Home About us Contact
|
Home About us Contact | ||
|
|
||
Healthcare Settings (healthcare + setting)
Selected AbstractsClinical reasoning: concept analysisJOURNAL OF ADVANCED NURSING, Issue 5 2010Barbara Simmons simmons b. (2010) Clinical reasoning: concept analysis. Journal of Advanced Nursing,66(5), 1151,1158. Abstract Title.,Clinical reasoning: concept analysis. Aim., This paper is a report of a concept analysis of clinical reasoning in nursing. Background., Clinical reasoning is an ambiguous term that is often used synonymously with decision-making and clinical judgment. Clinical reasoning has not been clearly defined in the literature. Healthcare settings are increasingly filled with uncertainty, risk and complexity due to increased patient acuity, multiple comorbidities, and enhanced use of technology, all of which require clinical reasoning. Data sources., Literature for this concept analysis was retrieved from several databases, including CINAHL, PubMed, PsycINFO, ERIC and OvidMEDLINE, for the years 1980 to 2008. Review methods., Rodgers's evolutionary method of concept analysis was used because of its applicability to concepts that are still evolving. Results., Multiple terms have been used synonymously to describe the thinking skills that nurses use. Research in the past 20 years has elucidated differences among these terms and identified the cognitive processes that precede judgment and decision-making. Our concept analysis defines one of these terms, ,clinical reasoning,' as a complex process that uses cognition, metacognition, and discipline-specific knowledge to gather and analyse patient information, evaluate its significance, and weigh alternative actions. Conclusion., This concept analysis provides a middle-range descriptive theory of clinical reasoning in nursing that helps clarify meaning and gives direction for future research. Appropriate instruments to operationalize the concept need to be developed. Research is needed to identify additional variables that have an impact on clinical reasoning and what are the consequences of clinical reasoning in specific situations. [source] Are clinical practical guidelines (CPGs) useful for health services and health workforce planning?DIABETIC MEDICINE, Issue 5 2010A critique of diabetes CPGs Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source] The development and implementation of the Pathway for Improving the Care of the Dying in general medical wardsINTERNAL MEDICINE JOURNAL, Issue 10 2009K. Jackson Abstract The majority of deaths in Australia occur in general hospital wards and most are neither sudden nor unexpected. The Pathway for Improving the Care of the Dying (PICD) is an adaptation of the Liverpool Care Pathway to the Australian healthcare setting (or ,to Australian conditions') and is designed to help ensure a ,good death' for patients dying outside the palliative care system. PICD consists of a series of prompts, guidelines, revised medical and nursing care plans and a number of medication algorithms. [source] Guidelines on the management of secondary prophylaxis of vascular events in stable patients in primary careINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 2 2004D.J. Betteridge Summary Atherothrombosis, thrombus formation superimposed on an existing atherosclerotic plaque, is an acute process leading to ischaemic events such as myocardial infarction, stroke and critical limb ischaemia. Patients presenting with clinical conditions associated with atherothrombosis are at increased risk of subsequent vascular events. The beneficial effect of antiplatelet therapies for short-term and long-term secondary prevention of atherothrombotic events has been established. These guidelines aim to provide evidence-based recommendations that will assist in the antiplatelet-mediated secondary prophylaxis of vascular events in patients with stable cardiovascular disease treated in the primary healthcare setting. Medline and the Cochrane library were accessed using free-text strategies in the domains of antiplatelet agents and antithrombotics. Development of the guidelines was driven by a series of Steering Committee meetings, in which the quality of relevant studies was assessed and identified using narrative summary. These guidelines present evidence and recommendations for the treatment of numerous atherothrombotic indications depending on individual patient circumstances. [source] Recent evidence on the development and maintenance of constructive staff,family relationships in the care of older people , a report on a systematic review updateINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2010Emily Haesler BN PgradDipAdvNsg Abstract Aim, This paper is an update to a systematic review that presents the best available evidence on the factors that are most effective in promoting constructive staff,family relationships in the care of older people in the institutional healthcare setting. Methods, Systematic review. Results, The updated review supports findings from the earlier review. Additional evidence points to the importance of monitoring care, family involvement in decision-making, staff upholding the uniqueness of the older person, trust, the involvement of the multidisciplinary care team and family dynamics as factors underpinning effective staff,family relationships. Conclusion, A number of factors critical to the development and maintenance of positive staff,family relationships in the institutional setting have been identified. The delivery of quality care is predicated on staff having an understanding of these factors. [source] Factors associated with constructive staff,family relationships in the care of older adults in the institutional settingINTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 4 2006Emily Haesler BN PGradDipAdvNsg Abstract Background, Modern healthcare philosophy espouses the virtues of holistic care and acknowledges that family involvement is appropriate and something to be encouraged due to the role it plays in physical and emotional healing. In the aged care sector, the involvement of families is a strong guarantee of a resident's well-being. The important role family plays in the support and care of the older adult in the residential aged care environment has been enshrined in the Australian Commonwealth Charter of Residents' Rights and Responsibilities and the Aged Care Standards of Practice. Despite wide acknowledgement of the importance of family involvement in the healthcare of the older adult, many barriers to the implementation of participatory family care have been identified in past research. For older adults in the healthcare environment to benefit from the involvement of their family members, healthcare professionals need an understanding of the issues surrounding family presence in the healthcare environment and the strategies to best support it. Objectives, The objectives of the systematic review were to present the best available evidence on the strategies, practices and organisational characteristics that promote constructive staff,family relationships in the care of older adults in the healthcare setting. Specifically this review sought to investigate how staff and family members perceive their relationships with each other; staff characteristics that promote constructive relationships with the family; and interventions that support staff,family relationships. Search strategy, A literature search was performed using the following databases for the years 1990,2005: Ageline, APAIS Health, Australian Family and Society Abstracts (FAMILY), CINAHL, Cochrane Library, Dare, Dissertation Abstracts, Embase, MEDLINE, PsycINFO and Social Science Index. Personal communication from expert panel members was also used to identify studies for inclusion. A second search stage was conducted through review of reference lists of studies retrieved during the first search stage. The search was limited to published and unpublished material in English language. Selection criteria, The review was limited to studies involving residents and patients within acute, subacute, rehabilitation and residential settings, aged over 65 years, their family and healthcare staff. Papers addressing family members and healthcare staff perceptions of their relationships with each other were considered for this review. Studies in this review also included those relating to interventions to promote constructive staff,family relationships including organisational strategies, staff,family meetings, case conferencing, environmental approaches, etc. The review considered both quantitative and qualitative research and opinion papers for inclusion. Data collection and analysis, All retrieved papers were critically appraised for eligibility for inclusion and methodological quality independently by two reviewers, and the same reviewers collected details of eligible research. Appraisal forms and data extraction forms designed by the Joanna Briggs Institute as part of the QARI and NOTARI systematic review software packages were used for this review. Findings, Family members' perceptions of their relationships with staff showed that a strong focus was placed on opportunities for the family to be involved in the patient's care. Staff members also expressed a theoretical support for the collaborative process, however, this belief often did not translate to the staff members' clinical practice. In the studies included in the review staff were frequently found to rely on traditional medical models of care in their clinical practice and maintaining control over the environment, rather than fully collaborating with families. Four factors were found to be essential to interventions designed to support a collaborative partnership between family members and healthcare staff: communication, information, education and administrative support. Based on the evidence analysed in this systematic review, staff and family education on relationship development, power and control issues, communication skills and negotiating techniques is essential to promoting constructive staff,family relationships. Managerial support, such as addressing workloads and staffing issues; introducing care models focused on collaboration with families; and providing practical support for staff education, is essential to gaining sustained benefits from interventions designed to promote constructive family,staff relationships. [source] The effect of management commitment to service quality on frontline employees' affective and performance outcomes: an empirical investigation of the New Zealand public healthcare sectorINTERNATIONAL JOURNAL OF NONPROFIT & VOLUNTARY SECTOR MARKETING, Issue 4 2006Nicholas J. Ashill Very little attention has been given to understand the antecedents of service recovery performance in a public healthcare setting. In this study, a cross-sectional survey investigates a model of service recovery performance. Frontline hospital employees completed a self-administered questionnaire on how factors characterising management commitment to service quality (MCSQ) affect their service recovery efforts. The results suggest the influence of MCSQ is mediated by frontline employees' affective commitment to their hospital. The research advances understanding of frontline service recovery performance in a public healthcare setting and the findings indicate that public healthcare managers can take actions on a number of fronts to assist progress towards the achievement of frontline service recovery excellence. Copyright © 2006 John Wiley & Sons, Ltd. [source] Impact of recurrent changes in the work environment on nurses' psychological well-being and sickness absenceJOURNAL OF ADVANCED NURSING, Issue 6 2006Rik Verhaeghe MSc RN Aim., This paper is a report of a study of how the occurrence and appraisal of recurrent changes in the work environment of hospital nurses affect psychological well-being (i.e. job satisfaction, eustress and distress) and absence through illness. Background., Many researchers have demonstrated the impact of major organizational changes on employees' psychological well-being, but only a few have focused on the permanent consequences in work conditions. In a contemporary healthcare setting, an increased number of recurrent operational changes has become a normal characteristic of nurses' work environment. Specific work situations have frequently been associated with occupational stress, whereas employees' appraisal of recurrent changes as stressors and their relation to psychological well-being and health outcomes (i.e. sickness absence) have been dismissed. Methods., A cross-sectional questionnaire survey was conducted in 2003 with 2094 Registered Nurses in 10 general hospitals. Logistic regressions were used to investigate the impact on psychological well-being and prospectively measured rates of sickness absence (frequency and duration). Results., The occurrence of changes in the work environment (in the past 6 months) had had a negative impact on staff psychological well-being. Nurses who had been confronted with changes scored statistically significantly higher for distress. Changes appraised as threatening were negatively related to job satisfaction and eustress, and positively related to distress and sickness absence (frequency and duration). Changes appraised as challenging were positively related to job satisfaction and eustress but had no impact on distress and sickness absence. Conclusion., Future research should take into consideration the impact of the occurrence and appraisal of recurrent changes in the work environment of healthcare employees (i.e. Registered Nurses) on psychological well-being and sickness absence. This should also be considered by managers when dealing with these nursing workforce issues. [source] From critical care to comfort care: the sustaining value of humourJOURNAL OF CLINICAL NURSING, Issue 8 2008Ruth Anne Kinsman Dean PhD Aims and objectives., To identify commonalities in the findings of two research studies on humour in diverse settings to illustrate the value of humour in team work and patient care, despite differing contexts. Background., Humour research in health care commonly identifies the value of humour for enabling communication, fostering relationships, easing tension and managing emotions. Other studies identify situations involving serious discussion, life-threatening circumstances and high anxiety as places where humour may not be appropriate. Our research demonstrates that humour is significant even where such circumstances are common place. Method., Clinical ethnography was the method for both studies. Each researcher conducted observational fieldwork in the cultural context of a healthcare setting, writing extensive fieldnotes after each period of observation. Additional data sources were informal conversations with patients and families and semi-structured interviews with members of the healthcare team. Data analysis involved line-by-line analysis of transcripts and fieldnotes with identification of codes and eventual collapse into categories and overarching themes. Results., Common themes from both studies included the value of humour for team work, emotion management and maintaining human connections. Humour served to enable co-operation, relieve tensions, develop emotional flexibility and to ,humanise' the healthcare experience for both caregivers and recipients of care. Conclusions., Humour is often considered trivial or unprofessional; this research verifies that it is neither. The value of humour resides, not in its capacity to alter physical reality, but in its capacity for affective or psychological change which enhances the humanity of an experience, for both care providers and recipients of care. Relevance to clinical practice., In the present era which emphasises technology, efficiency and outcomes, humour is crucial for promoting team relationships and for maintaining the human dimension of health care. Nurses should not be reluctant to use humour as a part of compassionate and personalised care, even in critical situations. [source] Biopsy forceps: Reusable or disposable?JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 7 2006Zvi Fireman Abstract Reusable and disposable biopsy forceps are both widely available for use in gastrointestinal endoscopy units. Biopsy forceps have design and material features that may interfere with cleaning, and reusable devices must be designed to function safely and effectively following sterilization in a healthcare setting. During the last decade, endoscopic accessories have evolved from reusable to disposable in many parts of the world. Although use of disposable devices helps reduce the potential risk of cross-contamination and spread of infection, there remains the factor of cost. Major concerns for reuse of endoscopic accessories center on two main areas: sterility, and the capability of the equipment to perform its function satisfactorily after repeated uses and sterilizations. Reusable biopsy forceps perform a designated number of procedures, thus becoming more cost-effective than disposable forceps, which are impossible to clean and sterilize. The potential risk of infectious disease transmission must be taken into account. There is also the consideration that reprocessing of disposable forceps may damage or destroy the fragile devices. [source] Collaborating with patients and their familiesJOURNAL OF HEALTHCARE RISK MANAGEMENT, Issue 4 2010Bev Johnson Patient- and family-centered care is a healthcare approach that emphasizes collaboration among patients, families, and healthcare providers. The key concepts of patient- and family-centered care can be applied in any healthcare setting to enhance patient safety, reduce the risk of medical errors, improve risk management processes, and create an organizational culture supportive of risk managers and open, honest communication. [source] Relationship between costs of lifestyle interventions and weight loss in overweight adultsOBESITY REVIEWS, Issue 1 2010R. P. Bogers Summary Lifestyle interventions in a healthcare setting are effective for weight loss, but it is unclear whether more expensive interventions result in more weight loss. Our objective was to explore the relationship between intervention costs and effectiveness in a systematic review of randomized trials. Intervention studies were selected from 14 reviews and from a systematic MEDLINE-search. Studies had to contain a dietary and a physical activity component and report data on measured weight loss in healthy Caucasian overweight adults. Intervention costs were calculated in a standardized way. The association between costs and percentage weight loss after 1 year was assessed using regression analysis. Nineteen original studies describing 31 interventions were selected. The relationship between weight loss and intervention costs was best described by an asymptotic regression model, which explained 47% of the variance in weight loss. A clinically relevant weight loss of 5% was already observed in interventions of approximately ,110. Results were similar in an intention-to-treat analysis. In conclusion, lifestyle interventions in health care for overweight adults are relatively cheap and higher intervention costs are associated with more weight loss, although the effect of costs on weight loss levels off with growing costs. [source] Facing highly infectious diseases: new trends and current conceptsCLINICAL MICROBIOLOGY AND INFECTION, Issue 8 2009P. Brouqui Abstract A highly infectious disease (HID) that is transmissible from person to person causes life-threatening illness and presents a serious hazard in the healthcare setting and in the community that requires specific control measures. Due to environmental factors, changes in lifestyle and many other unknown factors, the emergence of such HIDs is becoming more and more likely. As has already been demonstrated during the SARS outbreak, healthcare facilities are likely to be the origin of future HID outbreaks. Preparedness planning will be essential in helping facilities manage future outbreaks of emerging or resurgent infectious diseases. Guidelines have been developed by national and international institutions. To avoid contamination of healthcare workers, the care of HID patients should follow the same infection control rules that are applied to laboratory workers exposed to similar agents. Here, the current knowledge concerning the clinical care of patients with HIDs is reviewed, and specific aspects of the management of such diseases are introduced. [source] Prevalence and predictors of recurrence of major depressive disorder in the adult populationACTA PSYCHIATRICA SCANDINAVICA, Issue 3 2010F. Hardeveld Hardeveld F, Spijker J, De Graaf R, Nolen WA, Beekman ATF. Prevalence and predictors of recurrence of major depressive disorder in the adult population. Objective:, Knowledge of the risk of recurrence after recovery of a major depressive disorder (MDD) is of clinical and scientific importance. The purpose of this paper was to provide a systematic review of the prevalence and predictors of recurrence of MDD. Method:, Studies were searched in Medline en PsychINFO using the search terms ,recur*', ,relaps*', ,depress*', ,predict*' and course. Results:, Recurrence of MDD in specialised mental healthcare settings is high (60% after 5 years, 67% after 10 years and 85% after 15 years) and seems lower in the general population (35% after 15 years). Number of previous episodes and subclinical residual symptoms appear to be the most important predictors. Gender, civil status and socioeconomic status seem not related to the recurrence of MDD. Conclusion:, Clinical factors seem the most important predictors of recurrence. Data from studies performed in the general population and primary care on the recurrent course of MDD are scarce. [source] Working in partnership , developing a young people's service in a rural environmentACTA PSYCHIATRICA SCANDINAVICA, Issue 2002M. Mitchell Specific objective, The Project reviewed , The Provision of Services for Early Psychosis in Cornwall. It looked at staff feedback, user and carers' views, base line assessment and National Guidelines of Best Practice, and proposed significant changes to meet the needs of young people. Method, The Review was carried out under the auspices of the National Clinical Governance Team and used as its framework the RAID model of change. Results, This resulted in a series of recommendations, which informed new developments. Current initiatives include a Health Promotion Programme, Training Strategies in Primary Care and effective partnerships with young people's services. Conclusions, It proposes significant changes to the correct system of care by working outside the traditional healthcare settings and across the service boundaries of health, education and social care. The rurality of Cornwall provides a considerable challenge for service delivery. This review ensured that ownership rested with users, careers, staff and others who contributed and shaped its future direction. [source] Alcohol screening and brief intervention: dissemination strategies for medical practice and public healthADDICTION, Issue 5 2000Thomas F. Babor This paper introduces the concept of risky drinking and considers the potential of alcohol screening and brief intervention (SBI) to reduce alcohol-related problems in medical practice and in organized systems of health care. The research evidence behind this approach is reviewed. Potential strategies for the dissemination of SBI to systems of health care are then discussed within the context of a public health model of clinical preventive services. There is an emerging consensus that SBI should be promoted in general healthcare settings, but further research is needed to determine the best ways to achieve widespread dissemination. In an attempt to provide an integrative model that is relevant to SBI, dissemination strategies are discussed for three target groups: (1) individual patients and practitioners; (2) health care settings and health systems; and (3) the communities and the general population. Dissemination strategies are considered from the fields of social change, social science, commercial marketing and education in terms of their potential for translating SBI innovations into routine clinical practice. One overarching strategy implicit in the approaches reviewed in this article is to embed alcohol SBI in the more general context of preventive health services, the utility of which is becoming increasingly recognized as a critical supplement to more traditional clinical medicine. [source] Toward a Biopsychosocial Model for 21st -Century GeneticsFAMILY PROCESS, Issue 1 2005John S. Rolland M.D. Advances in genomic research are increasingly identifying genetic components in major health and mental health disorders. This article presents a Family System Genetic Illness model to address the psychosocial challenges of genomic conditions for patients and their families, and to help organize this complex biopsychosocial landscape for clinical practice and research. This model clusters genomic disorders based on key characteristics that define types of disorders with similar patterns of psychosocial demands over time. Key disease variables include the likelihood of developing a disorder based on specific genetic mutations, overall clinical severity, timing of clinical onset in the life cycle, and whether effective treatment interventions exist to alter disease onset and/or progression. For disorders in which carrier, predictive, or presymptomatic testing is available, core nonsymptomatic time phases with salient developmental challenges are described pre- and post-testing, including a long-term adaptation phase. The FSGI model builds on Rolland's Family System Illness model, which identifies psychosocial types and phases of chronic disorders after clinical onset. The FSGI model is designed to be flexible and responsive to future discoveries in genomic research. Its utility is discussed for research, preventive screening, family assessment, treatment planning, and service delivery in a wide range of healthcare settings. [source] A collaborative approach to embedding graduate primary care mental health workers in the UK National Health ServiceHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 5 2008Janine Fletcher MSc Abstract The UK National Health Service (NHS) workforce has recently seen the arrival of the Graduate Mental Health Worker (GMHW) in primary care. We established a Quality Improvement Collaborative to assist in embedding this new workforce in one Strategic Health Authority Area of England. The intervention utilised ,collaborative' technology which involves bringing together groups of practitioners from different organizations to work in a structured way to improve the quality of their service. The process was evaluated by an action research project in which all stakeholders participated. Data collection was primarily qualitative. During the project, there was an increase in throughput of new patients seen by the GMHWs and increased workforce satisfaction with a sense that the collaborative aided the change process within the organizations. Involvement of managers and commissioners from the Primary Care Trusts where the GMHWs were employed appeared to be important in achieving change. This was not, however, sufficient to combat significant attrition of the first cohort of workers. The project identified several barriers to the successful implementation of a new workforce for mental health problems in primary care, including widespread variation in the level and quality of supervision and in payment and terms of service of workers. A collaborative approach can be used to support the development of new roles in health care; however, full engagement from management is particularly necessary for success in implementation. The problems faced by GMHWs reflect those faced by other new workers in healthcare settings, yet in some ways are even more disturbing given the lack of governance arrangements put in place to oversee these developments and the apparent use of relatively unsupported and inexperienced novices as agents of change in the NHS. [source] Exploring the implications for health professionals of men coming out as gay in healthcare settingsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 1 2006Bob Cant MA Abstract Coming out as gay is a social process which redefines the relationship between the persons who have decided to disclose their homosexuality and their listeners. This paper, drawing upon Bakhtin's (1984) theories of dialogue, the coming-out literature of gay men and lesbians and contemporary literature on doctor,patient communication, explores the coming-out experiences of gay men with their general practitioners and sexual health clinic staff. The findings are based upon a study of 38 gay men and 12 health service managers in London. The informants were recruited purposively to reflect some of the diversity of the London setting; recruitment was carried out through the channels of gay voluntary organisations and through snowballing. Semi-structured interviews were conducted and a grounded-theory approach was adopted. It was found that coming out in general practice was often/mostly followed by silence/noncommunication on the part of the practitioner; coming out could, however, result in an improvement in communication if the patients were well supported and assertive. If coming out in sexual health clinics did not result in improved communication, the informants in this study were likely to change clinics until they did find improved communication. This paper raises questions about the communication and training needs of general practitioners. It also raises questions about inequalities of access to ,respectful' sexual health clinics; while men who are articulate about the narratives of their lives as gay men are able to exercise informed choices, there were grounds for concern about the choice behaviours of men who are less articulate about their life narratives. [source] Opportunistic screening for Chlamydia in general practice: the experience of health professionalsHEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 4 2003Elizabeth Perkins Abstract Chlamydia trachomatis is the most common curable bacterial sexually transmitted infection in the UK. The infection is asymptomatic in up to 70% of women, and if untreated, can lead to pelvic inflammatory disease, ectopic pregnancy and infertility. Chlamydial infection can be diagnosed using urine testing and is easily treated with antibiotics. In 1999, the UK Department of Health funded a pilot opportunistic Chlamydia screening programme in two health authorities. All sexually active women between the ages of 16 and 24 years attending general practices and other healthcare settings, such as family planning clinics, antenatal clinics and genito-urinary medicine services, were offered the opportunity to be screened for Chlamydia, regardless of the purpose of their visit. This evaluation was funded to assess the feasibility and acceptability of opportunistic screening. The evaluation was conducted using both qualitative and quantitative methods. The present paper describes findings from the qualitative evaluation study arising from the health professionals' experience of opportunistic screening in general practice. Receptionists were central to the opportunistic screening model in general practice and it was this aspect of the model that raised most concerns. Whilst general practitioners reported that the involvement of receptionists saved them time, the receptionists themselves were sometimes drawn into discussions for which they felt ill equipped and unsuitably located. This research suggests that a call,recall national screening programme would provide a better model to undertake Chlamydia screening in general practice. The advantages of this model are threefold. First, each individual within the target age range can receive information about Chlamydia through the post. Secondly, the test and more detailed information can be managed by a practice nurse in a private and confidential setting. Thirdly, individuals are not repeatedly offered the test when visiting the surgery. [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] Systematic review of the effectiveness of integrated care pathways: what works, for whom, in which circumstances?INTERNATIONAL JOURNAL OF EVIDENCE BASED HEALTHCARE, Issue 2 2009Davina Allen RGN BA(Hons) PhD Abstract Aim, Integrated care pathways (ICP) are management technologies which formalise multidisciplinary team-working and enable professionals to examine their roles and responsibilities. ICPs are now being implemented across international healthcare arena, but evidence to support their use is equivocal. The aim of this study was to identify the circumstances in which ICPs are effective, for whom and in what contexts. Methods, A systematic review of high-quality randomised controlled trials published between 1980 and 2008 (March) evaluating ICP use in child and adult populations in the full range of healthcare settings. Results 1For relatively predictable trajectories of care ICPs can be effective in supporting proactive care management and ensuring that patients receive relevant clinical interventions and/or assessments in a timely manner. This can lead to improvements in service quality and service efficiency without adverse consequences for patients. 2ICPs are an effective mechanism for promoting adherence to guidelines or treatment protocols thereby reducing variation in practice. 3ICPs can be effective in improving documentation of treatment goals, documentation of communication with patients, carers and health professionals. 4ICPs can be effective in improving physician agreement about treatment options. 5ICPs can be effective in supporting decision-making when they incorporate a decision-aide. 6The evidence considered in this review indicates that ICPs may be particularly effective in changing professional behaviours in the desired direction, where there is scope for improvement or where roles are new. 7Even in contexts in which health professionals are already experienced with a particular pathway, ICP use brings additional beneficial effects in directing professional practice in the desired direction. 8ICPs may be less effective in bringing about service quality and efficiency gains in variable patient trajectories. 9ICPs may be less effective in bringing about quality improvements in circumstances in which services are already based on best evidence and multidisciplinary working is well established. 10Depending on their purpose, the benefits of ICPs may be greater for certain patient subgroups than others. 11We do not know whether the costs of ICP development and implementation are justified by any of their reported benefits. 12ICPs may need supporting mechanisms to underpin their implementation and ensure their adoption in practice, particularly in circumstances in which ICP use is a significant change in organisational culture. 13ICP documentation can introduce scope for new kinds of error. Conclusions, ICPs are most effective in contexts where patient care trajectories are predictable. Their value in settings in which recovery pathways are more variable is less clear. ICPs are most effective in bringing about behavioural changes where there are identified deficiencies in services; their value in contexts where inter-professional working is well established is less certain. None of the studies reviewed included an economic evaluation and thus it is not known whether their benefits justify the costs of their implementation. [source] Content Validation of Parental Role Conflict in the Neonatal Intensive Care UnitINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2006Elenice Valentim Carmona MN PURPOSE.,To validate the content of the nursing diagnosis parental role conflict made by neonatal intensive care (NICU) nurses and researchers in the field and to identify the related major and minor defining characteristics. METHOD.,Fehring's Diagnostic Content Validation model using 59 neonatal specialists. FINDINGS.,Nineteen defining characteristics were validated for use in NICUs: four were considered major and 15 as minor. There was no correlation between nurse profiles and defining characteristic scores. CONCLUSIONS.,In this study, parental role conflict was validated for use in neonatal units but defining characteristics must be described in a clearer and more objective manner. NURSING IMPLICATIONS.,Validation studies in different healthcare settings are required so that the specificities of each clientele are met. NANDA diagnoses must be tested and validated at neonatal units, because this setting has developed few studies and their use in practice is a potential way to improve nursing care. [source] Current legal responses to elder abuseINTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 4 2006LL.B HONS, Paul Buka MSC Abstract., In this paper, legal provisions for dealing with elder abuse in social or healthcare settings will be considered. The need for such measures for detection and management of elder abuse will be highlighted. Interventions should take into account elderly victims' vulnerability, which may be due to physical and/or psychological dependence. The effectiveness of current interventions is limited due to a lack of cohesion and the absence of a specific legal framework. The term ,vulnerable adults' is broader than ,elder abuse'. It is difficult to estimate the extent of the problem of elder abuse because of the usually intimate settings within which it takes place , this may affect the strength of the evidence. The purpose of this paper is to encourage a debate on the effectiveness of current legal responses to elder abuse. The true figures of the incidence of abuse may never be known. Consequently, in criminal law trials, providing evidence on abuse can be very traumatic and intimidating for a victim because of the circumstances in which it generally takes place. The irony is that the likelihood of a criminal prosecution may be higher in more serious types of abuse where the evidence is overwhelming, on the basis of the res ipsa loquitor (facts speak for themselves) principle. The abuse in question may be domestic or institutional; the effects nevertheless are the same. [source] The use of conversational analysis: nurse,patient interaction in communication disability after strokeJOURNAL OF ADVANCED NURSING, Issue 3 2009Clare Gordon Abstract Title., The use of conversational analysis: nurse,patient interaction in communication disability after stroke. Aim., This paper is a report of a study to explore how nursing staff and patients with aphasia or dysarthria communicate with each other in natural interactions on a specialist stroke ward. Background., Nursing staff often talk with patients in a functional manner, using minimal social or affective communication. Little nursing research has been carried out with patients who have communication difficulties. Conversational analysis, used in other healthcare settings, is a way to explore these interactions in depth in order to gain further understanding of the communication process. Method., An observational study was carried out in 2005 and the data were 35·5 hours of videotape recording and field notes with 14 nursing staff and five patients with aphasia or dysarthria. The recordings were analysed using conversation analysis. Findings., Nursing staff controlled the conversations by controlling the topic and flow of conversations, creating asymmetry in all interactions. Patients had very little input because of taking short turns and responding to closed questions. These behaviours are related to the institutional context in which they occur. Conclusion., In rehabilitation, the focus for interaction may be thought to be patient goals, worries or plans for the future, but in this study nursing staff controlled the conversations around nursing tasks. This may be because they do not have the confidence to hold conversations with people with communication problems. Nursing staff need to receive training to reinforce communication rehabilitation programmes and to engage more fully with patients in their care, but also that a wider institutional culture of partnership is developed on stroke wards. [source] Interventions to Improve Transitional Care Between Nursing Homes and Hospitals: A Systematic ReviewJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 4 2010Michael A. LaMantia MD Transitions between healthcare settings are associated with errors in communication of information and treatment plans for frail older patients, but strategies to improve transitional care are lacking. A systematic review was conducted to identify and evaluate interventions to improve communication of accurate and appropriate medication lists and advance directives for elderly patients who transition between nursing homes and hospitals. MEDLINE, ISI Web, and EBSCO Host (from inception to June 2008) were searched for original, English-language research articles reporting interventions to improve communication of medication lists and advance directives. Five studies ultimately met all inclusion criteria. Two described interventions that enhanced transmission of advance directives, two described interventions that improved communication of medication lists, and one intervention addressed both goals. One study was a randomized controlled trial, whereas the remaining studies used historical or no controls. Study results indicate that a standardized patient transfer form may assist with the communication of advance directives and medication lists and that pharmacist-led review of medication lists may help identify omitted or indicated medications on transfer. Although preliminary evidence supports adoption of these methods to improve transitions between nursing home and hospital, further research is needed to define target populations and outcomes measures for high-quality transitional care. [source] Improving hand hygiene in community healthcare settings: the impact of research and clinical collaborationJOURNAL OF CLINICAL NURSING, Issue 1 2000Dinah Gould BSc, MPhil ,,Observation of nursing activities and bacteriological studies undertaken with a sample of nurses employed in a community NHS trust indicated that considerable scope for cross infection existed during domiciliary visits. ,,Poor conditions in patients' homes compromised nurses' ability to perform hand hygiene effectively, increasing risks. ,,A clinical trial indicated that carriage of medically significant bacteria likely to contribute to cross infection could be reduced by applying an antiseptic cream which exhibited residual effectiveness. ,,An audit of hand hygiene throughout the inner city trust indicated the need to pay greater attention to hand hygiene, especially during home nursing visits. The situation was less acute in a rural trust where a second audit was performed for comparative purposes. ,,The motivation of clinical staff to improve hand hygiene precautions was high. [source] Design of a clustered observational study to predict emergency admissions in the elderly: statistical reasoning in clinical practiceJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2007Gillian A. Lancaster MSc PhD CStat Abstract Objective, To describe the statistical design issues and practical considerations that had to be addressed in setting up a clustered observational study of emergency admission to hospital of elderly people. Study design and setting, Clustered observational study (sample survey) of elderly people registered with 18 general practices in Halton Primary Care Trust in the north-west of England. Results, The statistical design features that warranted particular attention were sample size determination, intra-class correlation, sampling and recruitment, bias and confounding. Pragmatic decisions based on derived scenarios of different design effects are discussed. A pilot study was carried out in one practice. From the remaining practices, a total of 4000 people were sampled, stratified by gender. The average cluster size was 200 and the intra-class correlation coefficient for the emergency admission outcome was 0.00034, 95% confidence interval (0,0.008). Conclusion, Studies that involve sampling from clusters of people are common in a wide range of healthcare settings. The clustering adds an extra level of complexity to the study design. This study provides an empirical illustration of the importance of statistical as well as clinical reasoning in study design in clinical practice. [source] Ethnography and the ethics of undertaking research in different mental healthcare settingsJOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2010H. ALLBUTT rgn ba msc phd Accessible summary ,,We report our experiences of seeking regulatory approval to undertake a qualitative research study using observation and interviews in three different mental healthcare settings. ,,All users of mental health services are classified as ,vulnerable' research participants by UK regulatory research systems. We argue that this is both disempowering to users and also at odds with current health care policy to promote service user involvement in research processes. ,,Access to mental healthcare sites was difficult in spite of agreement by senior area managers. Front-line team leaders acted as gatekeepers to influence which service users could be approached to take part in the study. This type of intervention may bias research samples and dilute the knowledge claims researchers can make from research undertaken in practice settings. Abstract This paper draws on our experiences of seeking research ethics and management approval for a 1-year ethnographic research study in three mental health settings. We argue that the increased bureaucratization of research governance in the UK is paternalistic and unfit for qualitative, non-interventionist study designs. The classification of all mental health services users as ,vulnerable' is also disempowering and contrary to government calls to increase user involvement in research processes. We relate our difficulties in accessing National Health Service sites to undertake our study despite endorsement by senior managers. The current research ethics system reinforces the gatekeeping role of front-line National Health Service staff but this may work to bias samples in favour of ,amenable' service users and exclude others from having their views and experiences represented in studies over the long-term. [source] Health Care for the Homeless Assesses the Use of Adapted Clinical Practice GuidelinesJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 11 2005Aaron J. Strehlow RN, FNP-C COLUMN EDITOR: Mary Jo Goolsby This article describes a process of evaluating and adapting existing clinical practice guidelines (CPGs) for homeless individuals by different healthcare providers in multiple healthcare settings across the country. Data were collected using a standardized evaluation tool in nine sites across the United States. Clinicians completed an evaluation of the CPG after every use. Most clinicians used the CPG five times. Descriptive statistics were reported on the characteristics of the clinicians, and the utility of the guidelines and written comments. Clinicians had an average of 12 years of clinical experience, 8 years of which were specifically spent working with homeless individuals. Ninety-one percent of the clinicians practiced in urban settings. The majority of clinicians felt the adapted guidelines met evaluation criteria. The major weaknesses reported the delineation of outreach and case management activities. Results did not vary by clinicians' disciplines, years of experience, or any other indicators. Clients and clinicians providing primary care to homeless individuals may benefit from utilizing Health Care for the Homeless Clinicians' Network adapted CPGs to assure quality, evidenced-based care to a vulnerable population. [source] | |||||||||||||||||||||||||||||||