Safe Nursing Care Research Articles

Pediatric Palliative Care: A Conceptual Analysis for Pediatric Nursing Practice

Although there have been significant advances in medical technology, thousands of children continue to die annually. Pediatric palliative care is a relatively new field and has not been well defined in the literature. Therefore, the purposes of this article were to provide a concept analysis of pediatric palliative care that presents pediatric nurses with fundamental information regarding this concept and to increase their ability to understand, identify, provide, and subsequently meet and enhance the needs of those children with a life-limiting illness and their families. With this enhanced understanding of pediatric palliative care, pediatric nurses will continue to improve and provide quality, safe nursing care for this vulnerable population of children with life-limiting illnesses.

Using Experienced Clinicians to Facilitate Clinical Education

Dedicated education units (DEUs) teach nursing students how to provide professional, competent, and safe nursing care using staff nurses as educators and reduce the number of adjunct clinical faculty required by schools of nursing. The authors describe a collaborative clinical partnership between a pediatric healthcare system and a school of nursing to pilot the use of a DEU for one-on-one clinical education of students with expert pediatric nurses.

Construction and practice of a safe emergency and out-patient clinic nursing care system based on JCI standard

Objective To establish a safe emergency and out-patient clinic nursing care system based on JCI standard.Methods We used a safe nursing care conception, improved our administration structure, perfected our safe administration regulations and processes, performed safe nursing care steps, prepared and carried out various emergency plans. We established a safe nursing care system which emphasizes the prevention priority.Results After implantation of JCI standard, the reporting rate of near miss increased 205%, which is not reported before. The rate of unsafe affair decreased 81.5%. Nursing care quality score increased 5.5%. The satisfaction rate of patient increased 22% and the satisfaction rate of the nursing staff increased to 99%.Conclusions JCI standard is helpful to promote the quality and level of nursing care which can reach the scientific, standardized and advanced level. Key words: JCI standard; Safe nursing care system; Emergency and out-patient department

Massagem no recém-nascido pré-termo: é um cuidado de enfermagem seguro?

Introduction This quantitative experimental study evaluated the massage effects on preterm neonates hospitalized in neonatal intermediate care units as far as their physiological stability is concerned. Material and methods The sample consisted of 32 clinically steady and healthy preterm neonates, hospitalized in Portuguese units of intermediate neonatal care. The neonates preterm were randomly distributed in two groups -control and experimental, having each group an equal number of 16. The groups did not present statistically significant differences in some basic features thus forming some equivalent groups. The experimental group had an average of 30,11 weeks of pregnancy, 1,326 Kg at birth and 20,44 days of hospitalization in the intermediate care unit. The control group had an average of 30,94 weeks of pregnancy, 1,400 Kg at birth and 17,81 days of hospitalization in the unit of intermediate care. During the study, both groups received the same pattern of neonatal care, except for the experimental group that received the massage. The managed massage was the Tiffany Field (Touch Research Institute) massage, during five consecutive days in three daily periods. It was managed by nurses from the respective units, being these executions trustworthily validly done, with homogeneity between the different executants of the almost perfect technique (96,7%) and with high validity execution (96,77%) 1. Results To evaluate the effect of massage in the stability of the preterm neonate, the physiological parameters measured were: respiratory and cardiac frequency, oxygen saturation, blood pressure and temperature. We verified that there are no statistically significant differences between the groups for what we may conclude that the massage is a safe nursing care in terms of the organization of the autonomous subsystem. Conclusions The achieved results suggest that the massage in the healthy and clinically stable preterm neonate hospitalized in neonatal intermediate care units was a safe intervention.

High‐Fidelity Simulation and Emergency Preparedness

Ongoing threats of bioterrorism and the consequences of natural disasters require nurses entering the workforce to be competent in emergency preparedness. Nurses need to collaborate with multidisciplinary teams and use their critical thinking skills to provide safe nursing care during potentially chaotic public health emergencies. Using Institute of Medicine recommendations and Quality and Safety Education for Nurses competencies, the authors describe a public health emergency simulation exercise with undergraduate senior nursing students enrolled in a public health clinical course. Students applied chronic disease, mental health, and pharmacology knowledge acquired in previous nursing courses to an unfolding infectious disease outbreak while practicing their assessment, treatment, delegation, organizational, and leadership skills. The students' quantitative evaluation of the experience indicated that 90.36% thought the purpose of the experience was clear, 91.5% thought the importance of delivering safe care during a public health emergency was stressed, and 79.5% thought the presimulation briefing and postsimulation debriefing helped them understand and participate in the drill. Qualitatively, the students' reflections of the exercise indicated that although they initially felt overwhelmed and anxious, they realized the importance of participating in emergency preparedness and recognized their ability to apply nursing skills learned in previous courses.

Using foresight in safe nursing care

This paper describes the importance of prospective risk analysis in healthcare, the development of the foresight training package and its underlying theory. Many high-reliability industries formally train staff in prospective risk analysis. Although there are tools to retrospectively analyse incidents in healthcare and although many staff are error aware there is no training to formalize this learning. Staff already use error awareness and often intervene to prevent patient harm resulting in many 'no harm' incidents. The National Patient Safety Agency has developed the foresight training package to broaden healthcare professionals' understanding of the many factors that can combine to contribute to an incident occurring, and to encourage shared learning. For management teams, this broader understanding will assist them in prospective risk assessment of the staff they manage enabling them to be proactive in minimizing risk. The training tool is based on Reason's 'three bucket' model. Throughout every stage in the development of the foresight training package the concept and materials were tested with front-line staff. Formal evaluation of the published package is due to be completed by May 2009.

Qualidade da assistência de enfermagem: a opinião do paciente internado em hospital universitário público

The aim is to analyze the patient’s view of nursing care at the medical surgery unit of a public university hospital. The descriptive study employed a quantitative method. The analyzed data was gathered by interviewing hospitalized patients over nursing care quality and evaluating it. The results showed that hygiene, physical comfort, physical activities, sleep and refreshment levels concerning safe nursing care were achieved by the staff. Physical safety, nutrition and hydration levels were proper; however, elimination and emotional needs levels reached nursing care thresholds. The levels regarding spiritual and social needs revealed deficient nursing care, testifying to the little attention provided by the staff involving those aspects. The quality control pattern applied in this research proved to be a precious tool to identify the caring procedure quality of the assistance delivered.

Examining the conflation of multiculturalism, sexism, and religious fundamentalism through Taylor and Bakhtin: expanding post‐colonial feminist epistemology

In this post-9/11 era marked by religious and ethnic conflicts and the rise of cultural intolerance, ambiguities arising from the conflation of multiculturalism, sexism, and religious fundamentalism jeopardize the delivery of culturally safe nursing care to non-Western populations. This new social reality requires nurses to develop a heightened awareness of health issues pertaining to racism and ethnocentrism to provide culturally safe care to non-Western immigrants or refugees. Through the lens of post-colonial feminism, this paper explores the challenge of providing culturally safe nursing care in the context of the post-9/11 in Canadian healthcare settings. A critical appraisal of the literature demonstrates that post-colonial feminism, despite some limitations, remains a valuable theoretical perspective to apply in cultural nursing research and develop culturally safe nursing practice. Post-colonial feminism offers the analytical lens to understand how health, social and cultural context, race and gender intersect to impact on non-Western populations' health. However, an uncritical application of post-colonial feminism may not serve racialized men's and women's interests because of its essentialist risk. Post-colonial feminism must expand its epistemological assumptions to integrate Taylor's concept of identity and recognition and Bakhtin's concepts of dialogism and unfinalizability to explore non-Western populations' health issues and the context of nursing practice. This would strengthen the theoretical adequacy of post-colonial feminist approaches in unveiling the process of racialization that arises from the conflation of multiculturalism, sexism, and religious fundamentalism in Western healthcare settings.

Exemplar

The purpose of this article is to discuss issues surrounding the development of a new Bachelor of Nursing course for the University of Notre Dame, Sydney, Australia. In particular, the focus of the discussion is on the factors that influenced the development of learning outcomes that would enable student nurses the opportunity to develop the knowledge, skills and attitudes needed to advance both personally and professionally a cultural awareness of self and others appropriate for the Australian context and delivery of culturally congruent and safe nursing care. (non-author abstract)

Japanese Nursing Association's commitment as a professional organization to provide safe and secure nursing care

Japanese Nursing Association's commitment as a professional organization to provide safe and secure nursing care

Quality and safety education in nursing: More than new wine in old skins

The current national focus on enhancing patient safety resonates with nurses because high quality, safe nursing care has been the raison d’être for the nursing profession. Nursing educators, organizations, and regulators have worked together for the past century to insure this one, essential outcome. Undergirding the profession’s enduring value for quality care is a growing cadre of well-educated clinicians, advanced practice nurses, nurse scientists, and a maturing discipline that is supported by well-established schools of nursing. Since registered nurses constitute 40% of the US health professions workforce, the sheer size of this one profession would predict a strong, secure safety net for consumers of health care. How could it be otherwise? While nurses and other health professionals entered the 21st century armed with life-saving technologies, silently accompanying those same technologies was an unrecognized seamlessness of care that was essential to their safe use. 1 Wachter R.M. The end of the beginning Patient safety five years after “To err is human.”. Health Affairs. 2004; 23 (Available at: http://content.healthaffairs.org/cgi/content/full/hlthaff.w4.534/DC1. Accessed on October 23, 2006): 534-545 Google Scholar No longer could the safe practice of any one provider guarantee that patients would receive either safe or effective health care because of the many providers, and many hand-offs involved in any one case. As hospitals became the environment for sicker and older patients, the safe margin of error for any one patient dramatically narrowed. L. Antoinette Bargagliotti is President, National League for Nursing (NLN). Jeanette Lancaster is President, American Association of Colleges of Nursing (AACN).

Monitoring Entry-Level Practice

The National Council Licensure Examination for Registered Nurses assesses whether a candidate has the ability to provide safe and effective nursing care upon entry into practice. It is essential that this assessment be current and relevant to nursing practice. The authors discuss methods that are used to provide evidence to support the 2007 NCLEX-RN Test Plan and to maintain the currency of the examination.

A Migrant Family's Experience of Palliative Care

The aim of this study was to explore the lived experience of palliative nursing care for different generations of a migrant family in the New Zealand context. Methodology used was an intrinsic case study. The twin threads of the family's region and their immigration experience influenced their experiences and their ways of coping in the four domains of family relationships, the support they received from their community, their ability to communicate, and their relationship with palliative care services. Palliative care was by a family approach with strong community support and empowered by culturally safe and appropriate nursing practice. This study explored the underpinnings of culturally safe palliative nursing care.

Case Study: Reconciling the Quality and Safety Gap through Strategic Planning

An essential outcome of professional practice environments is the provision of high-quality, safe nursing care. To mitigate the quality and safety chasm, nursing leadership at St. Michael's Hospital undertook a strategic plan to enhance the nursing professional practice environment. This case study outlines the development of the strategic planning process: the driving forces (platform); key stakeholders (process and players); vision, guiding principles, strategic directions, framework for action and accountability (plan); lessons learned (pearls); and next steps to moving forward the vision, strategic directions and accountability mechanisms (passion and perseverance).

Congestive Heart Failure Education Study

Nursing staff providing care to patients on a medical/surgical unit must be generalists rather than specialists in disease management. The diversity of illnesses seen among this population requires the nurse to be expert in many disease processes. The complexity of patients who are admitted to a medical/surgical unit continues to increase and is therefore challenging to nurses. Complex patient populations can be attributed to individuals living longer and the advancement of technology and information in treating serious medical conditions. Nursing expertise for different disease processes can vary according to experience, educational level, and knowledge regarding evidence-based practice. Lack of knowledge regarding current practice guidelines and care may result in poor patient outcomes and high cost. Confidence in performing safe and quality nursing care can also be affected by lack of knowledge. Continuing education for nursing must be made a priority for nurses to provide safe and high quality care. Education provided must be current and based on positive outcomes through research-based nursing practice.

What nurse case managers need to know about the Nurse Licensure Compact

In the late 1990s, the National Council of State Boards of Nursing (NCSBN) began exploring several nurse-licensing models that would simplify government processes and remove regulatory barriers, while increasing access to safe nursing care. The NCSBN decided on the mutual-recognition model (similar to that used for state driver's licenses), which allows a nurse to practice in states other than the one in which the license was issued, usually the state of residency, as long as that individual acknowledges that he or she is subject to each state's practice laws and discipline. Like the driver's license model, nursing practice across state lines is allowed, whether physical or electronic, unless the nurse is under discipline or a monitoring agreement that restricts practice across state lines.

Highlights From the 7th International Family Nursing Conference: Plenary Address: The “Hard Spots” of Family Nursing

The focus of this discussion is how nurses might more effectively work within the “hard spots” of family nursing to connect across difference. Taking a pragmatic stance toward knowledge, the practical consequences of ideas and theories informing definitions of family and family nursing practice are examined. The authors propose that the provision of competent, ethical, and culturally safe nursing care could be greatly enhanced by a relational view. In particular it is suggested that understanding family as a relational experience, understanding nursing and culture as relational processes and conceptualizing difference as a basis for connection can provide a foundation for more effectively working across differences. Using this relational view the authors outline processes that have the potential to foster more equitable, just, and compassionate family nursing practice.

Modified triangular posterior osteosynthesis of unstable sacrum fracture

We report preliminary results for unstable sacral fractures treated with a modified posterior triangular osteosynthesis. Seven patients were admitted to our trauma center with an unstable sacral fracture. The average age was 31 years (22-41). There were four vertical shear lesions of the pelvis and three transverse fracture of the upper sacrum. The vertical shear injuries were initially treated with an anterior external fixator inserted at the time of admission. Definitive surgery was performed at a mean time of 9 days after trauma. The operation consisted in a posterior fixation combining a vertebropelvic distraction osteosynthesis with pedicle screws and a rod system, whereby the transverse fixation was obtained using a 6 mm rod as a cross-link between the two main rods. Late displacement of the posterior pelvis or fracture was measured on X-ray films according to the criteria of Henderson. The patients were followed-up for a minimum time of 12 months. Four patients who presented with a pre-operative perineal neurological impairment made a complete recovery. No iatrogenic nerve injury was reported. One case of deep infection was managed successfully with surgical debridement and local antibiotics. All patients complained of symptoms related to the prominence of the iliac screws. The metalwork was removed in all cases after healing of the fracture, at a mean time of 4.3 months after surgery. No loss of reduction of fracture was seen at final radiological follow-up. The preliminary results are promising. The fixation is sufficiently stable to allow an immediate progressive weight-bearing, and safe nursing care in polytrauma cases. The only problem seems to be related to prominent heads of the distal screws.

Systemic oxygen-free radical production in iron-loaded mice.

Although iron is an essential element for normal cell metabolism, in excess quantities it is highly cytotoxic and lethal. In fact, acute iron poisoning is a leading cause of overdose mortality in young children. Hereditary hemochromatosis, a disorder of iron metabolism, is currently the most prevalent genetic disorder in the world, which results in organ failure and premature mortality. Hence, an enhanced understanding of its pathogenesis is critical for providing safe and effective nursing care to affected individuals and their families. Although the exact mechanism of iron's toxicity is not known, it was hypothesized that chronic iron loading would result in increased tissue (heart, liver, and spleen) concentrations of iron and increased free radical production in a murine model (n = 20). Our results show that chronic iron loading results in highly significant dose-dependent increases in tissue concentrations of iron and systemic free radical generation (p < 0.001).

Best practice guidelines.

Best practice guidelines and multidisciplinary pathways of care are becoming an established and essential feature of clinical practice. They can be seen in a wide variety of clinical settings ranging right across the primary, secondary and tertiary health and social care spectrums. The 1997 White Paper places strong emphasis on quality and consistency of care delivery and gives assurances of performance measurements, integrated care (Wilson, 1996) and clinical governance. It suggests making healthcare delivery against national standards a local responsibility and quality of care the driving force for decision making at every level of the service to ensure excellence for patients no matter where the care is provided. A number of controversial issues surround the use of guidelines. Some argue that they are a fetter on clinical discretion, clinical freedom and can lead to the practice of 'cookbook medicine'. Others maintain that they are an essential aid to providing safe and appropriate medical and nursing care.