Provision Of Nursing Care Research Articles

Do service innovations influence the adoption of electronic health records in long-term care organizations? Results from the U.S. National Survey of Residential Care Facilities

ObjectiveHealthcare organizations including residential care facilities (RCFs) are diversifying their services to meet market demands. Service innovations have been linked to the changes in the way that healthcare organizations organize their work. The objective of this study is to explore the relationship between organizational service innovations and Electronic Health Record (EHR) adoption in the RCFs. MethodsWe used the data from the 2010 National Survey of Residential Care Facilities conducted by the Centers for Disease Control and Prevention. The outcome was whether an RCF adopted EHR or not, and the predictors were the organizational service innovations including provision of skilled nursing care and medication review. We also added facility characteristics as control variables. Weighted multivariate logistic regressions were used to estimate the relationship between service innovation factors and EHR adoption in the RCFs. ResultsIn 2010, about 17.4% of the RCFs were estimated to use EHR. Multivariate analysis showed that RCFs employing service innovations were more likely to adopt EHR. The residential care facilities that provide skilled nursing services to their residents are more likely (OR: 1.42; 95% CI: 1.09–1.87) to adopt EHR. Similarly, RCFs with a provision of medication review were also more likely to adopt EHR (OR: 1.40; 95% CI: 1.00–1.95). Among the control variables, facility size, chain affiliation, ownership type, and Medicaid certification were significantly associated with EHR adoption. ConclusionsOur findings suggest that service innovations may drive EHR adoption in the RCFs in the United States. This can be viewed as a strategic attempt by RCFs to engage in a new business arrangement with hospitals and other health care organizations, where quality of care and interoperability of patients’ records might play a vital role under the current healthcare reform. Future research could examine the relationship between service innovations and use of different EHR functionality in RCFs.

Moral Reasoning Ability in Nursing Students of Shahid Sadoughi University of Medical Sciences

Background & Aim: The setting of nursing care provision is full of ethical dilemas which requires moral reasoning ability. This study was designed to evaluate the moral reasoning ability of nursing students of Shahid Sadoughi University of Medical Sciences in Yazd city. Material & Methods: It was a descriptive correlational study that was conducted in 2012. The sample consisted of 113 nursing students in their 2nd, 3rd, and 4th year of education who were recruited by census. Data was collected by NDT (Nursing Dilemma Test) according to Kohlberg levels of moral reasoning and analyzed by descriptive statistics and inferential methods (pearson,t-test-ANOVA) using SPSS - PC (V. 18). Results: The mean score of moral reasoning abilities among nursing students was 43/23±2/2. Among demographic characteristics, age was associated with moral reasoning (p=0/03). There was also a significant relationship between moral reasoning and years of education (p=0/04). Conclusion: According to the findings, it is suggested that those involved in educational planning use specific strategies in order to increase nursing students' moral reasoning ability.

The challenges in monitoring and preventing patient safety incidents for people with intellectual disabilities in NHS acute hospitals: evidence from a mixed-methods study.

BackgroundThere has been evidence in recent years that people with intellectual disabilities in acute hospitals are at risk of preventable deterioration due to failures of the healthcare services to implement the reasonable adjustments they need. The aim of this paper is to explore the challenges in monitoring and preventing patient safety incidents involving people with intellectual disabilities, to describe patient safety issues faced by patients with intellectual disabilities in NHS acute hospitals, and investigate underlying contributory factors.MethodsThis was a 21-month mixed-method study involving interviews, questionnaires, observation and monitoring of incident reports to assess the implementation of recommendations designed to improve care provided for patients with intellectual disabilities and explore the factors that compromise or promote patient safety. Six acute NHS Trusts in England took part. Data collection included: questionnaires to clinical hospital staff (n = 990); questionnaires to carers (n = 88); interviews with: hospital staff including senior managers, nurses and doctors (n = 68) and carers (n = 37); observation of in-patients with intellectual disabilities (n = 8); monitoring of incident reports (n = 272) and complaints involving people with intellectual disabilities.ResultsStaff did not always readily identify patient safety issues or report them. Incident reports focused mostly around events causing immediate or potential physical harm, such as falls. Hospitals lacked effective systems for identifying patients with intellectual disabilities within their service, making monitoring safety incidents for this group difficult.The safety issues described by the participants were mostly related to delays and omissions of care, in particular: inadequate provision of basic nursing care, misdiagnosis, delayed investigations and treatment, and non-treatment decisions and Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) orders.ConclusionsThe events leading to avoidable harm for patients with intellectual disabilities are not always recognised as safety incidents, and may be difficult to attribute as causal to the harm suffered. Acts of omission (failure to give care) are more difficult to recognise, capture and monitor than acts of commission (giving the wrong care). In order to improve patient safety for this group, the reasonable adjustments needed by individual patients should be identified, documented and monitored.

Nurses' roles in direct nursing care delivery in China

AimTo study the nurses' roles in direct nursing care delivery in the neurology ward in China. BackgroundAs patients' demands for healthcare have increased, the quality of the nursing service has become a focus of attention. Nurses play an important role in the delivery of care and can affect the quality of patient care. MethodsThis was a non-participation, observational, time-task/activity study. All nursing care providers were observed during two shifts (16hours) as constituents of the workload to explain the nurses' roles. ResultsAn astonishingly low percentage (25.6%) of the total patient care workload was conducted by registered nurses. The rest of the care was provided by nursing students (10.5%), health care assistants (21%), and a substantial portion by the patients' relatives (43.7%). ConclusionsNurses' roles in direct nursing care delivery are inadequate in China. Nurse staffing and allocation must meet the increasing demand from clients to secure the highest quality and safety of healthcare.

Upaya Peningkatan Mutu Perilaku Kesehatan Reproduksi Anak Jalanan Perempuan di Kota Malang melalui Pendekatan Teori Keperawatan Johnson Behavior Sistem Model

Adolescence is the age of the solid changes. At this time of great confusion adolescents experience in reaching his true identity. This period was characterized by growth, change, the emergence of a variety of occasions, and often face reproductive health risks. Sexual activity places adolescents at risk of challenges to various reproductive health problems. One part of the youth are a group of teenagers who are in a community of street children. The hard life on the streets with the unfavorable situation in which street children have to survive, forcing them to become adults before their time. Although they are socially categorized as a child, but almost all of them to adopt forms of behavior as a sign of rebellion against the maturity of some of the expectations that have been defined and determined by the local community. By adopting the mature form of behavior, they do not deserve the actions that should be done to children their age, which includes pre-marital sex (free sex), sexually transmitted diseases (STDs), use of drugs, homosexuality, and violence sexual. Easily they can acquire knowledge about sex influence attitudes toward sexual behavior of street children (Nurharjadmo, 1999). The low awareness and lack of knowledge of street children is likely to be one cause. Necessary handling and kepeduliaan of all parties to help alleviate them from such circumstances. Development of street children, especially in reproductive health issues for this still largely done by volunteers who are not health perpendidikan. Thus the involvement of the nursing profession as nursing care providers considered very important. This is consistent with the role of the nurse as educator, facilitator, coordinator, health reformers and observers (the National Workshop on Nursing 1983). This study aims to analyze the influence of coaching to nursing approach to the theory of "System Model Behavior" of the quality of reproductive health behavior of female street children. Research using experimental designs with pre-draft "Pre and Post Test Design. The population in this study were all female street children in Malang with a sample of respondents who take part in reproductive health coaching. Data is collected with the questionnaire enclosed. The results of the research done in getting the data that the quality of reproductive health behavior of female street children before treatment is given the majority (80%) have good manners, the remainder (20%), including less well with the average value of 17.76. Whereas after given treatment to be better with an average increase in value to 20.68. The details are as many as 76% in both categories and 24% is very good. Wilcoxon match pair test results to explain the value Asymp.Sig test (2-tailed) or p-value <α, namely (0.000 <0.05), so it can be concluded that the act of coaching to nursing approach to the theory of Johnson Behavior Model System can increase the mean average quality of reproductive health behavior of female street children in Malang.

Multimedia applications in nursing curriculum: The process of producing streaming videos for medication administration skills

PurposeStreaming videos (SVs) are commonly used multimedia applications in clinical health education. However, there are several negative aspects related to the production and delivery of SVs. Only a few published studies have included sufficient descriptions of the videos and the production process and design innovations. This paper describes the production of innovative SVs for medication administration skills for undergraduate nursing students at a public university in Jordan and focuses on the ethical and cultural issues in producing this type of learning resource. MethodThe curriculum development committee approved the modification of educational techniques for medication administration procedures to include SVs within an interactive web-based learning environment. The production process of the videos adhered to established principles for “protecting patients’ rights when filming and recording” and included: preproduction, production and postproduction phases. Medication administration skills were videotaped in a skills laboratory where they are usually taught to students and also in a hospital setting with real patients. The lab videos included critical points and Do's and Don’ts and the hospital videos fostered real-world practices. The range of time of the videos was reasonable to eliminate technical difficulty in access. ResultsEight SVs were produced that covered different types of the medication administration skills. The production of SVs required the collaborative efforts of experts in IT, multimedia, nursing and informatics educators, and nursing care providers. Results showed that the videos were well-perceived by students, and the instructors who taught the course. ConclusionsThe process of producing the videos in this project can be used as a valuable framework for schools considering utilizing multimedia applications in teaching.

10 YEARS ON - HAS THE GOLD STANDARDS FRAMEWORK (GSF) INFLUENCED NURSING CARE OF PATIENTS WITH END OF LIFE CARE NEEDS IN THE COMMUNITY?

IntroductionDistrict nurses (DN) play a key role in supporting patients with palliative care needs in the community. Gold Standards Framework (GSF) is a service improvement tool that was developed over...

The nature of sleep in 10 bedridden elderly patients with disorders of consciousness in a Japanese hospital.

No previous study has satisfactorily clarified the nature of sleep in elderly bedridden people with disorders of consciousness (DOC). The objective of the present study was to clarify the sleep states of 10 elderly bedridden patients with DOC in a Japanese hospital to facilitate provision of evidence-based nursing care and appropriate adjustment of patients' environments. Nocturnal polysomnography recordings were analyzed according to the standard scoring criteria, and the patients' sleep stages and quality were investigated. Of the 10 patients, 9 showed slow wave sleep (SWS), 4 showed very high values for sleep efficiency (96-100%), and in 3 of these patients, the percentage of SWS was ≥ 20%. Furthermore, three of these four patients had 200 or more changes in sleep stage. Although the mechanism is unknown, the amount of SWS combined with the value of sleep efficiency suggests that the quality of sleep is poor in elderly bedridden patients with DOC. Further study is needed to determine better indicators of good sleep in this population.

Conceptualizing an expanded role for RNs

In our changing health care system, the role of registered nurses (RNs) has become indistinguishable from other nursing and health care providers’ roles. The purpose of this research was to explore the perspectives of nurse leaders and direct care RNs about the existing and future RN scope of practice. This research used an interpretive description analysis on data that was garnered from nurse leaders and RNs through separate focus groups. Participants identified existing threats to their roles, examined their scope of practice and proposed changes to the RN scope of practice. Specific areas that were identified included leadership, advocacy and expansion of RNs practices were dominant themes.

Development of disaster nursing in Japan, and trends of disaster nursing in the world

The aims of this paper are to describe what Japanese nurses have learned and contributed to disaster nursing development, and to review trends of disaster nursing in the world. The content of the paper is based on literature reviews. The description of the paper is also based on experiences by author. Through experiences among Japanese nurses related to Hanshin-Awaji Earthquake in Japan, development of nursing support network, academic societies of disaster nursing, nursing care provision system were accomplished. Disaster nursing education at undergraduate and graduate programs and continuing training have been started. Descriptive research and evaluation research have been conducted in the world. Disaster nursing is one domain of nursing discipline generated from demands in reality and society. More research and capacity building related to disaster nursing are needed while facilitating development of networking and collaboration among relevant organizations.

Barriers preventing high-quality nursing care of people with disabilities within acute care settings: a thematic literature review

This literature review was conducted to identify obstacles in the provision of quality nursing care to people with disabilities within acute care settings. Research in 2006 by the Disability Rights Commission found that people with disabilities have healthcare needs that are not being adequately met with the quality of care expected or anticipated. Obstacles to the provision of high-quality nursing care are a matter of concern to nursing clinicians, educators and researchers involved with establishing and maintaining professional standards of care for nursing practice. Therefore, this review has identified three major themes illustrating barriers to provision of high-quality nursing care in the acute care setting to people with disabilities. Themes identified were: professional competence, professional attitudes and organisational management. Nurses have an obligation to take into account the concerns and needs of individual clients with a disability.

Families and health-care professionals' perspectives and expectations of family-centred care: hidden expectations and unclear roles.

Family-centred care (FCC) is viewed as a pivotal concept in the provision of high-quality nursing care for children and their families, yet implementation continues to be problematic worldwide. This research investigated how FCC was enacted from families and nurses' perspectives. Descriptive qualitative approach using elements of analysis from grounded theory method. Data were collected though individual interviews with 18 children aged 7-16 years, their parents (n = 18) and 18 nurses from two children's hospital and one children's unit in a large general hospital in Ireland. Four key themes were identified: expectations; relying on parents' help; working out roles; and barriers to FCC. Nurses wholeheartedly endorsed FCC because of the benefits for families and their reliance on parents' contribution to the workload. There was minimal evidence of collaboration or negotiation of roles which resulted in parents feeling stressed or abandoned. Nurses cited busy workload, under-staffing and inappropriate documentation as key factors which resulted in over-reliance on parents and hindered their efforts to negotiate and work alongside parents. Families are willing to help in their child's care but they require clear guidance, information and support from nurses. Hidden expectations and unclear roles are stressful for families. Nurses need skills training, adequate resources and managerial support to meet families' needs appropriately, to establish true collaboration and to deliver optimal family-centred care.

Outcomes of synergetic peer assessment: first-year experience

Active participation in learning activities and reviewing assessment activity can facilitate learners engaged in these processes. This case study reports student experiences of the process of peer assessment with teacher guidance in a group project for a first-year nursing course with 153 students. Twenty groups of students were assigned roles in exploring one of the two scenarios: one involved analysing diabetes mellitus and the other considered colorectal carcinoma, in each case covering provision of acute nursing care in hospitals and preparing health promotion strategies in a community. Each group also provided comments to the group that worked on the other scenario, based on prearranged assessment criteria. After receiving comments from their peer group, each group was then allowed to revise their drafts prior to final submission. The teacher’s input would be offered, if the peer feedback was inaccurate or insufficient. A survey was conducted to explore the learning experiences, and three semi-structured focus group interviews were conducted to triangulate findings with the survey. The first-year students expressed the need for both peer feedback and the lecturer’s direct guidance.

Independent nurse prescribing in HIV care

In this article we set out to briefly describe the HIV/AIDS epidemic in the UK today, HIV nursing care provision, and the role of highly active antiretroviral therapy—the medication used to suppress HIV infection. The majority of the text describes independent nurse prescribing in HIV care and the risks of drug interactions.

Illness experience of adults with cervical spinal cord injury in Japan: a qualitative investigation

BackgroundThere is growing recognition that healthcare policy should be guided by the illness experience from a layperson’s or insider’s perspective. One such area for exploration would include patient-centered research on traumatic Spinal Cord Injury (SCI), a condition associated with permanent physical disability requiring long-term and often complex health care. The chronicity of SCI can, in turn, affect individuals’ sense of self. Although previous research in Western countries suggests that people with SCI find a way to cope with their disability through social participation and family bonds, the process of adjustment among people with cervical SCI (CSCI) living in Japan may be different because of the restrained conditions of their social participation and the excessive burden on family caregivers. The purpose of this study was to examine the impact of injury and the process of accommodation in people with CSCI in Japan.MethodsSemi-structured home interviews were conducted with 29 participants who were recruited from a home-visit nursing care provider and three self-help groups. Interviews were recorded, transcribed and analyzed based on the grounded theory approach.ResultsFive core categories emerged from the interview data: being at a loss, discrediting self by self and others, taking time in performance, restoring competency, and transcending limitations of disability. Overall, the process by which participants adjusted to and found positive meaning in their lives involved a continuous search for comfortable relationships between self, disability and society.ConclusionsThe results of this study suggest that persons with CSCI do not merely have disrupted lives, but find positive meaning through meaningful interactions. Family members added to the discredit of self by making the injured person entirely dependent on them. Gaining independence from family members was the key to restoring competency in people with CSCI. At the same time, social participation was pursued for transcending the limitations of disability. The results also imply that social issues affect how people interpret their disability. These findings suggest that public health policy makers should recognize the need to enhance independence in people with disability as well as change the social assumptions about their care.

A Dialogical Trial for Understanding a Mother and a Child with Autism Spectrum Disorder: Preliminary Implication for Nursing and Care

The objective of this study is to demonstrate the change in qualitative levels of the context (evolution of context) in communication between a mother and a child with autism spectrum disorder (ASD). In order to realize this objective, we focus on the relationship between contexts, and describe dynamic change inside mother-child communication. The data were collected thorough fieldwork by interview to the mother and participant observation. We analyzed about qualitative level of a context by qualitative analysis. When the mother and the child with ASD experience repeated cycles of conflict and trial and error, the qualitative levels of the shared context of communication become comprehensive. The subject, which is the change in communication, is a context that arises in the parent and child’s whole unit. Synchronously, the context about how to understand the communication between the parent and child becomes comprehensive. We propose that the dialogic partner’s context and mother-child’s context evolves in synchrony. When the object of nursing becomes a unit, including the nursing care provider, nursing can be asserted as a change of relationship in the interaction between the nursing care provider and the mother and child.

A Survey of Factors Related to Nurses’ intention to respect for the law based on “Reasoned Action Theory” in Tehran University Hospitals in 2010

Nursing Care providers and clients have rights, responsibilities, rules and conditions that have to be observed and respected always. This descriptive–correlational study was conducted to determine factors related to intention to respect for the law based on the Theory of Reasoned Action in nurses at university’s hospitals. 145 nurses were selected by purposive sampling method. A questionnaire with 65 items was used including 4 parts: external variable, attitude, subjective norm and intention to respect Content and face validity was used for this questionnaire and reliability of the instrument was determined by internal consistency and test-retest methods, respectively. Using analysis variances, T-test, regression, and correlation coefficient, the relations between variables were obtained. Finally, using the path analysis test, the causality model was assessed. The results showed that 67% of nurses had positive attitude, 56.9% of nurses had positive subjective norm, and 93.6% of nurses had high intention to respect for the Causality assessment revealed that the model derived from research Using path analysis showd that nurses’ inclination to respect law was related to intention. However, subjective norm did not relate to respecting the nursing law.

Postmortem/Last Offices Nursing Care Effectiveness as Perceived by US Licensed Funeral Directors

Background: The provision of appropriate physical postmortem nursing care, or last offices, is important for all deceased people, particularly if further preparation is required by the funeral director for the purpose of open-casket viewing. However, the effectiveness of nursing practices in this regard has been the subject of minimal empirical research. Purpose and objectives: The purpose of this study was to explore postmortem/last offices nursing care effectiveness from the perspective of the licensed funeral director. The objectives were to describe the phenomenon of postmortem/last offices nursing care effectiveness, explore perceptions concerning how care procedures may aid or hinder the process of producing a desired cosmetic result with further preparation and gain insight into recommendations concerning care. Methods: A survey adopting qualitative methodology with open-ended questions was used for this study. A convenience sample of 20 licensed funeral directors from a single mid-western state in the US completed a web-based questionnaire. Data analysis involved reading each of the responses several times, initial coding, reviewing for similarities, clustering themes based on similarity, review, and final theme labelling. Results: The funeral directors provided observations, opinions and recommendations concerning effectiveness in relation to: body positioning; the use of ligatures and ties to secure extremities: removal or leaving in place of intravenous catheters and lines and surgical tubes and drains; removal or retention in the mouth of dentures and partial plates; cleansing of the body; and identification and shrouding of the body. Conclusions: The findings suggest that postmortem/last offices nursing care practices need to be considered carefully and be based on individual assessment. The participants’ general consensus regarding physical aspects of postmortem/last offices nursing care were largely in agreement with the nursing care practices that they typically observe. However, there were discrepancies that require further investigation. Conflicts of interest: none Acknowledgements: The author wishes to acknowledge the Indiana Funeral Directors Association for its invaluable assistance with contacting study participants

In search of legitimacy – registered nurses’ experience of providing palliative care in a municipal context

The palliative care approach was originally developed for hospice care and for persons with cancer diseases, but has gradually expanded to embrace other contexts and people of all ages, with various life-threatening diseases. The palliative care concept thus also applies to older people and the context of municipal care, where Registered Nurses (RNs) hold key care provision positions. The municipal context is not, however, focused primarily on advanced nursing care, and it is important to highlight RNs' prerequisites for care provision. The study's aim was to describe RNs' experience of providing palliative care for older people in a municipal context. Data were collected through focus group discussions with 20 RNs from four different municipalities in southern Sweden and were analysed using conventional content analysis. The results showed that the nurses experienced that it was they who cushioned the effects of unclear responsibilities between different organizations, but had limited legitimacy in the municipal context and in relation to other care providers. The results also showed that nurses lacked proper support and prerequisites for providing high-quality palliative care to older dying patients. The results pinpoint the importance of increased acknowledgement of nurses' knowledge and skills and a critical view on the effects of moving towards an organization composed of different consultants, which can lead to even more unclear responsibility for nursing care provision.

Job satisfaction and associated variables among nurse assistants working in residential care

While the work situation for nurse assistants in residential care is strenuous, they themselves often state that they are satisfied with their job. More knowledge is clearly needed of the interrelationship of variables associated with job satisfaction. This study aims to investigate job satisfaction and explore associated variables among nurse assistants working in residential care. A total of 225 respondents completed a questionnaire measuring general job satisfaction, satisfaction with nursing-care provision and measures concerning person-centered care, work climate, leadership, and health complaints. Job satisfaction was the outcome measure and comparisons were made among those reporting low, moderate, and high levels of job satisfaction; multiple regression analyses were used to explore associated variables. The caring climate and personalized care provision were associated with general job satisfaction. High levels of satisfaction with nursing-care provision were also associated with the general work climate, organizational and environmental support, and leadership. Low job satisfaction was mainly associated with health complaints. Nurse assistants working in a positive work climate, caring climate, with a positive attitude to their leaders, who receive organizational and environmental support, provide person-centered care and experience a higher degree of job satisfaction. It seems essential, however, to include both general and context-specific measures when investigating job satisfaction in this field as they reveal different aspects of the nurse assistant's work situation.