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Clinical Practice. (clinical + practice)
Selected AbstractsFactors associated with delirium severity among older patientsJOURNAL OF CLINICAL NURSING, Issue 5 2007Philippe Voyer PhD Aim., The goal of this study was to determine whether the factors associated with delirium varied according to the severity of the delirium experienced by the older patients. Background., Delirium among older patients is prevalent and leads to numerous detrimental effects. The negative consequences of delirium are worse among older adults with severe delirium compared with patients with mild delirium. There has been no study identifying those factors associated with delirium severity among long-term care older patients newly admitted to an acute care hospital. Design., This is a descriptive study. Methods., This is a secondary analysis study of institutionalized older patients newly admitted to an acute care hospital (n = 104). Upon admission, patients were screened for delirium with the Confusion Assessment Method and severity of delirium symptoms were determined by using the Delirium Index. Results., Of the 71 delirious older patients, 32 (45·1%) had moderate-severe delirium while 39 (54·9%) presented mild delirium. In univariate analyses, a significant positive relationship was observed between the level of prior cognitive impairment and the severity of delirium (p = 0·0058). Low mini-mental state examination (MMSE) scores (p < 0·0001), the presence of severe illness at the time of hospitalization (p = 0·0016) and low functional autonomy (BI: p = 0·0017; instrumental activities of daily living: p = 0·0003) were significantly associated with moderate-severe delirium. Older patients suffering from mild delirium used significantly more drugs (p = 0·0056), notably narcotics (p = 0·0017), than those with moderate-severe delirium. Results from the stepwise regression indicated that MMSE score at admission and narcotic medication use are the factors most strongly associated with the severity of delirium symptoms. Conclusions., This present study indicates that factors associated with moderate-severe delirium are different from those associated with mild delirium. Given the result concerning the role of narcotics, future studies should evaluate the role of pain management in the context of delirium severity. Relevance to Clinical Practice., As moderate-severe delirium is associated with poorer outcomes than is mild delirium, early risk factor identification for moderate-severe delirium by nurses may prove to be of value in preventing further deterioration of those older patients afflicted with delirium. [source] A systematic review of topical skin care in aged care facilitiesJOURNAL OF CLINICAL NURSING, Issue 1 2007Brent Hodgkinson BSc Aim., This systematic review aimed to evaluate the best available evidence regarding the effectiveness of topical skin care interventions for residents of aged care facilities. Introduction., Natural changes to skin, as well as increased predisposition to pressure sores and incontinence, means residents of aged care facilities readily require topical skin care. A range of interventions exist that aim to maintain or improve the integrity of skin of older adults. Methods., Pubmed, Embase, Current Contents, CINAHL and The Cochrane Library databases were searched, as well as Health Technology Assessment websites up to April 2003. Systematic reviews and randomized or non-randomized controlled trials were evaluated for quality and data were independently extracted by two reviewers. Results., The effectiveness of topical skin interventions was variable and dependent on the skin condition being treated. Studies examined the effectiveness of washing products on incontinence irritated skin. Disposable bodyworns may prevent deterioration of skin condition better than non-disposable underpads or bodyworns. Clinisan, a no-rinse cleanser may reduce the incidence of incontinence associated pressure ulcers when compared with soap and water. Conclusion., In general the quality of evidence for interventions to improve or maintain the skin condition in the older person was poor and more research in this area is needed. Relevance to Clinical Practice., Skin care is a major issue for nurses working with older people. On the basis of this review no clear recommendations can be made. This lack of strong evidence for nurses to base effective practice decisions is problematic. However, the ,best' evidence suggests that disposable bodyworns are a good investment in the fight against skin deterioration. No rinse cleansers are to be preferred over soap and the use of the bag bath appears to be a useful practice to reduce the risk of dry skin (a risk factor for breaches in skin integrity). [source] Evaluation of a training program to improve clinicians' assessment of patient stabilityDRUG AND ALCOHOL REVIEW, Issue 4 2009ADAM R. WINSTOCK Abstract Introduction and Aims. Public clinics in New South Wales (NSW), Australia play a central role in inducting and stabilising opioid dependent clients onto treatment before transfer to a community pharmacy. Clinical assessment of stability is a vital skill in ensuring that clients are appropriately and effectively transferred. A two-hour clinical training program was delivered to staff at 31 public clinics, that aimed to improve staff confidence in assessing client stability, and skills in negotiating the transfer of clients to community pharmacies. Design and Methods. Pre- and post-training evaluation was conducted examining self-ratings of confidence and ability in the assessment of client stability, and the perceived utility of a clinical algorithm to improve assessments. Follow-up was conducted 3 to 6 months post-training assessing individual and clinic level changes in clinical practice. Results. 205 staff completed pre- and post-training questionnaires. Staff demonstrated a moderate level of self-reported baseline knowledge and skills in assessing client stability (mean = 6.5; 1 = poor; 10 = excellent) that improved when re-assessed following the training (mean = 8.0). 76 staff responded to the follow-up questionnaire. , 75% reported some level of improvement in their approach to clinical practice regarding stability assessment, and 59% reported being more effective in identifying clients appropriate for community pharmacy transfer. Of 19 public clinics, 14 reported an increased focus on stability assessment. Nine clinics reported barriers to achieving changes in clinical practice. Discussion and Conclusions. This evaluation demonstrates that it is possible to implement a targeted clinical training package to staff that translates into positive changes in clinical practice.[Winstock AR, Lea T. Evaluation of a training program to improve clinicians' assessment of patient stability. Drug Alcohol Rev 2009;28:353,359] [source] Integrating Research into Clinical Practice: Development of an Echocardiography Research UnitECHOCARDIOGRAPHY, Issue 6 2009R.D.C.S., Tammy M. Green B.A. Introducing a research program into an echocardiography clinical practice can pose many challenges. Some initial factors to consider are the possible effects on the current clinical schedule and the equipment and personnel resources required to support the research projects. More importantly, how can an organization successfully complete reliable and accurate research projects? Here, we describe our experience with establishing an echocardiography research center within our clinical echocardiography practice. In addition, we identify key staff roles, highlight our current research practice methods, and suggest essential components that may prove advantageous when incorporating echocardiography research into a clinical practice. (ECHOCARDIOGRAPHY, Volume 26, July 2009) [source] Stricture associated with primary tracheoesophageal puncture after pharyngolaryngectomy and free jejunal interpositionHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 3 2006Gurston G. Nyquist MD Abstract Background. Free jejunal interposition has been one of the standard reconstructive options for patients undergoing total laryngopharyngoesophagectomy. Tracheoesophageal puncture (TEP) done primarily is a well-accepted means of voice restoration. The rapid recovery of swallowing and communication in patients who have advanced cancer of the upper aerodigestive tract is a valid goal. The objective of this study was to evaluate the functionality and complications of primary TEP in patients with a free jejunal interposition graft. Methods. Twenty-four consecutive patients who had free jejunal interposition were studied. Thirteen of these patients had a primary TEP. Stricture was assessed through barium swallow, laryngoscopy, and CT scan. Results. A statistically significant greater number of patients had stricture develop after primary TEP (p < .0325). All these patients had stricture develop at the distal anastomosis. These patients also tended to have a poorer quality of diet. Moreover, speech with a TEP prosthesis in patients with a free jejunal interposition was less intelligible and functional than speech with a TEP prosthesis after simple laryngectomy. Conclusions. This article recognizes an increased incidence of stricture formation after primary TEP as compared with non-TEP in patients undergoing pharyngolaryngectomy with free jejunal interposition. The morbidity and possible etiology of this complication are discussed. This clinical data have been translated into a change in clinical practice. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Endo-robotic resection of the submandibular gland in a cadaver model,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 11 2005David J. Terris MD Abstract Background. By means of a prospective, nonrandomized investigation, we evaluated the feasibility of performing endo-robotic resection of the submandibular gland in a cadaver model and compared the results of robotically enhanced endoscopic surgery with those from a conventional endoscopic technique. Methods. Procedural times were recorded in a consecutive series of 11 endoscopic submandibular gland resections using the daVinci Surgical System (Intuitive Surgical, Sunnyvale, CA) and a modified endoscopic surgical approach previously developed in a porcine model. The presence of neurovascular injury was assessed postoperatively, and the specimens were examined histologically. Results. Eleven endo-robotic submandibular gland resections were successfully performed in six cadavers (no conversions to open resection were necessary). The median duration of the procedures was 48 minutes (range, 33,82 minutes). Creation of the operative pocket took an average (±SD) of 12.2 ± 5.3 minutes, assembly of the robot required 9.3 ± 4.1 minutes, and the mean time for submandibular gland resection was 29.4 ± 8.9 minutes. The time required for robotic assembly was offset by the reduced operative time necessary compared with conventional endoscopic resection. Histologic examination confirmed the presence of normal glandular architecture, without evidence of excessive mechanical or thermal injury. There were no cases of apparent neurovascular injury. Conclusions. Robotically enhanced endoscopic surgery in the neck is feasible and offers a number of compelling advantages over conventional endoscopic neck surgery. Clinical trials will be necessary to determine whether these advantages can be achieved in clinical practice. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] The care of older people with dementia in acute hospitalsINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2010BA(Hons), DProf, Fiona Cowdell RN cowdell f. (2010) The care of older people with dementia in acute hospitals. International Journal of Older People Nursing 5, 83,92. Aim., To explore the experiences of patients and nursing staff of the care received by older people with dementia in acute hospitals. Background., The prevalence of dementia is steadily increasing as is the number of people with the condition requiring acute hospital care. Significant concerns about the quality of this care have been raised. There is a paucity of knowledge about the views of such care from the perspectives of people with dementia and nurses. Method., An ethnographic approach was used and data were collected thorough observation and interviews in one acute hospital in the United Kingdom. Findings., Findings suggest that care for older people with dementia in acute hospitals is not always optimum although there are clear exceptions. Generally, people with dementia found the delivery of care and the experience of being in hospital distressing as they did not know what was happening and they were often ignored. Nurses strive to give good care but do not always achieve this. Conclusion., Bourdieu's Model of Practice assists in explaining why care is as it is. There is a clear need to improve current practice. Relevance to clinical practice., It is imperative that innovative methods of developing practice are implemented and evaluated. Education alone will not lead to sustained changes in practice. Further research into this subject needs to be undertaken. [source] Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2010BSc (Hons) Nursing, Brendan McCormack D.Phil (Oxon), PGCEA mccormack b., dewing j., breslin l., coyne-nevin a., kennedy k., manning m., peelo-kilroe l., tobin c. & slater p. (2010) Developing person-centred practice: nursing outcomes arising from changes to the care environment in residential settings for older people. International Journal of Older People Nursing 5, 93,107 Aim., To present the nursing outcomes from the evaluation of developments in the care environment in residential settings for older people. Design., The evaluation data reported here is derived from a larger national programme of work that focused on the development of person-centred practice in residential services for older people using an emancipatory practice development framework. A multi-method evaluation framework was utilised. Outcome data were collected at three time points between December 2007 and September 2009. The data reported here were collected using an instrument called the ,Person-Centred Nursing Index'. Findings., Heavy workload was the main cause of stress among nurses. Personal and professional satisfaction with the job was scored highest by the total sample of nurses. Nineteen factors were examined using the Person-Centred Nursing Index. Statistically significant changes were observed in 12 of these. In addition, there were statistically significant changes in nurses' perceptions of caring, indicating a shift from a dominant focus on ,technical' aspects of care, to one where ,intimate' aspects of care were more highly valued. Relevance to clinical practice., The findings highlight the importance of the development of effective teamwork, workload management, time management and staff relationships in order to create a culture where there is a more democratic and inclusive approach to practice and space for the formation of person-centred relationships. [source] Coaching patients to self-care: a primary responsibility of nursingINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2009Julie Pryor BA Aim., To explore the process nurses use to guide and support patients to actively re-establish self-care. Background., The movement of hospitalized patients from less to more independence is primarily a nursing responsibility. Studies of nursing practice in inpatient rehabilitation settings have begun to shed some light on this, but as yet there is limited understanding of the actual skills nurses use to support patients to re-establish self-care. Method., This study used grounded theory. Microanalysis and constant comparative analysis of data collected during interviews with, and observation of, registered and enrolled nurses during everyday nursing practice in five inpatient rehabilitation units facilitated open, axial and selective coding. Relevant literature was woven into the final theory. Findings., To facilitate patient transition from the role of acute care patient to rehabilitation patient actively reclaiming self-care, nurses engaged in a three-phase process known as coaching patients to self-care. The three phases were: easing patients into rehabilitation, maximizing patient effort and providing graduated assistance. Conclusion., Coaching patients to self-care is a primary activity and technology of rehabilitation nursing. Relevance to clinical practice., Patients in a variety of settings would benefit from nurses incorporating coaching skills into their nurse,patient interactions. [source] Risk management dilemmas in dementia care: an organizational survey in three UK countriesINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2009Charlotte L. Clarke PhD Aims and objectives., The overall project aimed to understand the variability of the construction of risk in dementia care from the perspective of the person with dementia, family carers and practitioners with the intention of developing negotiated partnerships in risk management. This paper focuses on the objective of identifying the understandings of risk by practitioners. Background., Risk management can result in a ,safety first' approach to care practices, but this may be disempowering for people with dementia. Design., This paper describes the results of the first stage of the study: a survey to service managers or equivalent in health, social and voluntary sector care organizations in three countries of the UK. Methods., Data from this stage was collection by postal questionnaire (n = 46). Results., Risk was portrayed as a multidimensional concept and clustered around three themes: (1) Risk and Independence, (2) Risk and Resource, and (3) Organizational Risk Management. Conclusions., Very wide understandings of risk are identifiable, ranging from avoidance of physical harm through to managed risk taking to improve quality of life, and to an appreciation of the impact of organizational and professional patterns of behaviour resulting in harm to the person with dementia. Relevance to clinical practice., Obtaining information about the perspectives of others may help to illuminate some of the dilemmas experienced by staff in this study, and the development of risk assessment frameworks may assist staff to resolve some of these. [source] Development and psychometric testing of a new geriatric spiritual well-being scaleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2008Karen S. Dunn PhD Aims and objectives., Assess the psychometric properties of a new geriatric spiritual well-being scale (GSWS), specifically designed for older adults. Background., Religiosity and spiritual wellness must be measured as two distinct concepts to prevent confounding them as synonymous among atheist and agnostic population. Design., A test,retest survey design was used to estimate the psychometric properties. Methods., A convenience sample of 138 community-dwelling older adults was drawn from the inner city of Detroit. Data were collected using telephone survey interviews. Data analyses included descriptive statistics, structural equation modelling, reliability analyses, and point-biserial correlations. Results., The factorial validity of the proposed model was not supported by the data. Fit indices were ,2 = 185.98, d.f. = 98, P < 0.00, goodness-of-fit index of 0.85, comparative fit index of 0.87 and root mean error of approximation of 0.08, indicating a mediocre fit. Reliability statistics for the subscales ranged from being poor (0.36) to good (0.84) with an acceptable overall scale alpha of 0.76. Participants' performance stability and criterion-related validity were also supported. Conclusions., The GSWS is an age-specific assessment tool that was developed specifically to address a population's cultural diversity. Future research endeavors will be to test the psychometric properties of this scale in culturally diverse older adult populations for further instrument development. Relevance to clinical practice., Nurses need to recognize that agnostics/atheists have spiritual needs that do not include religious beliefs or practices. Thus, assessing patients' religious beliefs and practices prior to assessing spiritual well-being is essential to prevent bias. [source] Delirium and older people: what are the constraints to best practice in acute care?INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2008BHSc (Nursing), Jenny Day ADCHN, MEd (Adult Education) An Australian research team conducted a six-month acute care pilot study in a medical ward of a large hospital in New South Wales. Aim., To explore ways health practitioners might redesign their practice to include prevention, early detection and management of delirium in older people based on the best current practice. Method and design., Participatory action research (PAR) was selected as the best approach for involving ward staff to make sustainable clinical practice decisions. The PAR group comprised research academics and eight clinicians from the ward. Thirteen PAR sessions were held over 5 months. Clinicians described care of patients with delirium. Stories were analysed to identify constraints to best practice. Following PAR group debate about concerns and issues, there were actions toward improved practice taken by clinicians. Relevance to clinical practice., The following constraints to best practice were identified: delayed transfer of patients from the Emergency Department; routine ward activities were not conducive to provision of rest and sleep; assisting with the patient's orientation was not possible as relatives were not able to accompany and/or stay with the older patient. Underreporting of delirium and attributing confusion to dementia was viewed as an education deficit across disciplines. A wide range of assessment skills was identified as prerequisites for working in this acute care ward, with older people and delirium. Clinicians perceived that management driven by length of a patient's stay was incongruent with best practice delirium care which required more time for older patients to recover from delirium. Two significant actions towards practice improvement were undertaken by this PAR group: (i) development of a draft delirium alert prevention protocol and (ii) a separate section of the ward became a dedicated space for the care of patients with delirium. A larger study is being planned across a variety of settings. [source] Still going strong: perceptions of the body among 85-year-old people in SwedenINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2008Regina Santamäki Fischer PhD Background., Studies on the lived experience of an aging body are scarce. Aim and objectives., The aim of this study was to illuminate the experiences of the body among elderly people. Design., This study is part of the Umeå 85+ Study, a cross-sectional investigation into successful aging and threats against successful aging. The present study has an explorative design. Methods., The text from 40 thematic interviews with 85-year-olds was analysed using qualitative content analysis. Results., Two themes and seven subthemes were developed. The theme: Still going strong encompassed the subthemes of Exercising and being active, Caring for one's body, Standing on one's own two feet and Feeling healthy. The theme: Adapting to a failing body encompassed the subthemes of Not being able to perform activities and manage by oneself, Feeling fatigued and Compensating for bodily decline. Conclusions., The participants felt that the body was still a source of pleasure, in spite of its defects. Assistive devices were important for the maintenance of independence when the body declined. Relevance to clinical practice., When caring for elderly people with declining bodily function, it is important to have appropriate and well-tested equipment in readiness. [source] Tactile stimulation associated with nursing care to individuals with dementia showing aggressive or restless tendencies: an intervention study in dementia careINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2007Kirsti Skovdahl PhD Aim., This study aimed to describe from documentation both the caregivers' experiences of giving tactile stimulation to five people with moderate-to-severe dementia and who showed aggressive or restless tendencies, and the changes seen in them. Background., Clinical experiences indicate that tactile stimulation can contribute to a feeling of trust and confirmation as well as to improving communication, promoting relaxation and easing pain. There is, however, very little scientific documentation of the effects of touch massage for people with dementia. Design., From caregivers' documentation (28 weeks) of experiences, the giving of tactile stimulation to five randomly selected people with dementia showing aggressive or restless tendencies and the subsequent changes noticed. Method., The documentation was analysed by using qualitative content analysis. Results., All residents displayed signs of positive feelings and relaxation. The caregivers stated that they felt able to interact with the residents in a more positive way and that they felt they had a warmer relationship with them. Conclusion., Tactile stimulation can be seen as a valuable way to communicating non-verbally, of giving feedback, confirmation, consolation or a feeling of being valuable and taken care of. Relevance to clinical practice., Tactile stimulation has to be administered with respect and care, and given from a relational ethics perspective. Otherwise, there is a risk that tactile stimulation will be used merely as a technique instead of as a part of an effort to achieve optimal good, warm nursing care. [source] A model of event-generated dependence in older adultsINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2007APRN-BC, Kathleen L. Patusky PhD Aims and objectives., The proposed model of event-generated dependence characterizes dependence in older adults as an emergent phenomenon that may arise from interaction between the older adult with compromised health and the social environment, resulting in altered reciprocity. Background., Pejorative characterizations of dependence in older adults influence nursing care negatively. Concept analyses recommend the recognition that dependence is interactive in nature, not an inherent trait of the individual, and that dependence involves changes in interpersonal reciprocity. Conclusions., The model provides a testable causal path between dependence and psychological outcomes. Relevance to clinical practice., The event generated dependence model can sensitize nurses to an alternative view of dependence. It is important for nurses to recognize their role in determining the social environment of care, attend to the promotion of reciprocity with older adults as care is provided, and incorporate changes in their attitudes toward inequitable reciprocity. [source] An evaluation of the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older peopleINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2007Assumpta Ryan PhD MEd, BSc(Hons), PGCTHE Objectives., This paper reports the results of a study that aimed to evaluate the effectiveness of an educational and experiential intervention on nursing students' attitudes towards older people. Background., With repeated exposure to very sick older people in hospitals or nursing homes, nursing students are at risk of adopting stereotypical views about this section of the population as frail and dependent. Design., A pre- and post-test design was used to conduct the study. Methods., Using Kogan's Attitudes Towards Old People Scale, the attitudes of nursing students were tested at the beginning of a degree programme in Adult Nursing (n = 130) and one year later (n = 94) following a series of visits to a well-older person in the community. Results., Nursing students reported positive attitudes towards older people and these were retained throughout the first year of their nurse training. No statistically significant differences were found associated with any of the five independent variables in either pre- or postintervention students. Conclusions., The attitudes of nursing students towards older people remained positive. While it is possible that the experiential and educational interventions utilized in this study may have contributed to the retention of positive attitudes, further research is required to test this hypothesis. Relevance to clinical practice., Nurses have a major role to play in responding to the health and social care needs of older people and their families. The cultivation of positive attitudes is a key factor in enabling practising nurses to respond to this challenge. [source] The impact of residential respite care on the behaviour of older people with dementia: literature reviewINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2007Christine C. Neville RN, FANZCMHN Aim., The aim of this review was to examine the impact of residential respite care on the behaviour displayed by older people with dementia. Background., Relocation of older people with dementia to a different care setting could have a negative impact on their behaviour. If such a response is anticipated, a short-term admission to a residential aged care facility for respite care would appear to be futile for the older person and their home caregiver. Therefore, it is important to know what the outcomes of residential respite care are in relation to behaviour for older people with dementia. Methods., A literature search was undertaken and papers emerged from a range of disciplines. The search terms ,respite'; ,respite care'; ,residential respite care'; ,short-stay', ,short-term', ,overnight stays/admissions', ,behav*' and various combinations of these terms were used to find relevant publications in English from Ageline, CINAHL, Medline and, Psychinfo databases dating from 1966. Other key publications were located when searching through the reference lists of retrieved publications. A limited body of literature on residential respite care for older people with dementia was revealed. Results., Six studies were identified, which met the criteria of residential respite care as the intervention and behaviour as an outcome. Conclusions., The studies had a variety of methodological limitations and produced contradictory findings. The strength of the studies was the reporting of outcomes for respite recipients who are usually overlooked in the outcomes for respite research. Relevance to clinical practice., Residential respite care has great anecdotal support but more empirical and evaluative research is needed on outcomes for the respite recipients. [source] Research use in the care of older people: a survey among healthcare staffINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2006Anne-Marie Boström MSc Background., Sweden has one of the largest proportions of older people in the world. To manage the healthcare needs of an aging population, there has been an alteration from hospital care to community-based care. In these settings, the majority of staff is enrolled nurses (EN) and nurse aides (NA) without university education. Aim and design., The overall aim of this cross-sectional survey was to explore staff perceptions of factors related to research utilization in the care of older people. Method., Questionnaires covering research utilization and demographics were sent to all staff (n = 132) working in seven units in older people care. The response rate was 67% (n = 89). The respondents consisted of ENs/NAs (n = 63), Registered Nurses (RN) and rehabilitation professionals (RP) as physiotherapists and occupational therapists (RN/RP n = 26). Results., Most of staff reported positive attitudes towards research. The RNs/RPs stated more often than the ENs/NAs that they wanted to base their practice on research (81% vs. 25%; P = 0.001). The RNs/RPs also reported a greater extent of research use in daily practice (54% vs. 17%; P = 0.001). Support from colleagues (77% vs. 22%; P < 0.001) and unit managers (73% vs. 10%; P < 0.001) for implementing research findings was also more frequently reported by the RNs/RPs compared with the ENs/NAs. The majority of the ENs/NAs stated Do not know on many items concerning attitudes towards research, support for research utilization and actual use of research. Conclusions., Despite overall positive attitudes towards research, the majority of staff did not use research findings in daily practice. This was particularly valid for the EN/NA group. Relevance to clinical practice., There is an urgent need for managers and others in the care of older people to develop strategies for implementing evidence-based practice that involves the EN/NA group. [source] Students' ideals for nursing older people in practiceINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2006Erica S. Alabaster MSc Aim., Drawing on research exploring nursing students' experiences of working with older people, this paper aims to demonstrate how context and culture can impact on the realization of their ideals. Background., The principles underpinning individualized and person-centred approaches to care resonate with those focal to gerontologic nursing. Restrictive contexts of care and pervasive workplace cultures render nurses unable to deliver care in accord with these. Design and method., This interpretive study was informed by phenomenological,hermeneutic theory. A purposive sample (n = 10) was recruited from a single educational institution. Data were generated in two phases using loosely structured interviews and supplementary activity. Themes explicating their experiences were identified via systematized detailed analysis and issues pertaining to nursing students' orientation towards older people cut across these. Findings and discussion., Students perceived that older people were prone to depersonalization and marginalization, so sought to show respect by coming to know individuals, form human connections with them and personalize care accordingly. Giving respect, promoting personhood, asserting reciprocal identity and maintaining dignity were prominent features of this but were often frustrated by practices and cultures encountered in mainstream settings. Conclusions., Nursing students' approaches to older people are contextual and reflect elements of person-centred ideology. Their attempts upholding their ideals are liable to be subverted by workplace norms. Preparatory education should address these, assist students to learn how to attend to personhood in restrictive environments and offer targeted placements in age-specific and non-acute services. Relevance to clinical practice., Demographic trends mean that working with older people has increased significance for nurses in most settings. Person-centredness is seen as beneficial for older people but contemporary service imperatives and enduring practices are inhibitory, preventing entrants to nursing from developing related skills. [source] Promoting breast health: older women's perceptions of an innovative intervention to enhance screeningINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2006Robin Y. Wood EdD Aims and objectives., This study is a continuation of prior funded research in which we tested the use of age and ethnically sensitive video breast health kits to increase knowledge about breast cancer and enhance the screening practices of breast self-examination and mammography among older Caucasian and African-American women. Background., Breast cancer is the most frequent cancer in women worldwide and accounts for 23% of all cancers. Mammography is currently the best procedure available for mass screening of breast cancer. However, underutilization of mammography is a problem among older women in the United States. Elders are at the greatest risk for developing and dying from breast cancer but they are the least likely group to be screened routinely with mammograms or to practice breast self-examination, particularly if they are African-American. Design., Participatory qualitative evaluation focus groups were used to assess the overall impact of the video kit intervention programme and to elucidate the quantitative findings of the original study. Methods., Four focus groups were conducted in two diverse settings with a purposive sample of 23 participants (N = 23). The overall sample was predominantly African-American (87%) with mean age of 71 ± 7.9 years and mean education completed of 12 ± 3.4 years. Results., Five major themes emerged from group discussions: usability and appeal of the intervention, fear and empowerment, personal relevance and intergenerational sharing, impact on screening behaviours, and story telling. Conclusions., Analyses suggest that customized media materials constructed especially for older African-American women empowered participants in this sample to action regarding their own breast health. Relevance to clinical practice., These findings may translate to global populations where risk is increasing but screening programmes are not widely available. Given that older women are historically difficult to access and impact, further design and evaluation of innovative and sensitive educational programmes such as the one described here are recommended. [source] Nurses' experiences of caring encounters with older people living in Swedish nursing homesINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 1 2006Lars Westin MNSc Aim., The aim of the study was to describe and interpret the meaning of nurses' experiences of caring encounters with residents in nursing homes. Background., Life for residents in nursing homes can be characterized as a process of decreased physical and psychological resources. Therefore, encounters with nurses are important activities for providing meaning and security for the residents. Research in this field has previously focused on communication, attitudes and job satisfaction, but gives limited knowledge about what the human encounters in this context mean for the nurses. Method., A hermeneutic method was used in this study. Interviews were conducted with 14 nurses from two nursing homes about their experiences of caring encounters. The transcribed interview texts were interpreted as a whole. Results., In the interpretation of the text concerning the meaning of nurses' experiences of encounters with resident's four themes and 11 subthemes emerged. The comprehensive interpretation mainly showed possible ways available being present, being significant and being aware of opportunities for the nurse to find meaning in the encounter with the resident, but impossible ways as being inadequately were also revealed. Conclusion., This study shows the importance of caring encounters between nurses and residents in nursing homes. The good encounters provide various possible ways for nurses to find meaning and a sense of communion with residents. However, bad encounters, described as being inadequate, were found to inhibit nurses from finding meaning in their encounters with residents. Relevance to clinical practice., Meeting the needs of older people in nursing homes requires special knowledge about the importance of the caring encounter. Therefore, nurses in this care context need supervision and continuous education in order to gain relevant knowledge about the meaning of caring encounters for themselves and residents. [source] A systematic review of health-related quality of life instruments used for people with venous ulcers: an assessment of their suitability and psychometric propertiesJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Simon J Palfreyman Aims and objectives., To review the quality of life questionnaires used to measure the impact of venous ulceration and to evaluate their psychometric properties. Background., Venous leg ulcers have a negative impact on quality of life. Health-related quality of life can be measured using structured questionnaires. Nurses are the primary care providers for patients with venous ulceration and are ideally placed to assess and develop these types of questionnaires. There may also be an opportunity to use such quality of life instruments to measure the impact of nursing interventions in other areas where nurses are the key care providers. Design., Systematic review. Method., Studies were sought that used quality of life instruments to evaluate the impact of venous ulceration. Fourteen electronic bibliographical databases and 11 Internet-based health services research related resources were searched. In addition, grey literature was sought and the reference lists of relevant articles checked. Data were extracted regarding the type of instrument used, sample, number of items and domains and psychometric performance of the instrument. Results., The initial search identified a total of 338 potential citations. After review, a total of 31 studies were included: 17 used generic and 14 used disease-specific instruments. Five different types of generic and seven disease-specific instruments were identified. There was significant heterogeneity between the studies in terms of study design, aetiology of ulceration and times of assessment. The disease-specific instruments showed limitations in relation to their applicability to venous ulcer patients because of flaws in design or validation. Conclusions., The literature on quality of life related to venous ulceration failed to sufficiently distinguish between those with different causes of leg ulceration. There appeared to be problems with the ability of current quality of life instruments to detect changes in quality of life related to ulcer healing. Relevance to clinical practice., There appears to be an opportunity for nurses to develop a health-related quality of life health-related quality of life instruments to evaluate their impact on patient outcomes. Such instruments could potentially allow nursing interventions to be assessed more effectively than the recently proposed nursing metrics. [source] The role of antenatal pelvic floor muscle exercises in prevention of postpartum stress incontinence: a randomised controlled trialJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Linda Mason Aim., This article reports a randomised controlled trial to determine the efficacy of antenatal pelvic floor muscle exercises in the primary prevention of postpartum stress incontinence in primiparous women. Background., Pelvic floor muscle exercises are effective in treating stress incontinence, yet prevention studies demonstrate equivocal findings. Design., Randomised controlled trial. Method., Pregnant women recruited from two hospitals in North-west England were randomised to an intervention (n = 141) or control group (n = 145). Data were collected from 2005,2006. The intervention comprised four sessions of taught pelvic floor muscle exercise training during pregnancy and 8,12 maximal contractions repeated twice daily at home. A modified Bristol Female Lower Urinary Tract Symptom questionnaire, Leicester Impact Scale and Three Day Diary were administered at 20 and 36 weeks of pregnancy and three months postpartum. Results., The intervention group was more likely to exercise their pelvic floor muscles compared to controls at 36 weeks (p = 0·019) and three months (0·022), reporting fewer episodes of incontinence and a lower score on the Leicester Impact Scale. However, these differences were not statistically significant. Conclusion., Significant differences were not demonstrated between the groups in relation to incontinence episodes and degree of bother of symptoms postpartum, although trends indicate a positive effect. Further research is necessary to address issues of adherence and the effect of pelvic floor muscle exercise undertaken during pregnancy on postpartum stress urinary incontinence. Relevance to clinical practice., A proportion of women did not meet the required attendance at antenatal class, furthermore, few exercised their pelvic floor muscles during pregnancy according to instructions. Health professionals need to find ways to instruct and motivate women to perform pelvic floor muscles exercises regularly during pregnancy and the postpartum. [source] Psychometric properties of the Chinese version of the Bipolar Spectrum Diagnostic ScaleJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Hsin Chu Aim and objectives., The aim of this study was to test the psychometric properties of the Chinese version of the Bipolar Spectrum Diagnostic Scale (C-BSDS) in a Chinese population to serve as an aid to clinical diagnosis of bipolar disorders. Background., Bipolar spectrum disorders are often misdiagnosed because of the wide range of symptoms seen in patients. The consequences of delayed diagnoses or misdiagnoses can be devastating. Design., A cross-sectional research design. Method., Two hundred patients with affective disorders from a psychiatric outpatient clinic in Taiwan were enrolled. Internal consistency reliability and two-week test,retest reliability were performed to evaluate the reliability of the C-BSDS. Expert content validity and factor analysis were used for testing construct validity. To evaluate sensitivity and specificity, the Chinese version of the Mini International Neuropsychiatric Interview (MINI) was used as the gold standard for diagnosis. Results., The internal consistency coefficient measured by intra-class correlation (ICC) was 0·81, the test,retest reliability coefficient was 0·85 and the expert validity was 0·85. For construct validity, ,irritable and hyper-energetic factors' and ,depressed and lack of energy factors' were extracted by factor analysis. These two factors reflected the structure of the original scale and accounted for 33·27% of the variance. The optimal cut-off was 12, which yielded a sensitivity of 74 and a specificity of 0·97 for detecting bipolar disorder and for bipolar II disorder these were 0·79 and 0·68, respectively. Conclusions., The C-BSDS showed good reliability and validity, and the results were consistent with the English version of the BSDS. Therefore, the C-BSDS is an effective tool for evaluation of a Chinese population. Relevance to clinical practice., The BSDS can further increase the detection rate of bipolar disorders, especially bipolar II disorder, with satisfactory sensitivity and specificity. It can effectively assist with clinical screening of patients for bipolar spectrum disorders. [source] Patients' perceptions of information and support received from the nurse specialist during HCV treatmentJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Anne Grogan Aim., To identify patients' perceptions of support received from the nurse specialist during Hepatitis C virus (HCV) treatment. Background., HCV is a worldwide health problem. However, it is a treatable disease and treatment success rates are high. Unfortunately, treatment comes with a multitude of adverse side effects and patients require informational and psychological support from specialist nurses while on treatment. To date, there is little nursing research on support received from this specialist nursing care. Design., This study used a quantitative descriptive design. Method., A 59-item questionnaire collected data from 106 patients with a diagnosis of HCV attending a HCV outpatient clinic. Results., Overall, patients were very satisfied with support received. Advice on contraception was well received. However, many patients did not feel supported with regard to advice on sleep management. There were no statistically significant differences between overall satisfaction and gender, age, genotype and risk factor. However, there were significant correlations found between support received and reported genotype. Those patients presenting with genotype 1, who are mostly infected through blood or blood products, indicated that they require more support in relation to information on side effects of treatment, quality of life and support groups. Specific approaches to support and advice for this cohort may need to be incorporated into current services. Conclusion., Results of this study reinforce the need for the ongoing use of specialist nurse services and development of this service where no such facilities exist. In addition, the service may need to further recognise and support the information and psychological needs of patients with differing modes of HCV infection. Relevance to clinical practice., Findings provide information to practising nurse specialists about patient's views of information and support received from nurse specialists in HCV treatment centres and identify where deficits exist. [source] Preoperative information needs of children undergoing tonsillectomyJOURNAL OF CLINICAL NURSING, Issue 19-20 2010Aoife Buckley Aims and objectives., To identify the information needs of children undergoing tonsillectomy with reference to content of information, method of delivery, information providers and timing of information provision. Background., Tonsillectomy can be anxiety provoking for children and preoperative preparation programmes are long recognised to reduce anxiety. However, few have been designed from the perspectives of children and to date little is known about how best to prepare children in terms of what to tell them, how to convey information to them, who can best provide information and what is the best timing for information provision. Design., A qualitative descriptive study. Method., Data were collected from nine children (aged 6,9) using interviews supported by a write and draw technique. Data were coded and categorised into themes reflecting content, method, providers and timing of information. Results., Children openly communicated their information needs especially on what to tell them to expect when facing a tonsillectomy. Their principal concerns were about operation procedures, experiencing ,soreness' and discomfort postoperatively and parental presence. Mothers were viewed as best situated to provide them with information. Children were uncertain about what method of information and timing would be most helpful to them. Conclusion., Preoperative educational interventions need to take account of children's information needs so that they are prepared for surgery in ways that are meaningful and relevant to them. Future research is needed in this area. Relevance to clinical practice., Practical steps towards informing children about having a tonsillectomy include asking them what they need to know and addressing their queries accordingly. Child-centred information leaflets using a question and answer format could also be helpful to children. [source] Literature review: should antipyretic therapies routinely be administered to patient fever?JOURNAL OF CLINICAL NURSING, Issue 17-18 2010Jane V Carey Aims and objectives., To determine whether the practices of routinely treating fever with antipyretic medications or physical cooling methods are supported by the literature. Background., Fever is one of the commonest symptoms presented to caregivers. Previous research suggests that treating fever with antipyretic medications or physical cooling methods is often routine practice. This article considers that fever and the febrile response may have been preserved through evolution because of its advantage for host defences and that fever may have an adaptive value. It is questioned whether the administration of antipyretic therapies could prolong the duration of illness, as interventions to lower body temperature are acting against the body's natural response to infection. Design., Literature review. Method., Electronic databases and the Internet were searched, supplemented by citation tracking. Articles were eligible if the participants studied had received pharmacological or physical cooling interventions to reduce their body temperature during fever. The interventions were evaluated in regard to whether they prolonged duration of illness. Results., Results were inconsistent. None of the studies found that antipyretic therapies reduced duration of illness in patients with fever. Evidence suggests that antipyretic therapies do not reduce the duration of illness, but can prolong it. Conclusions., The evidence on which to base recommendations for practice is weak but does not support the current practice of administering antipyretic therapies routinely to patients with fever. Physical cooling methods alone should never be used. Nurses should assess patients with fever on an individualised basis and use antipyretic therapies selectively. Relevance to clinical practice., The administration of antipyretics to patients with fever is an important issue, and nurses are at the forefront of decision-making. Evidence-based care delivery is expected by the NMC. A protocol to assist decision-making when caring for patients with pyrexia is suggested. [source] Post-discharge health care needs of patients after lung cancer resectionJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Kwua-Yun Wang Aims and objective., To determine the health care needs of patients after surgical resection of lung cancer at discharge and evaluate the significance of factors associated with such needs. Background., Other studies have found that symptom distress level, social supports and health beliefs are associated with health care needs. Design., Sixty-two participants were recruited from a thoracic surgery clinic at a medical centre in Taipei from July,December 2005. Data related to demographic variables, disease characteristics, functional status, symptom distress and social support were collected. Methods., The patients were administered the Karnofsky Performance Scale, the Symptom Distress Scale,Chinese Modified Form, the Social Support Scale (adapted from the Interpersonal Support Evaluation List), the Health Needs Scale and self-reported rating scales for pain. Data were analysed using Pearson's correlation coefficients and linear regression models. Results., Pulmonary function was found to be correlated with the level of need for health care information and physiological care. Self-perceived symptom distress and degree of distress were also correlated with levels of need for information, physiological care and psychosocial care. The level of pain was found to be correlated with the level of need for health care information and physiological care. After controlling for pain level, multivariate analysis revealed that self-perceived symptom severity (p = 0·032) and degree of distress (p = 0·043) were modestly correlated with the need for health care. Conclusions., Pulmonary function, self-perceived symptom distress, degree of distress and level of pain were correlated with the level of need for health care information and physiological care. Self-perceived symptom severity and degree of distress were independent predictors of health care needs. Relevance to clinical practice., Administration of relevant questionnaires to assess postoperative symptom distress may be necessary for optimal disease management. [source] A structured observation of the interaction between nurses and patients during the administration of medication in an acute mental health unitJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Joy A Duxbury Aims., This aims of this study are to describe current practice in the administration of medication in an acute psychiatric unit and explore factors that influence nurses' decisions regarding the administration of medication during ,rounds'. Background., Medication ,rounds' form part of the ward routine in many inpatient mental health settings. Nurses make several clinical decisions about administrating medication; yet, concerns have been raised about the poor assessment of patients' needs and the quality of the information exchanged. Design., A structured non-participant observational design was used for this research. Method., This study involved the observation of 20 medication ,rounds' over three months. The Ward Administration of Medication Schedule was used to report on the interactions between nurses and patients and aspects of their communication during each round. Results., From the rounds observed nurses appeared adept at communicating a positive interpersonal style but less so in demonstrating skills portraying collaboration and information giving. For example whilst nurses communicated warmth in 97% of cases, using non-verbal behaviours such as good eye contact, the provision of information was only initiated in 46% of cases. Enquiries regarding the patient's general health and medication taking (35% and 17% respectively) were less commonly observed. Verbal consent was sought in only 25% of cases. Procedural matters were adhered to overall. Conclusions., Findings suggest limited collaboration between nurses and patients and the poor monitoring of health status and medication effects. Information exchange could be improved; however, this may be related to medication procedures that make it difficult to explore sensitive information with patients, rather than nursing skills and behaviour. Relevance to clinical practice., The Ward Administration of Medication Schedule can be used as a clinical or educational tool in the administration of medication. In both instances, it may be self-administered and used to reflect on personal skills or employed as an observational tool during peer review and audit. [source] Concept formation: a supportive process for early career nursesJOURNAL OF CLINICAL NURSING, Issue 17-18 2010Tracey Thornley Background., Individuals come to understand abstract constructs such as that of the ,expert' through the formation of concepts. Time and repeated opportunity for observation to support the generalisation and abstraction of the developing concept are essential if the concept is to form successfully. Development of an effective concept of the ,expert nurse' is critical for early career nurses who are attempting to integrate theory, values and beliefs as they develop their clinical practice. Aim., This study explores the use of a concept development framework in a grounded theory study of the ,expert nurse'. Design., Qualitative. Method., Using grounded theory methods for data collection and analysis, semi-structured interviews were conducted with registered nurses. The participants were asked to describe their concept of the ,expert nurse' and to discuss their experience of developing this. Results., Participants reported forming their concept of the ,expert nurse', after multiple opportunities to engage with nurses identified as ,expert'. This identification did not necessarily relate to the designated position of the ,expert nurse' or assigned mentors. When the early career nurse does not successfully form a concept of the ,expert nurse', difficulties in personal and professional development including skill/knowledge development may arise. Conclusion., To underpin development of their clinical practice effectively, early career nurses need to be provided with opportunities that facilitate the purposive formation of their own concept of the ,expert nurse'. Formation of this concept is not well supported by the common practice of assigning mentors. Relevance to clinical practice., Early career nurses must be provided with the time and the opportunity to individually develop and refine their concept of the ,expert nurse'. To achieve this, strategies including providing opportunities to engage with expert nurses and discussion of the process of concept formation and its place in underpinning personal judgments may be of assistance. [source] | ||||||||||