Significant elements in nursing situations. Experience-orientated situational research in nursing

Patients or residents and nurses often do not perceive situations where nursing care is provided in their full complexity. Furthermore they attach different significance to the individual elements of such situations as e.g. the actions of the persons involved, the structures of the relationships, the results of the nursing care or the surrounding conditions. The qualitative research study presented in the following is based on a specifically elaborated situational perspective and reveals those elements leading to experience any situation where nursing care is provided as successful or unsuccessful on the part of patients and nurses. The reconstruction of complex situations where nursing care is provided reveals decisive aspects for the active development of nursing action and points out that effective nursing care is distinguished by being related to the present and adapted to the respective situation.     

The essence of nursing.

In the first of two articles, Alison Kitson outlines the fundamental elements of nursing, and how they should be protected and communicated. She argues that having the ability to care for the patient as a whole person is the essence of good nursing practice, in which a range of environmental and organisational conditions prevail, and over which the nurse must be in control. Similarly, basic observation and practical skills in traditional nursing must be evident before nurses can be assured they have met basic needs. She considers the effect of health care and other changes on nursing, along with strategies for ensuring that the essence of nursing is protected. The second article will appear next week.     

Quality nephrology nursing care: beyond Kt/V.

Through a critical review of nursing and medical literature, this article argues that nephrology nurses have embraced Kt/V at the expense of other core elements of nephrology nursing care. The focus on quality care as technical expertise may dominate at the expense of interpersonal care. Nurses need to challenge the influence Kt/V has on other aspects of nephrology nursing care.     

Developing a patient care model for an integrated delivery system.

An integrated healthcare delivery system requires a consistent patient care delivery model. The authors describe the process used to define common elements of the patient care model. These elements include the roles of chief nurse executives, first-line managers, staff registered nurses, and unlicensed assistive personnel. In addition, the philosophy of nursing and support functions (staff education and nursing dashboard for quality measurement) in place across the system are discussed.     

Nursing care delivery systems. Status and vision

Nurse executives may compare nursing care delivery system elements in their organizations to data from 987 U.S. hospitals. The report includes the status of governance, patient assignment, and other elements in 1986 and 1989 as well as projections for 1992. The changes and projections comprise a vision for the near future of hospital nursing.     

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.     

The home as a setting for care. Clarifying the boundaries of practice

This article has outlined the need for clarification of home care nursing practice to retain the elements essential to professional practice. Home care that is nursing focused, based on concepts of community health nursing, and client/family centered forms the core of professional home care nursing. Technical services that are provided in the home should be clearly delineated so that consumers, payors, and practitioners can determine the roles and functions of the various providers. Professional home care, practiced not just by nursing but by all licensed providers, is practice driven. The boundaries of practice are determined by professional standards with a basis in scientific theory and research. The foundation for this type of practice is strong and should continue to be practiced in the future. Technical house call services, on the other hand, are product driven, often with a zeal for the bottom line profits that does not take into account what is the best product for a specific patient situation or how well that product has been tested. There is definitely a need for both services in delivering health care to people in their homes. It is also hoped that both areas of service can work together to facilitate the management of patient and family needs. It is important, though, to fully define the type and substance of care that is provided in the home setting. Without this ongoing clarification, home care will continue to be fragmented and interpreted differently by everyone involved.     

The CNS as a cost manager.

The role of the clinical nurse specialist (CNS) in a cost-conscious environment includes the need to be alert to opportunities for cost-containment. Efforts to improve the quality of nursing care need to be balanced with the ability to manage costs. The CNS is in a key position to guide and influence decision-making about cost savings. This article reviews costs in health care and the elements of total nursing costs. CNSs can affect costs in three areas: direct costs, indirect costs, and supplies/equipment. Practical examples in each of the three areas are given for actions that are potentially useful to the CNS who desires to reduce the costs to patients and document the cost savings generated by nursing.     

An Evaluation Guide to Assist with Implementation of Nursing Diagnosis

Nursing diagnosis is increasingly recognized as an integral component of professional nursing practice. Implementation of nursing diagnosis impacts on all elements of professional practice: the philosophy, purpose, and objectives of an organization; care planning; quality assurance; staff education; performance standards; the nursing care delivery system; documentation; and patient classification. A guide organized around these elements has been developed to assist with the implementation of nursing diagnosis. This guide can be used to gather information to plan for the implementation of nursing diagnosis or as a post-test to judge the success of the implementation process.     

An evaluation guide to assist with implementation of nursing diagnosis

Nursing diagnosis is increasingly recognized as an integral component of professional nursing practice. Implementation of nursing diagnosis impacts on all elements of professional practice: the philosophy, purpose, and objectives of an organization; care planning; quality assurance; staff education; performance standards; the nursing care delivery system; documentation; and patient classification. A guide organized around these elements has been developed to assist with the implementation of nursing diagnosis. This guide can be used to gather information to plan for the implementation of nursing diagnosis or as a post-test to judge the success of the implementation process.     

基础护理是护理工作永恒的基本内容

基础护理始终是护理工作不变的基本内容,护理专业的职能理念随着时代进步和专科医疗发展而变化,全面加强临床护理工作,强化基础护理是医疗护理工作发展的要求,作为护理管理人员,做好基础护理必须科学地利用好人力资源,要有医疗护理安全意识,做好基础护理工作的质量控制,提高护理质量。     

Improving work morale of nurses despite insurance cost cutting. 2. Program planning

Declining resources in health care frequently translate into work overload and declining opportunities for nursing staff. Faced with increases in absenteeism and lower morale among staff, nursing administrators must develop low-cost approaches to these problems. Building on the assessment process in Part 1, the authors present elements of program planning, illustrating the process with a low-cost model program to improve morale that addresses workload, learning opportunities, and organizational rewards for staff nurses.     

Missed nursing care: a concept analysis

Title.  Missed nursing care: a concept analysis.
Aim.  This paper is a report of the analysis of the concept of missed nursing care.
Background.  According to patient safety literature, missed nursing care is an error of omission. This concept has been conspicuously absent in quality and patient safety literature, with individual aspects of nursing care left undone given only occasional mention.
Method.  An 8-step method of concept analysis – select concept, determine purpose, identify uses, define attributes, identify model case, describe related and contrary cases, identify antecedents and consequences and define empirical referents – was used to examine the concept of missed nursing care. The sources for the analysis were identified by systematic searches of the World Wide Web, MEDLINE, CINAHL and reference lists of related journal articles with a timeline of 1970 to April 2008.
Findings.  Missed nursing care, conceptualized within the Missed Nursing Care Model, is defined as any aspect of required patient care that is omitted (either in part or in whole) or delayed. Various attribute categories reported by nurses in acute care settings contribute to missed nursing care: (1) antecedents that catalyse the need for a decision about priorities; (2) elements of the nursing process and (3) internal perceptions and values of the nurse. Multiple elements in the nursing environment and internal to nurses influence whether needed nursing care is provided.
Conclusion.  Missed care as conceptualized within the Missed Care Model is a universal phenomenon. The concept is expected to occur across all cultures and countries, thus being international in scope.     

The "Zurich Quality Model of Nursing Care", based on the "Quality of Health Outcome Model" (QHOM): a new perspective in measuring quality in nursing care

Ensuring and maintaining a high level of quality in nursing care becomes more and more important as economic pressure is increasing and personnel is being reduced. The nursing executives of four large Swiss hospitals therefore commissioned a group of nursing scientists and nursing experts with the task of developing a trendsetting model to represent, assess, and interpret the quality of nursing care. The "Quality of Health Outcome Model" (QHOM) served as a basis for development. More than 60 nurses from acute care hospitals and specialized clinics assessed a first draft of the model in hearings and by means of questionnaires. The model integrated earlier attempts at quality screening regarding structures, processes and results, complementing these three elements with a fourth: the patients, whose characteristics influence the results of nursing care remarkably. Thus, the former one-dimensional, linear viewpoint was resolved into a dynamic representation of all four elements, illustrating a specific concept of nursing care. Through the multi-dimensionality of the model the complexity of the nursing process is better represented. The model's core consists of eight exemplary indicators of quality, each of which is relevant to nursing and for each of which criteria and assessment tools have been formulated. The model is seen as a basis and reference for the quality development and first opportunities for clinical application have been succesfully employed. The project can serve as a paradigm of networking amongst hospitals and cooperation between nursing scientists and experts, and of the critical significance of such collaboration to the advancement of nursing quality.     

Care management: scientific thoughts on a current topic

The following article deals with one of the management concepts now undergoing extensive international debate--the care management concept favored in Great Britain--and discusses its importance in respect to the optimization of outpatient nursing care in the Federal Republic of Germany. After a presentation of the key elements comprising the concept, four central task complexes relating to care management are discussed: establishing demand--and need oriented nursing, assuring the integration and continuity of care, especially when chronic diseases are involved, helping family members to provide nursing care and promoting health as one of the nursing profession's tasks. It is shown that care management is a tool that can be used to tackle deficits in outpatient nursing care and find innovative solutions to them, thereby promoting the nascent professionalization of nursing in Germany, a trend that is long overdue in international terms.     

Primary nursing. Teamwork is the answer

Eight years of experience with primary nursing in a 750-bed acute care teaching hospital revealed several persistent problems: isolationism among nurses, communication problems between nurses and physicians, inadequate documentation, and insufficient time for patient and staff education, resulting in frustration for the nursing staff. By combining the basic elements of primary and team nursing, a 3-month pilot in one unit resulted in improved job satisfaction for professional staff, improved quality assurance scores, and increased physician-nurse communication.     

Use of the nursing minimum data set.

The purpose of this study was to obtain information about usage of the Nursing Minimum Data Set (NMDS). Forty-six individuals (44%) who requested the NMDS Data Collection Manual responded to a mailed questionnaire. Most respondents reported actually using the Manual to educate other nurses or to structure nursing documentation. More than one third of the respondents used all of the elements within the NMDS, but the majority used, or intended to use, the elements in the Nursing Care category. The majority of NMDS elements that were being used, or intended to be used, were available from handwritten patient records. The NMDS elements had been recorded on an ongoing basis by 86% of the respondents, but only 31% could retrieve readily all of the elements. Implications for access to comparable, minimum nursing care and resources data are discussed.     

Improving nursing morale in a climate of cost containment. Part 2. Program planning

Declining resources in health care frequently translate into work overload and declining opportunities for nursing staff. Faced with increases in absenteeism and lower morale among staff, nursing administrators must develop low-cost approaches to these problems. Building on the assessment process in Part 1 (October 1984 JONA), the authors present elements of program planning, illustrating the process with a low-cost model program to improve morale that addresses workload, learning opportunities, and organizational rewards for staff nurses.     

Specialism in nursing: the case of nursing care for elderly people

Is elderly care nursing a speciality? This paper reports results from an interview-based study which aims to uncover the distinctive elements of nursing work with elderly people Within the context of sociological literature on specialism it is concluded that a case for seeing elderly care nursing as a speciality area can be made However, that case has implications for the continued marginalization of elderly people in society