What do nurses do? An observational survey of the activities of nurses on acute surgical and rehabilitation wards

Aim  The subject of the study described in this article is an activity analysis of nursing care given on an acute surgical ward at a District General Hospital as compared to that given on a rehabilitation ward at a Community Hospital.
Methods  Obtaining a global overview of nursing activities on the two study wards was a focal issue. The project consisted of undertaking in excess of 60 h of observation with 10 registered nurses (RNs) of various grades in the two settings.
Findings It was found that both sets of nurses undertook similar types of activities. Overall more indirect care activities than direct care occurred on both wards. These findings are similar to the findings of other studies where the majority of RNs' activities are said to relate to the co-ordinating and management aspects of patient care.
Conclusion  It is concluded that the 'glue function' or maintaining a holistic overview of patient care given by all members of the health care team is an important part of nursing care delivery.     

Older patients' first 72 hours in hospital

The aim of this study was to determine what kind of care older patients receive in hospital during the first 72 h after admission. This was examined through four categories: patient's arrival on the hospital ward; patient's daily schedule on the ward; information and guidance; and interaction during the hospital stay. The focus was on five patients aged over 70 who had been admitted for prescribed examinations and care, including starting insulin medication, colonoscopy and a computed tomography scan of the colon. The data were collected by means of non-participant observation; interpretation was based on the method of content analysis. The results showed that the patients' arrival on the ward consisted of routine procedures and periods of waiting. The patients' daily schedule was determined by the ward's routines. They had very little control or influence over their own care, and limited privacy. Interaction between the patient and personnel was minimal, and lasted for only short periods of time. Patients were important sources of information for one another. There was also good cooperation among patients, helping one another to cope with minor everyday problems. It is concluded that nursing staff on the ward were preoccupied by their own routines and largely failed to take into account the views of their patients.     

The gate still swings both ways in rural Texas

Aims  To give nurse managers a perspective of what it is like to practice in a frontier or rural setting without the resources of the metropolitan centres.
Background  I grew up in rural Texas and more recently had the opportunity to work with rural hospitals seeking to be designated as Nurse Friendly by the Texas Nurses Association. This renewed my interest in and great respect for nurses on the frontier and other rural areas.
Key issues  This article summarizes some characteristics of rural nursing in relation to their practices that address patient safety and quality of care, nurse satisfaction and balanced life style, community service, and teamwork/relationships.
Conclusions  I conclude that there are many advantages and satisfactions in rural nursing that are different from but equally as meaningful and challenging as metro nursing practice.
Implications for nursing management  This article is important because there is a shortage of nurses everywhere; however, direct care nurses and nurse managers in rural areas may have greater challenges in meeting their patient's needs while balancing their personal lives.     

The life of a new long stay patient: a reflexive experience

The care received by one patient in an acute psychiatric ward setting is described and analyzed by examining the relevant literature and the patient's perspective through a therapeutic relationship with a psychiatric nursing student. The patient is described as the new long stay patient and the reasons for the existence of this group are discussed. The paper concludes by stating the need to provide for those patients who are inappropriately occupying acute beds because there is no available alternative. This is found to cause problems for the individual, for psychiatric services and for nursing care.     

Estimating nurses' workload using the Diagnosis Procedure Combination in Japan

Aim:  To examine the methods used to estimate nurse staffing levels in acute care settings with Diagnosis Related Groups, which in Japan are called the Diagnosis Procedure Combination (DPC).
Methods:  For estimating staffing requirements, the study used four DPC groups: (1) acute or recurrent myocardial infarction (AMI) with stenting, (2) angina pectoris with coronary artery bypass grafting (CABG), (3) sub-arachnoid haemorrhage (SAH) with clipping surgery, and (4) cerebral infarction with carotid endarterectomy (CEA). Registered nurses with more than 3-year nursing experience in nine university hospitals in the Tokyo metropolitan area completed self-report questionnaires in order to obtain nursing care time and care intensity per each DPC. The concordance rate was measured by Kendall's coefficient of concordance. The relationship between the care time and the care intensity was examined by a time series graph per DPC. Care intensity consisted of professional judgement, mental effort for helping patients, professional skill, physical effort for providing activities of daily living support, and nurse stress, based on the Hsiao and colleagues' model of resource-based relative value scale.
Results:  Twenty-five nurses in nine university hospitals answered for a hypothetical typical patient with AMI and with CABG, and 28 nurses in nine university hospitals answered for a hypothetical typical patient with SAH and with CEA. Kendall's coefficient of concordance was 0.896 for AMI, 0.855 for CABG, 0.848 for SAH, 0.854 for CEA. The time series data of the care time and the care intensity items showed different patterns for each DPC.
Conclusion:  The DPC for cardiovascular and cerebral surgical procedures can be used for estimating nurses' workload.     

A sampling study of bedside nursing activity in a cardiac surgical intensive care unit. Part 2

For a selected group of 17 patients following cardiac surgery, 33 discrete elements of nursing workload have been defined, and the nurse's bedside activities logged at 1 min intervals throughout the 24 h immediately following the patient's return from the operating theatre. It is possible to identify three broad types of activity undertaken by the bedside nurse; technical nursing care (Type 1), intermittent nursing care (Typy 2), and the balance of the nurse's time, largely concerned with observation and liaison with other staff — learning activities (Type 3). The time devoted to technical nursing care reduces significantly over the patient's first 24 h in the ward. On the other hand the time devoted to intermittent nursing care and learning activities is shown to be shift dependent. The effect of the efficient utilisation of computer technology is estimated, and it is demonstrated that the implementation of such technology would result in the expansion of the time available for the nurse to observe the patient. The potential benefits and drawbacks of this are discussed.     

Factors influencing nurse–patient interaction in the acute psychiatric setting: An exploratory investigation

Nurse–patient interaction in acute psychiatric in-patient facilities has been the subject of much discussion in the literature and remains a contentious issue. How and why nurses interact with patients in the acute care setting requires definition within the current dynamic environment of mental health service provision. Factors which impact on the manner in which nurses care for patients also require investigation. This article presents the findings of a collaborative research study that investigates factors that influence nurse–patient interaction in the acute psychiatric setting. Ten nurses on the study ward were given opportunity, through semi-structured interviews, to outline and describe the factors perceived to influence nurse–patient interaction. Factors identified as influencing interaction included the ward environment, something always comes up, nurses’ attributes, patient factors, instrumental support and focus of nursing. Issues which emerged from the study provide managers and clinical nurses with an opportunity for generating new possibilities for nurse–patient interaction. However, these issues must be addressed in a sensitive way that takes into account the complex and dynamic nature of acute care settings.     

Nurse-led ward rounds: a valuable contribution to acute stroke care

Stroke is a devastating condition. The Royal College of Physicians (2008) highlights that integrated stroke care can improve patient care. Nurses are an integral part of the multidisciplinary team, providing 24/7 stroke care from planning and implementing care to the evaluation of the patient's condition. To improve the way nurses manage stroke patients in an acute setting, a nurse-led ward round was initiated to look at essential nursing care. The Imperial College Healthcare Trust stroke senior nursing team, consisting of a clinical nurse specialist, a ward manager, and a charge nurse, have organised a weekly stroke nurse-led ward round. The team takes rounds to each stroke patient in the ward to examine and evaluate the essentials of nursing care (e.g. oral care, skin integrity, continence, bowel and bladder management), and current stroke outcome measures. During the rounds, the team address nursing issues, make appropriate nursing goals, and discuss their plans with the nurses and other members of the team. A nurse-led ward round has addressed nursing issues in a timely proactive fashion. The initiative has been successful in improving clinical communication between nurses and patient involvement in their care planning. It has also empowered nurses to make decisions within their professional arena, and its contribution has had an impact on patient care and safety through early detection and prevention of stroke complications.     

优质护理服务在精神科开放式病房中的应用

目的:探讨优质护理服务在精神科开放式病房中的应用效果。方法:学习领会优质护理服务示范工程精神实质,改善住院环境,规范服务流程,改革护士排班模式,实施小组责任制护理,夯实基础护理,规范康复治疗,改革护理质量控制等措施创建精神科优质护理服务示范病房,创建前(2010年2～7月)后(2010年7～12月)采用我院护理工作满意度调查表进行调查、比较。结果:创建优质护理服务示范病房后患者总满意度及对护理服务、护理技术、护士态度、病房环境维度的满意度与实施前比较差异均有统计学意义(P<0.01)。结论:创建优质护理服务示范病房,护士服务由被动变主动,可有效地提高护理质量,提高患者满意度,同时能提升护士自我价值感。