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Practice.
Kinds of Practice. Selected AbstractsPrevalence of Sedentary Lifestyle in Individuals With High Blood PressureINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2010Nirla Gomes Guedes RN OBJECTIVE., To identify the prevalence of a sedentary lifestyle in individuals with high blood pressure. METHODS., This cross-sectional study was conducted among 310 individuals with high blood pressure. RESULTS., The prevalence of the diagnosis of sedentary lifestyle was 60%. The more common defining characteristics were "lack of physical conditioning" and "lack of practice for physical exercises." The nursing diagnosis was associated with age and presence of diabetes. Individuals who presented with a sedentary lifestyle related to lack of motivation were significantly younger. CONCLUSIONS., This study showed a high prevalence of "sedentary lifestyle" and its associations with age and the presence of diabetes. IMPLICATIONS TO NURSING PRACTICE., The acknowledgement of "sedentary lifestyle" contributes to the choice for nursing interventions that promote physical activity centered on the subject and the surroundings. [source] The Use of Nursing Diagnoses in Perioperative DocumentationINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2010Kristiina Junttila PhD Hoitotyön kirjaaminen; hoitotyön diagnoosit; perioperatiivinen hoitotyö; Perioperative Nursing Data Set PURPOSE., To clinically validate the nursing diagnoses of the first Finnish version of Perioperative Nursing Data Set (PNDS) by using them in perioperative documentation. METHODS., Nursing diagnoses were used in documentation in four operating departments with 250 patients. In analysis, nonparametric tests were applied. FINDINGS., While intraoperatively nursing diagnoses focused on physiological concerns, postoperatively the focus shifted to that of recovery. CONCLUSIONS., The findings revealed the importance of safety-related routines in perioperative care. Nursing diagnoses in the Finnish version of PNDS are sensitive in describing the rationales for perioperative care. IMPLICATIONS FOR NURSING PRACTICE., Nursing classifications illustrate the nursing process in a structured form. Nursing diagnosis is an early step in the decision-making process that aims to achieve expected outcomes in nursing care. TARKOITUS:, Validoida PNDS-luokituksen suomalaisen version diagnoositermit käyttämällä niitä perioperatiivisen hoitotyön kirjaamisessa. MENETELMÄT:, Hoitotyön diagnooseja käytettiin kirjaamisessa 250 potilaan kohdalla. Aineiston analyysissä käytettiin ei-parametrisiä testejä. TULOKSET:, Hoidon intraoperatiivisessa vaiheessa korostuvat potilaan fysiologiaan liittyvät ja postoperatiivisessa vaiheessa potilaan toipumiseen liittyvät hoitotyön diagnoosit. JOHTOPÄÄTÖKSET:, Perioperatiivisessa hoitotyössä painottuvat potilaan hoidon turvallisuuteen tähtäävät rutiinit. PNDS-luokituksen suomalaisen version diagnoositermejä voidaan käyttää kuvaamaan leikkauspotilaiden hoidon tarpeita. TULOSTEN HYÖDYNNETTÄVYYS:, Hoitotyön prosessia voidaan kuvata rakenteisesti hoitotyön luokituksilla. Hoitotyön diagnoosin määrittäminen on osa päätöksentekoprosessia tavoitteena tunnistaa ja saavuttaa toivotut tulokset potilaan hoidossa. [source] Determining Critical Incident Nursing Interventions for the Critical Care Setting: A Pilot StudyINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2009Elizabeth Wong CRNA PURPOSE., The purpose of this research survey was to determine which Adult Critical Care Core Nursing Interventions (ACCCNIs) in the Nursing Interventions Classification constitutes a critical incident nursing intervention (CINI). A CINI is defined as any indirect or direct care registered nurse (RN)-initiated treatment performed in response to a life-threatening nursing diagnosis. METHODS., A list of ACCCNIs were sent to 50 critical care RNs in two survey rounds. Responses >80% for each ACCCNI was determined to be a CINI. FINDINGS., Forty-one ACCCNIs were determined to be CINIs. CONCLUSIONS., It is recommended that CINIs be included as a separate Nursing Intervention Classification category to reflect current nursing practice. IMPLICATIONS FOR NURSING PRACTICE., CINIs can enhance RN competency, education, and vigilance, thereby preventing or decreasing the number of deaths that occur from critical incidents. [source] Using Nursing Interventions Classification as a Framework to Revise the Belgian Nursing Minimum Data SetINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2009Koen Van den Heede PhD Nursing Interventions Classification (NIC); Minimale Verpleegkundige Gegevens; ontwikkeling van consensus PURPOSE., To develop the revised Belgian nursing minimum data set (B-NMDS). METHODS., The Nursing Interventions Classification (NIC, 2nd edition) was used as a framework. Six expert nurse panels (cardiology, oncology, intensive care, pediatrics, geriatrics, chronic care) were consulted. Seventy-nine panelists completed standardized e-mail questionnaires and discussed results in face-to-face meetings. FINDINGS., We initially selected 256 of 433 NIC interventions. After panel discussions, plenary meetings, and pretesting, the revised B-NMDS (alpha version) contained 79 items covering 22 NIC classes and 196 NIC interventions. CONCLUSIONS., Consensus building promoted acceptance of the B-NMDS, while the NIC provided a good theoretical basis and guaranteed international comparability. IMPLICATIONS FOR NURSING PRACTICE., The revised B-NMDS instrument can be used to visualize nursing activities in different applications (e.g., financing, staffing allocation). DOELSTELLING., Ontwikkeling van een nieuwe versie van de Minimale Verpleegkundige Gegevens (MVG). METHODE., De Nursing Interventions Classification (NIC, 2nd editie) werd gebruikt als raamwerk. Zes experten panels (cardiologie, oncologie, intensieve zorgen, pediatrie, geriatrie, chronische zorg) werden geraadpleegd. Zeven-en-negentig panelleden vulden gestandaardiseerde e-mail vragenlijsten in en bediscussieerden de resultaten in werkgroepvergaderingen. RESULTATEN., We selecteerden initieel 256 van de 433 NIC-interventies. Na panel-discussies, plenaire vergaderingen, en pre-tests, bevatte de herziene MVG (alpha versie) 79 items uit 22 NIC klassen en 196 NIC-interventies. CONCLUSIES., Het draagvlak voor de herziene versie van MVG werd gecreëerd door het nastreven van consensus. Het gebruik van NIC vormde hierbij een geode theoretische basis en verhoogt het internationaal karakter van de nieuwe MVG. IMPLICATIES VOOR DE VERPLEEGKUNDIGE PRAKTIJK., De nieuwe MVG kan gebruikt worden om de dagelijkse verpleegkundige praktijk zichtbaar te maken in verschillende beleidsdomeinen (e.g., financiering, toewijzing personeel). [source] Novel Nursing Terminologies for the Rapid Response SystemINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2009Elizabeth Wong CRNA PURPOSE., Nursing terminology with implications for the rapid response system (RRS) is introduced and proposed: critical incident nursing diagnosis (CIND), defined as the recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication; critical incident nursing intervention, defined as any indirect or direct care registered nurse-initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a CIND; and critical incident control, defined as a response that attempts to reverse a life-threatening condition. DATA SOURCES., The current literature, research studies, meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. DATA SYNTHESIS., The current nursing diagnoses, nursing interventions, and nursing outcomes listed in the North American Nursing Diagnosis Association International Classification, Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), respectively, are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of such standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations when activating the RRS. CONCLUSIONS., The North American Nursing Diagnosis Association International Classification, NIC, and NOC are urged to refine their classifications and include CIND, critical incident nursing intervention, and critical incident control. The RRS should incorporate standardized nursing terminology to describe patient care during life-threatening situations. IMPLICATIONS FOR NURSING PRACTICE., Refining the diagnoses, interventions, and outcomes classifications will permit nursing researchers, among others, to conduct studies on the efficacy of the proposed novel nursing terminology when providing care to patients during life-threatening situations. In addition, including the proposed novel nursing terminology in the RRS offers a means of improving care in such situations. [source] Coining and Defining Novel Nursing Terminology.INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2009Part 3: Critical Incident Control PURPOSE.,In the third of a three-part series, a novel nursing terminology is introduced and proposed for inclusion in the Nursing Outcomes Classification (NOC),Critical incident control (CIC),defined as a response that attempts to reverse a life-threatening condition. Critical incident nursing diagnosis (CIND), defined as recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication, and critical incident nursing intervention, defined as any indirect or direct care registered nurse,initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a CIND, were introduced in Parts 1 and 2 of this series, respectively. DATA SOURCES.,The current literature, research studies, meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. DATA SYNTHESIS.,The current nursing outcomes in the NOC are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations. CONCLUSION.,Coining and defining novel nursing terminology, CIC, for patient care during life-threatening situations is important and fills the gap in the current standardized nursing terminology. IMPLICATIONS FOR NURSING PRACTICE.,Refining the NOC will permit nursing researchers, among others, to conduct studies on nursing diagnoses in conjunction with the proposed novel nursing terminology, CIC. [source] Coining and Defining Novel Nursing Terminology.INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 4 2008Part 2: Critical Incident Nursing Intervention PURPOSE.,In the second of a three-part series, a novel nursing terminology is introduced and proposed for inclusion in the Nursing Interventions Classification (NIC): Critical incident nursing intervention (CINI), defined as any indirect or direct care registered nurse,initiated treatment, based upon clinical judgment and knowledge that a registered nurse performs in response to a critical incident nursing diagnosis (CIND). A CIND is defined as recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication. DATA SOURCES.,The literature, research studies, meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. DATA SYNTHESIS.,The current nursing interventions in the NIC are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations. CONCLUSION.,Coining and defining novel nursing terminology, CINI, for patient care during life-threatening situations is important and fills the gap in the current standardized nursing terminology. IMPLICATIONS FOR NURSING PRACTICE.,Refining the NIC will permit nursing researchers, among others, to conduct studies on nursing interventions in conjunction with the proposed novel nursing terminology, CINI. The first article in this series (Part 1) introduced the novel nursing terminology: CIND; the present article (Part 2) introduces the novel nursing terminology: CINI; and the third article in this series (Part 3) will introduce the novel nursing terminology: critical incident control. [source] Diagnoses and Interventions Pertinent to Intellectual Disability Nursing§INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 4 2008Fintan K. Sheerin BNS, PgDipEd PURPOSE.,The field of intellectual disability care in Ireland has been undergoing significant change, and this has called into question the role of specialist intellectual disability nursing. This review aims to identify the diagnoses and interventions that are employed by intellectual disability nurses. DATA SOURCES.,Exploration of the relevant professional literature, drawing on a broad scope of sources, was completed. DATA SYNTHESIS.,Examination and discussion within the taxonomic structure of the Nursing Interventions Classification. CONCLUSIONS.,Initial data set of diagnoses and interventions identified as a basis and justification for further systematic examination of specialist intellectual disability nursing practice. IMPLICATIONS FOR NURSING PRACTICE.,Explication and elaboration of the contribution of specialist nursing within intellectual disability care settings. CUSPÓIR.,D'aistrigh a lán rudaí sna cúram le daoine faoi mhíchumas intleachtach, in Eireann. Dá bharr sin, tháinig ceisteanna faoi páirt den banaltracht speisialta faoi mhíchumas intleachtach. Lorg an athbhreithniú seo cur ceist ar na fáthmheasa agus na headrána den speisialtóir san banaltract le daoine faoi mhíchumas intleachtach. FOINSÍ AN FAISNÉIS.,Taiscealaíocht den litríocht gairmiúil atáábhartha den ábhar. SINTÉIS AN FAISNÉIS.,Scrúdú agus suaitheadh sna cabhail den Nursing Interventions Classification. TÁTAIL.,Foireann na sonraí faoi na fáthmheasa agus na headrána chun scrúdaigh cleachtas den banaltracht speisialta faoi mhíchumas intleachtach. IMPLEACHTAÍ FAOI CLEACHTAS DEN BANALTRACHT.,sMíniú agus saothrú faoi dréacht den speisialtóir san banaltract le daoine faoi mhíchumas intleachtach sna seirbhís sláinte. [source] Coining and Defining Novel Nursing Terminology.INTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2008Part 1: Critical Incident Nursing Diagnosis PURPOSE.,In the first of a three-part series, a novel nursing terminology is introduced and proposed for inclusion in the North American Nursing Diagnosis Association (NANDA) International Classification,Critical incident nursing diagnosis (CIND),defined as the recognition of an acute life-threatening event that occurs as a result of disease, surgery, treatment, or medication. DATA SOURCES.,The literature, research studies, and meta-analyses from a variety of disciplines, and personal clinical experience serve as the data sources for this article. DATA SYNTHESIS.,The current nursing diagnoses in the NANDA International Classification are inaccurate or inadequate for describing nursing care during life-threatening situations. The lack of standardized nursing terminology creates a barrier that may impede critical communication and patient care during life-threatening situations. CONCLUSIONS.,Coining and defining a novel nursing terminology, CIND, for patient care during life-threatening situations are important and fill the gap in the current standardized nursing terminology. IMPLICATIONS FOR NURSING PRACTICE.,Refining the NANDA International Classification will permit nursing researchers, among others, to conduct studies on nursing diagnoses in conjunction with the proposed novel nursing terminology: CIND. Parts 2 and 3 of this series will propose additional nursing terminology: critical incident nursing intervention and critical incident control, respectively. [source] A Conceptual Model for Nursing InformationINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 2 2008Rodney Hughes MSc PURPOSE.,This Conceptual Model for Nursing Information describes the core activities of nursing, the collection of information about these activities, and argues that these activities must be described using standardized nursing languages. DATA SOURCES.,Relevant literature, both national and international, was reviewed and summarized. DATA SYNTHESIS.,A maximum data set for nursing was developed. CONCLUSIONS.,In the United Kingdom, a new and radical approach to the process of nursing is required; one that demonstrates that nursing is the decision-making that takes place in all core activities of nursing. IMPLICATIONS FOR NURSING PRACTICE.,Unless nurses have a clear view of what the profession requires from technological solutions for the recording of nursing activities, less than optimal solutions will be forced upon the profession. [source] Using NANDA, NIC, and NOC (NNN) Language for Clinical Reasoning With the Outcome-Present State-Test (OPT) ModelINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 3 2006CRRN-A, Donald D. Kautz RN PURPOSE.,To analyze the degree to which standardized nursing language was used by baccalaureate nursing students completing Outcome-Present State-Test (OPT) model worksheets in a clinical practicum. METHODS.,A scoring instrument was developed and 100 worksheets were retrospectively analyzed. FINDINGS.,NANDA nursing diagnoses were correctly stated in 92% of the OPT models. Nursing Outcomes Classification (NOC) outcomes were explicitly stated in 22%, and implied in 72%. Interventions matched appropriate Nursing Interventions Classification (NIC) activities in 61%. CONCLUSIONS.,NANDA, NIC, and NOC (NNN) language was used inconsistently by students in this sample. IMPLICATIONS FOR PRACTICE.,If NNN language is to advance nursing knowledge, its promotion, representation in curriculum development, and active use is necessary. Educational research is needed on the facilitators and barriers to NNN language use. [source] Factors 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] Organization Change: Theory and Practice. (2nd edition) by Burke W. WarnerPERSONNEL PSYCHOLOGY, Issue 4 2008Article first published online: 4 NOV 200 First page of article [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] Employer-supported volunteering benefits: Gift exchange among employers, employees, and volunteer organizationsHUMAN RESOURCE MANAGEMENT, Issue 2 2009Jonathan E. Booth Abstract Using gift exchange theory to explain the growing trend of employers offering employer-supported volunteering (ESV) benefits, this article discusses the creation of exchange relationships between the employer and employee and between the volunteer organization and employee. Hypotheses derived from the employee's perspective are tested with a nationally representative sample of volunteers (n=3,658). Findings suggest that ESV benefits are positively related to hours volunteered by the employee. Volunteer hours predict employee perceptions of skill acquisition, and such perceptions are positively related to perceptions of job success and employer recognition. We discuss the implications of these findings for business, employees, and volunteer organizations, with an emphasis on human resource management policy and practice. © 2009 Wiley Periodicals, Inc. [source] Human resource manager insights on creating and sustaining successful reduced-load work arrangementsHUMAN RESOURCE MANAGEMENT, Issue 4 2008Alyssa Friede Although human resource managers have critical insights into the successful implementation of reduced-load work arrangements, relatively few studies focus on their perspective. These arrangements are a growing work form for employees who choose to work less than full-time with a commensurate decrease in salary. Qualitative data analysis was used to identify key success factors noted in interviews with 52 HR managers in 39 companies. Individual employee characteristics (e.g., self-regulatory work habits) were viewed as most critical. Also important were the design of the arrangement (e.g., clarifying the arrangement in advance) and workgroup relationships (e.g., positive supervisor-employee relationships). We conclude with eight new takeaways for HR managers on how to create and sustain successful reduced-load work arrangements and directions for future research and practice. © 2008 Wiley Periodicals, Inc. [source] Work redesign: Eight obstacles and opportunitiesHUMAN RESOURCE MANAGEMENT, Issue 4 2005Michael A. Campion Successful work-design initiatives must overcome many obstacles in order to have their intended impact. This article outlines eight obstacles to work redesign: (1) influences on multiple outcomes, (2) trade-offs between different approaches, (3) difficulty in choosing appropriate units of analysis, (4) difficulty in predicting the nature of the job, (5) complications from individual differences, (6) job enlargement occurring without job enrichment, (7) creating new jobs as part of growth or downsizing, and (8) differences between longterm and short- term effects. This article examines the nature of these eight obstacles, reviews prior research on this topic, and outlines suggestions for managing these obstacles in practice. © 2005 Wiley Periodicals, Inc. [source] The Use of Person,Group Fit for Employment Selection: A Missing Link in Person,Environment FitHUMAN RESOURCE MANAGEMENT, Issue 3 2001James D. Werbel Given an increased emphasis on work teams in organizations, it is important to select applicants based on their ability to make contributions to a given work team. This paper proposes that person,group fit should be useful to select applicants for work teams and suggests that effective use of person,group fit will create both more cohesive work units and more effectively functioning work units. It proposes ways to make valid and reliable assessments of person,group fit that could be used to minimize bias in the selection process. Finally, it addresses several implications of using the person,group fit paradigm for human resource management practice. © 2001 John Wiley & Sons, Inc. [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] | ||||||||||||||||