Creating effective nursing partnerships: relating community development to participatory action research

The purpose of this article is to demonstrate the importance of creating effective partnerships between nurses practising community development (CD) and nurses engaged in participatory action research (PAR). To that end, an overview of the theoretical principles of CD and PAR is provided and the central tenets of each methodology explored. This is followed by a discussion of the similarities and differences inherent in CD and PAR which derive from the same theoretical and philosophical foundation; that of critical social theory. Examples of two research projects highlight the relationship between CD and PAR and demonstrate the value of creating effective practitioner/researcher partnerships. Finally, some of the lessons learned in creating these important partnerships will be presented. Although this call for practitioner/researcher alliance is not new, what is new is the central role the practising nurse could take in research. Creating partnerships between practising nurses and nurse researchers advances the opportunity to actualize responsive and effective PAR and to fulfill nursing's social contract.     

Relocating care: negotiating nursing skillmix in a mental health unit for older adults

Mental health care in Australia in the last 20 years has moved from stand-alone psychiatric hospitals to general hospitals and the community. This paper reports an action research project exploring the experiences of nurses on an acute mental health unit for older adults staffed with a skillmix of mental health and general nurses, which recently transitioned from a psychiatric to a general hospital. The new service provides comprehensive health care, including the management of physical co-morbidity and a recovery orientation. Recovery acknowledges the role and rights of consumers and carers in planning and management of care, choice and individual strengths (Shepherd). The new ward received additional resources to establish the model of care, including a broader skillmix. The paper explores the dynamics of development of a new model of care and of bringing together staff with different professional orientations, cultures and priorities. Focus groups and interviews were conducted with 18 staff. Analysis resulted in three themes relating to the impact of competing goals and foci of care upon professional boundaries; competing organisational cultures and the impact of service change upon work practices. The findings are explored in relation to ideas about health care delivery associated with neoliberalism.     

麻醉恢复室入室护理流程的应用

目的探讨麻醉恢复室(post-anesthesia care unit,PACU)入室护理流程的临床实践效果。方法建立PACU入室护理流程,内容包括连接呼吸机、连接监护仪、管道交接、皮肤交接等流程和对PACU护士进行培训、考核。结果流程应用前,术后患者入室护理时间从7.0 min降至流程应用后4.0 min,无1例发生护理风险及不良事件。结论 PACU入室护理流程的应用提高了护理质量,加强了患者安全。     

集束化护理干预在急诊重症监护病房机械通气病人护理中的应用

[目的]探讨集束化护理干预在急诊重症监护病房(EICU)机械通气病人护理中的应用。[方法]采用方便抽样方法,将296例EICU机械通气病人分为观察组134例和对照组162例,观察组采用集束化护理干预,对照组采用常规护理。病人转出EICU时评价效果。[结果]观察组病人意外脱管率、肺部感染率、病死率低于对照组(P<0.05);观察组病人住院费用、机械通气时间、住EICU时间少于对照组(P<0.05)。[结论]对EICU机械通气病人采用集束化护理干预,可降低相关并发症的发生率、病死率,减轻病人的经济负担,有益于医患双方。     

Transformative 'cultural shifts' in nursing: participatory action research and the 'project of possibility'

Transformative 'cultural shifts' in nursing: participatory action research and the lsquo;project of possibility'
For some time scholars have called for changes in nursing in order to address the subjugated position of nurses within health care. This paper argues that through an engagement with participatory action research, nurses open up a possibility to bring about transformative shifts in nursing culture. The motivation for nurses to engage with this research process arises out of an acknowledgement that they can no longer live with the sense of pain and crisis endemic in much of their nursing practice, and a desire to take action to bring about transformative change within their local ward cultures. However, their participation in critical reflective and collaborative processes that underpin action research exposes an array of minor scattered nursing practices which frustrate possibilities for transformative change. Drawing on empirical accounts from research conducted by the author, the paper argues that once made explicit, these minor practices and the regimes of truth that nurture and sustain them, can be reconstructed and the possibility of transformative cultural shifts in nursing will then emerge.     

The manifestation and nursing management of agitation in institutionalised residents with dementia

This participatory action research study is the first formal research study undertaken by nurses in a nursing development unit. The study emerged as the result of nurses brainstorming issues that they perceived to be problematic in their nursing practice and their unit environment. The nurses of the psycho-geriatric nursing development unit, Wallsend Aged Care Facility, New South Wales, Australia identified that the management of agitated behaviour manifested by their severely demented clients was a major challenge in their practice. As a result, a pilot participatory action research study was designed to measure how agitation manifested, to measure the severity of agitation and to identify current nursing practices used to manage it and their outcome. Results of the study demonstrated that nurse actions triggered the majority of most highly rated episodes of agitated behaviour in this group of elderly residents, and that the majority of these nurse actions related to those involved in carrying out activities of daily living for the residents.     

The value of participatory action research in clinical nursing practice

This paper demonstrates the value of participatory action research (PAR) and promotes its use by nurses in clinical practice. PAR has gained popularity in nursing and health-care research, offering a way of developing practice-based knowledge that can improve nursing care. PAR is described in detail: what PAR is, how to use PAR in clinical practice, and the steps in the PAR cycle as applied during an exemplar study in which nurses used PAR to address their concerns and develop, implement and evaluate a model of care in an acute medical ward. The authors advocate PAR as a collaborative means to improve the nursing care for patients in varied clinical practice settings.     

The nursing process in crisis-oriented psychiatric home care

Crisis-oriented psychiatric home care is a recent development in the Dutch mental health care system. Because of the difference between psychiatric care in the home and in the hospital, an action research project was initiated. This project was directed at the nursing process and the nurses' role and skills in psychiatric home care. The main goal of the project was to describe and to standardize nursing diagnoses and interventions used in crisis-oriented and long-term psychiatric home care. The development of supporting methods of assessment and intervention were also important aspects of this project. In this article a crisis-oriented psychiatric home care programme and the first developmental research activities within this programme are described. To support the nursing process, the development of a nursing record and an assessment-format, based on Gordon's Functional Health Patterns (FHP), took place. By means of content analysis of 61 nursing records, the most frequently stated nursing diagnoses, based upon the North American Nursing Diagnosis Association (NANDA) taxonomy, were identified. The psychiatric diagnostic categories of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were also collected. The most common categories found were those of mood disorders and schizophrenia or psychotic disorders. Seventy-five per cent of the nursing diagnoses showed up within four FHP: role-relationship, coping-stress tolerance, self-perception/self-concept and activity-exercise. The nursing diagnosis of 'ineffective individual coping' was stated most frequently. This is not surprising because of the similarities in the definitions of this nursing diagnosis and the concept of 'crisis' to which the psychiatric home care programme is oriented. Further research activities will be focused on standardization of nursing diagnosis and the interventions that nurses undertake in this type of care.     

Sleep and nursing care activities in an intensive care unit

This study aimed to describe the quality of sleep of non‐intubated patients and the night‐time nursing care activities in an intensive care unit. The study also aimed to evaluate the effect of nursing care activities on the quality of sleep. An overnight polysomnography was performed in 21 alert, non‐intubated, non‐sedated adult patients, and all nursing care activities that involved touching the patient were documented by the bedside nurse. The median (interquartile range) amount of sleep was 387 (170, 486) minutes. The portion of deep non‐rapid‐eye‐movement (non‐REM) sleep varied from 0% to 42% and REM sleep from 0% to 65%. The frequency of arousals and awakenings varied from two to 73 per hour. The median amount of nursing care activities was 0.6/h. Every tenth activity presumably awakened the patient. Patients who had more care activities had more light N1 sleep, less light N2 sleep, and less deep sleep. Nursing care was often performed while patients were awake. However, only 31% of the intervals between nursing care activities were over 90 min. More attention should be paid to better clustering of care activities.     

重症监护室护理成本研究进展

介绍了护理成本的定义,研究护理成本的目的和意义,国内外护理成本的核算方法及其现存的问题。综述了近年来国内外监护室护理成本的研究进展。     

重症监护室护理成本研究进展

介绍了护理成本的定义．研究护理成本的目的和意义．国内外护理成本的核算方法及其现存的问题。综述了近年来国内外监护室护理成本的研究进展。     

Participatory action research and photovoice in a psychiatric nursing/clubhouse collaboration exploring recovery narrative

ACCESSIBLE SUMMARY: ? Personal stories about recovery in mental health are important sources of knowledge. ? Research methods are needed for exploring personal stories of recovery which honour and empower the authors of recovery stories. ? The Clubhouse of Winnipeg and an assistant professor in psychiatric nursing piloted a research project using photography in order to explore, document and share Clubhouse Member stories of recovery. ABSTRACT: The Clubhouse of Winnipeg (a community psychosocial rehabilitation centre) collaborated with a psychiatric nursing assistant professor on a participatory action research (PAR) project exploring the concept of recovery using a using a research method called photovoice. The collaborative project -Our Photos Our Voices- demonstrates how PAR and photovoice are well suited for collaborative research in mental health which honours principles underlying consumer empowerment and recovery. The foundation of empowerment is the power to act on one's behalf; PAR and photovoice support the full participation of concerned individuals in all aspects of research with the ultimate goal of action to solve problems or to meet goals identified by those individuals. Empowerment is also the ability to lay claim to one's own truth. At the core of the recovery model is the principle that recovery is defined by the individual and based on individual determinations of meaningful goals and a meaningful life. The Our Photos Our Voices project uses PAR and photovoice to effectively access, explore, document and share personal, local knowledge about recovery grounded in the personal experience of the Clubhouse researchers.     

The Norwegian teaching home program: developing a model for systematic practice development in the nursing home sector

Background. In the mid-1990s, there was persistent critique of the quality of care provided in residential aged care facilities in Norway, in line with similar concerns expressed in many other countries. Difficulties recruiting qualified staff and high turnover led to difficult working conditions. Little prestige was associated with providing geriatric care. Collaboration between educational institutions, universities and elderly care institutions with the purpose of strengthening education, competence development, practice development and research within elderly care was poorly developed. The Norwegian teaching nursing home (NTNH) program was launched to address these issues. Aim. The purpose of the NTNH was to contribute to the quality of care of frail older persons by improving the competence of staff, improving the prestige of working with older people, stimulating development of services, facilitating research into the care of older persons, and developing good learning environments for students. Methods. The NTNH-program was developed over a period of seven years, applying a participatory action research design. Progressing through four phases, it involved a number of people and institutions across Norway. Results. Formal and informal competence of staff was increased. A large number of practice development projects contributed to increased quality of care in selected problem areas. Models of competence development were disseminated to other institutions, thereby improving the level of competence beyond the NTNHs. Learning conditions for students were improved. Following a formal evaluation of the program, teaching nursing homes (TNHs) were established on a permanent basis in 2004, with financial support from the Department of Health and Social Services. In 2008, a total of 20 TNHs are part of the NTNH program. Conclusions. The NTNH program led to permanent establishment of a series of TNHs responsible for contributing to competence development, practice development and research on a continuous basis in order to secure high levels of care to the Norwegian nursing home population. The program has created substantial enthusiasm within the nursing home sector and has increased the prestige of these institutions.     

儿童腺样体切除术后在麻醉恢复室的护理

目的 探讨小儿腺样体全麻术后在恢复室的护理要点,减少术后并发症的发生。方法 对70例腺样体切除术后患儿进行严密监护, 在麻醉恢复室(PACU)平均监护时间64.29min,动态记录患儿的生命体征、血氧饱和度,严格掌握好拔管的指征,离PACU的标准,针对护理隐患预见性护理。结果 麻醉恢复期发生各种并发症41例（58.57%）,其中舌后坠12例（17.14%）,轻度喉痉挛2例（2.86%）,躁动26例（37.14%）,寒战1例（1.43%）。腺样体切除术后患儿护理效果满意,均安全度过麻醉恢复期。结论 儿童腺样体切除术后易发生躁动、气道梗阻, 应加强安全防护以及呼吸道的管理,以利于减少患儿麻醉后的并发症,提高手术安全性。     

规范化护理告知程序在重症医学科的应用

目的：探讨在重症医学科开展规范化护理告知程序的临床应用实践方法及效果。方法选择梁平县人民医院重症医学科2012年1～12月入住患者835例作为对照组,采取常规护理告知方法,将2013年1～12月入住本科患者893例作为观察组,运用规范化护理告知程序。对两组患者的满意度、投诉例数、护士差错例数进行分析比较。结果观察组患者满意度为（95．90±1．31）％,明显高于对照组,差异有统计学意义（ P＜0．01）;观察组投诉例数为2例,护士差错例数为23例,均明显少于对照组,差异有统计学意义（ P＜0．05）。结论在重症医学科根据不同对象、住院阶段,实施有针对性的规范化护理告知程序,可改善护患关系,减少投诉,提高患者满意度,同时增强护士的法律意识,提升护士综合素质,减少护理差错的发生。     

人性化综合护理措施对重症监护室患者恢复的影响

目的:探讨人性化综合护理措施对普外科重症监护室患者恢复的影响.方法:将2011年1月～2012年1月我院普外科重症监护室收治的100例患者作为对照组,给予常规护理;将2012年2～10月我院普外科重症监护室收治的77例患者作为研究组,在常规护理的基础上给予人性化综合护理措施.对比分析两组患者的住院时间、抢救成功率、焦虑情绪及对护理工作的满意度.结果:研究组患者的住院时间短于对照组(P＜0.05),抢救成功率高于对照组(P＜0.05),人住重症监护室第15 d焦虑得分低于对照组(P＜0.05),对护理工作的满意度高于对照组(P＜0.05).结论:人性化综合护理能有效提高普外科重症监护患者的抢救成功率,促进患者恢复,缩短患者住院时间,降低患者焦虑情绪,最终提高其对护理工作的满意率,值得临床推广应用.     

我国临床护理发展趋势

针对医疗市场新形势,提出了实施专科护士培训、设立标准化护理单元、实行医护分开综合目标管理等临床护理发展新趋势,并对其优势和不足以及具体运行过程中的关键环节进行分析,为改进临床护理工作提供依据和指导。     

Investigating and implementing change within the primary health care nursing team

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter-professional team-working into sharper focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspectives of service users; identifies areas of change; clarifies core and specialist skills; defines new roles among the primary health care nursing team; proposes a new model of working; and identifies appropriate education. The project was set in a general practice in south-west England and used an action research methodology. The objectives were to create a change in practice and to develop and refine existing theory to underpin nursing roles. Throughout the research regular team meetings allowed reflection and discussion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and individual interviews with GPs, practice managers and area managers. Reflective diaries and a patient survey were also used. The analysis of the quantitative and qualitative data collected from patients formed a basis for practice development and facilitated the team's reflection on the areas of change. Overall high satisfaction with services and care was expressed in the patient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and responsibilities for team members. Regarding the team perspective, the data indicated many areas that could be considered for development. The community nursing team decided to concentrate on three key areas: child health, leg ulcer management, and cardiovascular health. The research concludes that action research presents some problems and challenges but is a useful approach to developing team-working in primary health care.     

经皮扩张气管切开术在ICU的应用和护理

目的探讨运用经皮气管扩张切开术（PDT）在重症监护病房（ICU）中的应用效果和护理。方法以气管切开术患者40例为研究对象,随机分为标准的开放性气管切开术（OT）组和经皮扩张气管切开术（PDT）组,每组20例,比较两组的手术时间、术中出血量及术后出血量,并总结分析行PDT患者的护理过程。结果 PDT组手术时间为（10.82±1.47）min、术中出血量及术后出血量分别为（5.86±0.18）mL、（3.21±0.13）mL,与OT组比较,P〈0.01。结论与标准的外科气管切开术组比,PDT手术时间短,出血量少,更加易于护理。