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Acute Care Settings (acute + care_setting)
Selected AbstractsDEVELOPING STRATEGIES TO GATHER INFORMATION ABOUT THE MATERNITY EXPERIENCES OF INDIGENOUS WOMEN IN AN ACUTE CARE SETTINGAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2002Jennifer Watson ABSTRACT: This project emerged from the concerns of health care professionals at a large acute care hospital in the Northern Territory of Australia. The aim of the project was to develop educational resources through information and experiences provided by Aboriginal and Torres Strait Islander women and health care professionals. The objectives are to optimise collaboration and participation by Indigenous and Torres Strait Islander women in sharing their maternity experiences about the birthing of their baby either in hospital, or out of hospital before arrival. Stage one of a three stage project is reported here. In stage one a modified Delphi method was used to interview ten purposefully chosen professional Indigenous women with insight into the research process and changing social arrangements. Stage two involved the development of an interview schedule and face-to-face interviews. Stage three includes the development of a questionnaire to be answered by health care professionals. Discussion of the background to the study, reviewed literature and issues identified from interviews with the professional Indigenous women regarding best methods and appropriate data collection processes is presented. Research described here explores issues of concern for Indigenous women from the Northern Territory around their child birthing experiences in an acute care setting. [source] THE MATERNITY EXPERIENCES OF INDIGENOUS WOMEN ADMITTED TO AN ACUTE CARE SETTINGAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2002Jennifer Watson ABSTRACT: This is the report of stage two of a three-stage project. The aim of the project is to develop educational resources through information and experiences provided by Aboriginal and Torres Strait Islander women and health care professionals. The objectives were to optimise collaboration and participation by Indigenous and Torres Strait Islander women in sharing their maternity experiences about the birthing of their babies either in hospital, or out of hospital before arrival. The descriptive research of stage two explores issues that existed for twelve Indigenous women during and after their birthing experiences in an acute care setting. The results will inform patient and professional educational programs and policy in order to enhance the experiences for Indigenous women admitted to the acute care setting before or following birth. The results show broad variation in responses related to antenatal care, preparation for hospital and for birth, coming into town, accommodation, family support, experiences while in hospital, relationship with hospital staff and being away from home. Miscommunication and lack of cultural and spiritual understanding by health care professionals generally is a constant theme. The need for preparation of Indigenous women generally, prior to admission to an acute care setting, is confirmed. [source] EVIDENCE SYNTHESIS: Appropriateness of using a symbol to identify dementia and/or deliriumINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 3 2010Sonia Hines RN BN Abstract Aim, The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. Methods, Using the methods of the Joanna Briggs Institute, we conducted a systematic search of a wide range of databases, Internet resources and unpublished literature. Papers meeting the inclusion criteria were critically appraised by two independent reviewers. Data were extracted, using the standardised tool from the Joanna Briggs Institute, from those papers considered to be of sufficient quality. Because of significant methodological heterogeneity, no meta-analysis was possible and results are presented narratively instead. Results, From a total of 37 retrieved papers, 18 were found to be of sufficient relevance and quality to be included in the review. There was general consensus among the literature that a symbol for dementia is appropriate in the acute care setting. It was also clear from the research that an abstract symbol, as opposed to one that explicitly attempts to depict dementia, was most acceptable to staff, people with dementia and their carers. Conclusions, Both staff and health consumers seem to have largely positive perceptions and attitudes towards the use of a symbol for dementia. Families and carers of people with dementia are frequently concerned about their loved one wandering away and becoming lost and unable to identify themselves, and these concerns seem to outweigh any reservations they hold about the use of a symbol or some other identifier. In healthcare settings the use of symbols to indicate special needs seems well established and widely accepted. However, regarding the use of a symbol for dementia in the broader community, there remain concerns about issues such as stigmatisation and the potential for victimisation of this vulnerable population and so further research is indicated. [source] Minimising undernutrition in the older inpatientINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2007Dawn Vanderkroft BSc internshipNutr&Diet APD Abstract Background, Malnutrition among elderly hospitalised patients is widespread and has been shown to lead to adverse health outcomes. The effectiveness of interventions to minimise undernutrition in elderly inpatients is not well documented. Objectives, To identify the best available practices, in the hospital setting, that minimise undernutrition or the risk of undernutrition, in the acute care patient especially for the older patient. The review will assesses the effectiveness of a range of interventions designed to promote adequate nutritional intake in the acute care setting, with the aim of determining what practices minimise malnutrition in the elderly inpatients. Search strategy, English language articles from 1980 onwards were sought using Medline, Premedline, Cinahl, Austrom-Australasian Medical Index and AustHealth, Embase and Science Citations Index. Selection criteria, For inclusion the study had to include an intervention aiming to minimise undernutrition in hospitalised elderly patients aged 65 years or older. All study designs were included. Data collection and analysis, Two independent reviewers assessed the eligibility of each study for inclusion into the review, critically appraised the study quality and extracted data using standardised tools. For each outcome measure results were tabulated by intervention type and discussed in a narrative summary. Results from randomised controlled trials were pooled in meta-analyses where appropriate. Main results, Twenty-nine studies met the inclusion criteria, with a total of 4021 participants. The focus of 15 interventions was the supplying of oral supplements to the participants, six focused on enteral nutrition therapy, four interventions made changes to the foods provided as part of the hospital diet, one included the services of an additional staff member and three incorporated the implementation of evidence-based guidelines. Ten meta-analyses were conducted from which the main findings were: significant improvements in weight status and arm muscle circumferences with an oral supplement intervention, P < 0.05. Reviewers' conclusions, The findings of the review support the use of oral supplements to minimise undernutrition in elderly inpatients. The results also emphasise the need for more high-quality research using appropriate outcome measures in the area of minimisation of undernutrition, particularly interventions that make alterations to the hospital diet and address support for feeding patients at the ward level. [source] Evaluation of a falls prevention programme in an acute tertiary care hospitalJOURNAL OF CLINICAL NURSING, Issue 2 2007M Hth Sci, PG Dip Clin Epi, Teresa A Williams BN Aims and objectives., To evaluate a systematic, coordinated approach to limit the severity and minimize the number of falls in an acute care hospital. Background., Patient falls are a significant cause of preventable injury and death, particularly in older patients. Best practice principles mandate that hospitals identify those patients at risk of falling and implement interventions to prevent or minimize them. Methods., A before and after design was used for the study. All patients admitted to three medical wards and a geriatric evaluation management unit were enrolled over a six-month period. Patients' risk of falling was assessed using a falls risk assessment tool and appropriate interventions implemented using a falls care plan. Data related to the number and severity of falls were obtained from the Australian Incident Monitoring System database used at the study site. Results., In this study, 1357 patient admissions were included. According to their risk category, 37% of patients (n = 496) were grouped as low risk (score = 1,10), 58% (n = 774) medium risk (score = 11,20) and 5% (n = 63) high risk (score = 21,33) for falls. The incidence of falls (per average occupied bed day) was eight per 1000 bed days for the study period. Compared with the same months in 2002/2003, there was a significant reduction in falls from 0·95 to 0·80 (95% CI for the difference ,0·14 to ,0·16, P < 0·001). Conclusion., We evaluated a systematic, coordinated approach to falls management that included a falls risk assessment tool and falls care plan in the acute care setting. Although a significant reduction in falls was found in this study, it could not be attributed to any specific interventions. Relevance to clinical practice., Preventing falls where possible is essential. Assessment of risk and use of appropriate interventions can reduce the incidence of falls. [source] The sensitivity and specificity of the Morse Fall Scale in an acute care settingJOURNAL OF CLINICAL NURSING, Issue 1 2002BEV O'CONNELL MSc, FRCNA [source] Diagnosis and treatment of atrial fibrillation in the acute care settingJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 6 2010ACNP-BC, Fatima Nottingham MS Abstract Purpose: To discuss the causes of atrial fibrillation (AF), risk factors, and pathophysiology, and review current treatment guidelines for AF in the inpatient setting. Data sources: Peer-reviewed medical and nursing journals, American College of Cardiology (ACC), American Heart Association (AHA), and European Society of Cardiology (ESC) practice guidelines. Conclusions: There are many predisposing factors to AF and a variety of treatment modalities. Nurse practitioners (NPs) should acquaint themselves with the pathophysiology and evidence-based treatments in order to provide individually based care to patients. Implications for practice: Pharmacological management is often warranted in patients with AF. NPs must be aware of updated clinical evidence in order to properly treat patients to provide symptomatic relief and improve quality of life. [source] Blood cultures for febrile patients in the acute care setting: Too quick on the draw?JOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2008ACNP-BC, Barbara K. Chesnutt MSN Abstract Purpose: To review the fever literature and determine how 38.3°C was deemed the optimal fever threshold that predicts bacteremia. Data sources: PubMed, MEDLINE, Cochrane database, and the Cumulative Index to Nursing and Allied Health. Conclusions: A temperature of 38.3°C has come to be the threshold value that typically triggers diagnostic fever evaluation for bacteremia in hospitalized patients. Studies that define predictors of bacteremia provide conflicting results, and most bacteremia predictor models have not been externally validated. Therefore, current fever guidelines are based on consensus opinion rather than large clinical trials identifying a specific threshold with high sensitivity and a high negative predictive value. Implications for practice: The use of a single temperature threshold of 38.3°C for the prediction of bacteremia is not sufficient in all patients. Additional factors should be considered, including patient population, supporting clinical signs and symptoms, and the patient's medical history. [source] Levels of autonomy of nurse practitioners in an acute care settingJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2007CCRN (Clinical Nurse Manager), Corazon B. Cajulis DNP Abstract Purpose: The purpose of this descriptive study was to determine the level of autonomy of nurse practitioners (NPs) providing care to an adult patient population in an acute care setting. Data sources: Data were collected from 54 NPs in different specialty areas currently working in a large metropolitan hospital. The Dempster Practice Behaviors Scale was used to measure the autonomy of the NPs. Conclusions: The overall mean autonomy score of 117.37 (SD = 14.55) indicates a high level of autonomy of the NPs in this study. Forty-one percent of the participants had very high levels of autonomy, 31.5% had extremely high levels of autonomy, and 19% had moderate levels of autonomy. Demographic variables of age; years worked as an NP, as an RN, and at current job; highest educational level; basic nursing preparation; NP certification; and specialty had no statistically significant relationship with autonomy scores. Implications for practice: The results of this study provided preliminary evidence of the level of autonomy of NPs providing inpatient care to adult patients in an acute care setting. The findings could lead to future research on the impact of NP services on patient outcomes and clinical productivity in acute care settings. [source] Palliative care in aged care facilities for residents with a non-cancer disease: results of a survey of aged care facilities in South AustraliaAUSTRALASIAN JOURNAL ON AGEING, Issue 2 2005Carol Grbich Objectives:,This study reports the results of a cross-sectional study of residential aged care facilities in South Australia which sought to quantify the extent of specialist palliative care involvement in residential aged care facilities as well as identifying the current need for palliative care. Method:,A questionnaire was completed by 51 Directors of Care from 51 of 90 facilities targeted, representing a response rate of 57% and representing 20% of the total number of South Australian licensed beds. Facilities responding were representative of residential aged care facilities in South Australia for location, type of funding and level of care. Results:,Thirty facilities (59%) used specialist palliative care services during 2001 with the average number of residents consulted being four. There were 627 deaths recorded in the 2785 licensed beds, a death rate of 23%. The majority of these deaths were from non-cancer diseases (83%) and up to two-thirds of all deaths occurred away from low care facilities, usually in an acute care setting. Main reasons for transfer away from the facility were; an acute care episode requiring other expertise, rapid deterioration of the resident, care needs beyond the facility, or the general practitioner or family requested a transfer. Care Directors estimated that 7% of their current residents would be considered palliative and the majority of these had non-cancer diseases (78%). Conclusion:,These findings indicate that palliative care is an important aspect of care in residential aged care facilities for clients with a non-cancer diagnosis. [source] DEVELOPING STRATEGIES TO GATHER INFORMATION ABOUT THE MATERNITY EXPERIENCES OF INDIGENOUS WOMEN IN AN ACUTE CARE SETTINGAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2002Jennifer Watson ABSTRACT: This project emerged from the concerns of health care professionals at a large acute care hospital in the Northern Territory of Australia. The aim of the project was to develop educational resources through information and experiences provided by Aboriginal and Torres Strait Islander women and health care professionals. The objectives are to optimise collaboration and participation by Indigenous and Torres Strait Islander women in sharing their maternity experiences about the birthing of their baby either in hospital, or out of hospital before arrival. Stage one of a three stage project is reported here. In stage one a modified Delphi method was used to interview ten purposefully chosen professional Indigenous women with insight into the research process and changing social arrangements. Stage two involved the development of an interview schedule and face-to-face interviews. Stage three includes the development of a questionnaire to be answered by health care professionals. Discussion of the background to the study, reviewed literature and issues identified from interviews with the professional Indigenous women regarding best methods and appropriate data collection processes is presented. Research described here explores issues of concern for Indigenous women from the Northern Territory around their child birthing experiences in an acute care setting. [source] THE MATERNITY EXPERIENCES OF INDIGENOUS WOMEN ADMITTED TO AN ACUTE CARE SETTINGAUSTRALIAN JOURNAL OF RURAL HEALTH, Issue 3 2002Jennifer Watson ABSTRACT: This is the report of stage two of a three-stage project. The aim of the project is to develop educational resources through information and experiences provided by Aboriginal and Torres Strait Islander women and health care professionals. The objectives were to optimise collaboration and participation by Indigenous and Torres Strait Islander women in sharing their maternity experiences about the birthing of their babies either in hospital, or out of hospital before arrival. The descriptive research of stage two explores issues that existed for twelve Indigenous women during and after their birthing experiences in an acute care setting. The results will inform patient and professional educational programs and policy in order to enhance the experiences for Indigenous women admitted to the acute care setting before or following birth. The results show broad variation in responses related to antenatal care, preparation for hospital and for birth, coming into town, accommodation, family support, experiences while in hospital, relationship with hospital staff and being away from home. Miscommunication and lack of cultural and spiritual understanding by health care professionals generally is a constant theme. The need for preparation of Indigenous women generally, prior to admission to an acute care setting, is confirmed. [source] Communicating with Subjects: Special Challenges for Resuscitation ResearchACADEMIC EMERGENCY MEDICINE, Issue 11 2005Ilene Wilets PhD Abstract In May 2005, Academic Emergency Medicine sponsored a one-day consensus conference held in association with the 2005 Society for Academic Emergency Medicine meeting in New York City. The conference, entitled "Ethical Conduct of Resuscitation Research," addressed a variety of issues regarding the successful conduct of research in acute care settings. A number of important breakout sessions were convened based on challenges specific to resuscitation research. "Communicating with Subjects" was one such session, dedicated toward perfecting the conduct of informed consent for research. The breakout session was attended by 15 insightful emergency medicine investigators, administrators, and ethicists. Issues of research information disclosure, subject comprehension, and the voluntariness of research participation were addressed. Consensus statements were developed and are discussed within this report. [source] Culturally diverse patient,nurse interactions on acute care wardsINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 6 2006Jane Cioffi RN PhD The nurse,patient interaction is central to providing nursing care. This qualitative study explores nurses' and culturally diverse patients' experiences within nurse,patient relationships in acute care wards. Eight nurses and their respective patients volunteered to join the study and were interviewed. The three themes identified in relationships between nurses and culturally diverse patients were shared tension, perceived difference and held awareness. It is concluded from the study that relationships between nurses and culturally diverse patients in acute care wards during short episodes of hospitalization are not easy for nurses and need to receive deeper consideration as to how they can be developed more effectively. It is recommended that educational support be provided to develop more effective interactions between nurses and patients with research being carried out to investigate factors that can strengthen culturally diverse patient,nurse interactions in acute care settings. [source] Estimating nurses' workload using the Diagnosis Procedure Combination in JapanINTERNATIONAL NURSING REVIEW, Issue 3 2008Y. Kamijo rn Aim:, To examine the methods used to estimate nurse staffing levels in acute care settings with Diagnosis Related Groups, which in Japan are called the Diagnosis Procedure Combination (DPC). Methods:, For estimating staffing requirements, the study used four DPC groups: (1) acute or recurrent myocardial infarction (AMI) with stenting, (2) angina pectoris with coronary artery bypass grafting (CABG), (3) sub-arachnoid haemorrhage (SAH) with clipping surgery, and (4) cerebral infarction with carotid endarterectomy (CEA). Registered nurses with more than 3-year nursing experience in nine university hospitals in the Tokyo metropolitan area completed self-report questionnaires in order to obtain nursing care time and care intensity per each DPC. The concordance rate was measured by Kendall's coefficient of concordance. The relationship between the care time and the care intensity was examined by a time series graph per DPC. Care intensity consisted of professional judgement, mental effort for helping patients, professional skill, physical effort for providing activities of daily living support, and nurse stress, based on the Hsiao and colleagues' model of resource-based relative value scale. Results:, Twenty-five nurses in nine university hospitals answered for a hypothetical typical patient with AMI and with CABG, and 28 nurses in nine university hospitals answered for a hypothetical typical patient with SAH and with CEA. Kendall's coefficient of concordance was 0.896 for AMI, 0.855 for CABG, 0.848 for SAH, 0.854 for CEA. The time series data of the care time and the care intensity items showed different patterns for each DPC. Conclusion:, The DPC for cardiovascular and cerebral surgical procedures can be used for estimating nurses' workload. [source] Inpatient falls in adult acute care settings: influence of patients' mental statusJOURNAL OF ADVANCED NURSING, Issue 8 2010Huey-Ming Tzeng tzeng h.-m. (2010) Inpatient falls in adult acute care settings: influence of patients' mental status. Journal of Advanced Nursing,66(8), 1741,1746. Abstract Title.,Inpatient falls in adult acute care settings: influence of patients' mental status. Aim., This paper is a report of a study of fallers' mental status as one of the patient-related intrinsic risk factors for falls. Background., Whether confusion is one of the most important risk factors associated with risk of falling in hospital settings is unclear. Literature reviews have not identified consistent evidence for effective preventive interventions for patients with mental status deficits. Methods., This retrospective research was conducted in six adult acute care units in a community hospital in the United States of America. The data source was the 1017 fall incidents occurring between 1 July 2005 and 30 April 2009. Descriptive statistics and Pearson chi-square tests were used to analyse the data. Results., The presence of mental status deficits was identified as the dominant issue in 346 (34%) falls. The group of fallers with mental status deficits (32·1%, n = 111) seemed to have fewer toileting-related falls than those without mental status deficits (46·7%, n = 314). Fallers with mental status deficits tended to have more severe fall injuries than those without mental status deficits (,2 = 10·08, d.f. = 3, P = 0·018). Conclusion., Risk assessment and targeted surveillance should be used as part of falls prevention policy. Involving nursing staff and family members in assessing a patient's mental status may help to prevent falls caused by mental status deficits. [source] A literature review: factors that impact on nurses' effective use of the Medical Emergency Team (MET)JOURNAL OF CLINICAL NURSING, Issue 24 2009Lisa Jones Aims and objectives., The aim of this literature review is to identify factors, both positive and negative, that impact on nurses' effective use of the Medical Emergency Team (MET) in acute care settings. Background., Outcomes for patients are often dependent on nurses' ability to identify and respond to signs of increasing illness and initiate medical intervention. In an attempt to improve patient outcomes, many acute hospitals have implemented a rapid response system known as the Medical Emergency Team (MET) which has improved management of critically ill ward patients. Subsequent research has indicated that the MET system continues to be underused by nurses. Design., A comprehensive thematic literature review. Methods., The review was undertaken using key words and the electronic databases of Cumulative Index to Nursing and Allied Health Literature (CINAHL), OVID/MEDLINE, Blackwell Synergy, Science Direct and Informit. Fifteen primary research reports were relevant and included in the review. Results., Five major themes emerged from the analysis of the literature as the major factors effecting nurses' use of the MET system. They were: education on the MET, expertise, support by medical and nursing staff, nurses' familiarity with and advocacy for the patient and nurses' workload. Conclusions., Ongoing education on all aspects of the MET system is recommended for nursing, medical and MET staff. Bringing MET education into undergraduate programs to prepare new graduates entering the workforce to care for acutely ill patients is also strongly recommended. Further research is also needed to determine other influences on MET activation. Relevance to clinical practice., Strategies that will assist nurses to use the MET system more effectively include recruitment and retention of adequate numbers of permanent skilled staff thereby increasing familiarity with and advocacy for the patient. Junior doctors and nurses should be encouraged to attend ward MET calls to gain skills in management of acutely ill patients. [source] Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providersJOURNAL OF CLINICAL NURSING, Issue 4 2003Elizabeth Manias BPHARM, FRCNA, MNursStud, MPharm Summary ,,There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers. ,,This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work. ,,Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate. ,,Three major themes emerged from interview data: planning for ward allocation, communication and professionalism. ,,In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff. ,,Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses. ,,For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration. ,,A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles. ,,The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled , with the aim of providing quality patient care. [source] Levels of autonomy of nurse practitioners in an acute care settingJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 10 2007CCRN (Clinical Nurse Manager), Corazon B. Cajulis DNP Abstract Purpose: The purpose of this descriptive study was to determine the level of autonomy of nurse practitioners (NPs) providing care to an adult patient population in an acute care setting. Data sources: Data were collected from 54 NPs in different specialty areas currently working in a large metropolitan hospital. The Dempster Practice Behaviors Scale was used to measure the autonomy of the NPs. Conclusions: The overall mean autonomy score of 117.37 (SD = 14.55) indicates a high level of autonomy of the NPs in this study. Forty-one percent of the participants had very high levels of autonomy, 31.5% had extremely high levels of autonomy, and 19% had moderate levels of autonomy. Demographic variables of age; years worked as an NP, as an RN, and at current job; highest educational level; basic nursing preparation; NP certification; and specialty had no statistically significant relationship with autonomy scores. Implications for practice: The results of this study provided preliminary evidence of the level of autonomy of NPs providing inpatient care to adult patients in an acute care setting. The findings could lead to future research on the impact of NP services on patient outcomes and clinical productivity in acute care settings. [source] A Qualitative Case Study Review of Role Transition in Community NursingNURSING FORUM, Issue 4 2007Joyce Zurmehly PhD PURPOSE.,This paper aims to describe existing community nursing practices and to explore factors that are associated with the transition of clinical practice from acute care settings to community care settings. METHOD.,This qualitative case study assessment described existing community nurse practices and explored factors that were associated with the transition to community practice from acute care settings. The 48 participants in this case study were registered nurses who were working in community care nursing during the interview process. CONCLUSIONS.,The results of this investigation revealed themes derived from data collection, including autonomy, client and family, education, and community as nursing work. This study indicated that making the transition to community-based nursing includes conceptual as well as emotional adjustments. Community nursing practice was seen by the participants as nursing that captures a holistic approach incorporating multiple dimensions from psychological, sociological, economic, and physical to spiritual aspects that provides services in interaction between the community nurse, the client, and the family. The findings indicate a need for additional supportive preparation strategies incorporated into nursing orientation and continuing education programs. Future research investigating agency culture and socialization would provide a more definitive survey of perceptions and competencies needed for role. [source] Nurse-led discharge from high dependency unitNURSING IN CRITICAL CARE, Issue 2 2003Gillian Knight Summary ,High dependency care is a rapidly evolving area of critical care, with high patient turnover, which ultimately leads to high levels of pressure for beds ,There is a growing trend emerging, recognizing the importance and value of nurse-led initiatives in delivering effective nursing care in acute care settings ,One specific nurse-led initiative this author has developed is that of nurse-led discharge (NLD) from the high dependency unit (HDU), in order to optimize the utilization of critical care beds within the HDU ,An audit of the current practice was undertaken, which ultimately led to the implementation of NLD ,Early experiences indicate that HDU beds are now being used more effectively [source] Australian occupational therapy practice in acute care settingsOCCUPATIONAL THERAPY INTERNATIONAL, Issue 3 2001Dr Susan D. Griffin Lecturer, Faculty of Health Sciences Abstract A national sample of occupational therapists was surveyed to explore the nature of Australian occupational therapy practice in acute care settings. Self-care was the major client need that therapists reported they addressed, with an initial interview being the most common assessment procedure. Client education was the most frequently used intervention. The most important skills therapists reported for effective practice in acute care were time management, quick clinical reasoning and lateral thinking. Important workplace characteristics included a cooperative health-care team and early referral. Therapists reported that their most important resources were supportive senior therapists and a well-resourced equipment pool. Three attitudinal factors emerged. Therapists in interdisciplinary teams and those with more experience had more positive attitudes. Younger therapists experienced more concern about not being able to do more for their patients. Results suggest a need for graduates to be better prepared in some skill areas and to have more realistic expectations of practice in this area. Department managers need to ensure younger therapists receive adequate support from senior therapists. Further research is needed to determine how best to provide this support and to further examine the influence of the education experience on practice expectations. Copyright © 2001 Whurr Publishers Ltd. [source] Occupational injuries among aides and nurses in acute care,AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 12 2009R.L. Rodríguez-Acosta PhD Abstract Background Occupational injuries are common among nursing personnel. Most epidemiologic research on nursing aides comes from long-term care settings. Reports from acute care settings often combine data on nurses and aides even though their job requirements and personal characteristics are quite different. Our objective was to assess risk of work-related injuries in an acute care setting while contrasting injuries of aides and nurses. Methods A retrospective cohort of aides (n,=,1,689) and nurses (n,=,5,082) working in acute care at a large healthcare system between 1997 and 2004 were identified via personnel records. Workers' compensation filings were used to ascertain occupational injuries. Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (95% CI). Results Aides had higher overall injury rates than nurses for no-lost work time (RR,=,1.2, 95% CI: 1.1,1.3) and lost work time (RR,=,2.8, 95% CI: 2.1,3.8) injuries. The risk of an injury due to lifting was greater among aides compared to nurses for both non-lost work time and lost work time injuries. Injury rates among aides were particularly high in rehabilitation and orthopedics units. Most of the injuries requiring time away from work for both groups were related to the process of delivering direct patient care. Conclusions Our findings illustrate the importance of evaluating work-related injuries separately for aides and nurses, given differences in injury risk profiles and injury outcomes. It is particularly important that occupational safety needs of aides be addressed as this occupation experiences significant job growth. Am. J. Ind. Med. 52:953,964, 2009. © 2009 Wiley-Liss, Inc. [source] Medicare and Medicaid: Conflicting Incentives for Long-Term CareTHE MILBANK QUARTERLY, Issue 4 2007DAVID C. GRABOWSKI The structure of Medicare and Medicaid creates conflicting incentives regarding dually eligible beneficiaries without coordinating their care. Both Medicare and Medicaid have an interest in limiting their costs, and neither has an incentive to take responsibility for the management or quality of care. Examples of misaligned incentives are Medicare's cost-sharing rules, cost shifting within home health care and nursing homes, and cost shifting across chronic and acute care settings. Several policy initiatives,capitation, pay-for-performance, and the shift of the dually eligible population's Medicaid costs to the federal government,may address these conflicting incentives, but all have strengths and weaknesses. With the aging baby boom generation and projected federal and state budget shortfalls, this issue will be a continuing focus of policymakers in the coming decades. [source] Intimate Partner Violence: Development of a Brief Risk Assessment for the Emergency DepartmentACADEMIC EMERGENCY MEDICINE, Issue 11 2009Carolyn Snider MD Abstract Objectives:, Women assaulted by intimate partners are frequently patients in emergency departments (EDs). Many victims and health care providers fail to take into account the potential risks of repeat partner violence. The objective of this study was to use data from a larger study of domestic violence risk assessment methods to develop a brief assessment for acute care settings to identify victims at highest risk for suffering severe injury or potentially lethal assault by an intimate partner or former partner. Methods:, Victims of intimate partner violence (IPV) were interviewed twice between 2002 and 2004. The baseline interview included the 20 items of Campbell's Danger Assessment (DA; predictor). The follow-up interview, conducted 9 months later on average, assessed abuse inflicted since the baseline interview (outcome). Multiple logistic regression was used to identify questions on the DA most predictive of severe abuse and potentially lethal assaults. Female IPV victims were recruited from New York City family courts, Los Angeles County Sheriff's Department 9-1-1 calls, New York City and Los Angeles shelters, and New York City hospitals; 666 women responded to the DA at baseline, and 60% participated in follow-up interviews. Results:, Severe injuries or potentially lethal assaults were experience by 14.9% of retained study participants between the baseline and follow-up interviews. The best brief prediction instrument has five questions. A positive answer to any three questions has a sensitivity of 83% (95% confidence interval = 70.6% to 91.4%). Conclusions:, This instrument can help predict which victims may be at increased risk for severe injury or potentially lethal assault and can aid clinicians in differentiating which patients require comprehensive safety interventions. [source] | ||||||||||