation of these two variables might highlight areas where more detailed audit is desirable. This study demonstrates that the more immobile patients on a ward, the less the hours allocated to Registered and Learner grade nurses. Some possible reasons for this are suggested and the effects of this deployment on nursing practice and staff recruitment are discussed. It is felt that provision of appropriate nursing care to the most dependent patients in continuing care areas is essential, and that high levels of trained staff are needed to ensure this.