Let the change come from within. The process of change in nursing.

Current developments in nurse management and education have resulted in significant changes to nursing practice. By planning ahead and acting as change agents, nurses can seize the initiative to apply change in a positive way.     

The nursing triage process: a video review and a proposed audit tool.

OBJECTIVE: To review the activity of the nurse triage process. SETTING: The triage room for adults attending the accident and emergency department of the Cardiff Royal Infirmary. METHODS: 226 triage processes were videotaped over 31 h during July 1994. Activities were subsequently analysed using a specially designed chart. RESULTS: Areas for improvement in staff communication skills and patient privacy were identified. CONCLUSIONS: The use of video in the triage room allows assessment of the triage process and is a valuable aid to training. Additionally, a potential visual audit tool has been identified.     

Mouth care in cancer nursing: using an audit to change practice

Patients with cancer face an assault on oral health from their disease and accompanying treatment options and are vulnerable to developing oral problems; therefore, the maintenance of oral health is particularly important. A study was carried out in one oncology unit within a large teaching hospital to measure the extent of oral problems in cancer patients, current mouth care practices and staff knowledge. The findings showed that oral problems were common, but were: (1) underreported by patients (2) underdiagnosed by doctors and nurses (3) inadequately treated, and (4) inadequately documented. Nursing staff were found to have knowledge deficits. Changes to practice as a result of these findings included the development of oral care guidelines; additionally, patient information leaflets and posters were produced and a staff education programme was introduced. A further audit found that there had been significant improvements in the diagnosis and treatment of oral problems and increased reporting of previously ignored problems by patients.