Nursing needs of acutely ill older people

BACKGROUND: Investigating older acutely ill hospitalized patients' nursing needs and quality of care is paramount, given the growing pressure on nurses to provide increasingly intensive levels of care to a growing older population while at the same time working with reduced staffing levels. AIMS: The aims of this study were to determine: (1) important aspects of nursing care as perceived by older patients, their family member/carer who observed care during hospitalization, and nurses; (2) satisfaction levels of patients, family/carers and nurses on nursing care received; and (3) mismatches between nursing care priorities and satisfaction with nursing care. METHODS: Two hundred and thirty-two acutely ill patients aged over 65 years, 99 carers/family members and 90 nurses completed the Caregiving Activities Survey, which measures importance of and satisfaction with various aspects of nursing care. Qualitative data, which qualified responses to survey items, were also obtained from participants. RESULTS: Patients, carers and nurses perceived that carrying out doctors' orders was the most important aspect of nursing care, followed by physical care, psychosocial care and discharge planning. Nurses and carers rated physical care, psychosocial care and discharge planning more highly than patients. Physical care was rated highly by patients in terms of importance, but rated moderately in terms of satisfaction. Carers' and patients' ratings of satisfaction with physical care were lower than nurses' ratings of opportunities to provide it. The importance of discharge planning was rated highly by nurses but all groups were only moderately satisfied with this aspect of care. STUDY LIMITATIONS: The findings do not apply to acutely ill older patients with confusion, mental illness or more than early stage dementia. CONCLUSIONS: Patients, nurses and family/carers were generally in agreement about the relative importance of particular aspects of nursing care. Nurses may need to communicate more effectively with older patients and their family carers about the particular roles they will play during the patient's hospital episode, the expectations they have of patients in the process of healing and recovery, and the reasons for the actions they take in aiding this process. The findings are useful in making nurses more aware of the expectations and needs of older hospital patients and their carers. They provide evidence for developing both new models of nursing care for this patient group, and nursing education programmes.     

Providing psychosocial and physical rehabilitation advice for patients with burns

Title.  Providing psychosocial and physical rehabilitation advice for patients with burns.
Aim.  This paper is a report of a study evaluating the perceived skills of nursing and allied healthcare professionals in providing psychosocial and physical rehabilitation advice, including the effect of years of burn injury experience.
Background.  Recovery from burn injuries is a complex mix of physical and psychosocial rehabilitation, yet research in the UK has demonstrated that healthcare professionals feel more competent at giving advice to patients on issues of physical rehabilitation than psychosocial rehabilitation.
Methods.  This was a replication study with a cross-sectional design. A questionnaire survey was conducted with a convenience sample of healthcare professionals in a large urban hospital with specialist burn and plastic services in New Zealand. The data were collected in 2005.
Results.  Consistent with the UK results, New Zealand healthcare professionals rated their skills in advising patients about physical items of burn rehabilitation higher than their skills for psychosocial items. Years of experience working with burns was related to greater perceived skill in advising patients on physical rehabilitation. In contrast, no relationship between years of experience and perceived skill in the provision of psychosocial rehabilitation advice was found.
Conclusion.  Strategies to enhance effective staff/patient communication should form an integral part of staff education. The psychosocial needs of patients must be incorporated as an essential part of such strategies.     

A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care

hasson h. & arnetz j.e. (2009)   A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care. International Journal of Older People Nursing   5 , 5–15
doi: 10.1111/j.1748-3743.2009.00186.x
Background.  Comparisons of different stakeholders' ratings of the quality of older people care can help to drive quality improvement.
Aim.  The aim was to compare staff, older care recipients' and their relatives' quality of care ratings.
Design.  Cross-sectional questionnaire surveys in 2003 and 2004, using a repeated measures design on an organizational level.
Methods.  Nursing staff, care recipients and relatives in two older people care organizations were included. The ratings of an overall quality grade, information, activities, general care and staff skills were compared between the respondent groups.
Results.  Care recipients in both organizations rated the overall quality grade significantly higher than nursing staff and relatives. Staff ratings of the information given to care recipients were significantly more positive than care recipients' and relatives' ratings. All three groups gave lowest ratings to the quality of activities offered to care recipients, with lowest ratings from nursing staff.
Conclusions.  Concurrent measurements of staff, care recipients and relatives' care quality perceptions can provide a broad evaluation of an organization's strength and limitations.
Relevance to clinical practice.  Staff, care recipients' and relatives' perceptions can be useful for older people care organizations and decision makers in developing care processes and outcomes of care.     

Hospitals' organizational variables and patients' perceptions of individualized nursing care in Finland

Aim  To examine the association between hospitals' organizational variables and patients' perceptions of individualized care.
Background  There is lack of evidence related to the effects that the hospital environment has on patient perceptions of the individuality of care they receive.
Methods  A cross-sectional design was used. The questionnaire survey data were obtained from 861 (response rate 82%) hospital patients and 35 (100%) nurse managers in Finland.
Results  An inverse relationship between the size of the hospital and ward and patients' perceptions of individualized care was found. Increased staffing or skill mix failed to predict a higher patient perception of individualized care, but primary nursing care delivery did.
Conclusions  Instead of increasing the amount of nursing staff, there is a need to improve the quality of the nurse–patient interactions to facilitate individualized care. The generalizability of the study is limited by the regional nature of the setting.     

Utilization of Nursing Diagnosis in Three Australian Hospitals

PURPOSE. To document nursing diagnoses on nursing care plans in an Australian context where NANDA nursing diagnoses were utilized.
METHODS. An audit of 198 nursing care plans at three selected hospitals by three university lecturers involved in teaching nursing diagnosis.
FINDINGS. Pain was the nursing diagnosis most often documented; the majority of other diagnoses pertained to physical problems experienced by patients.
CONCLUSIONS. The results of this research add to the knowledge of nursing diagnosis utilization and have implications for the provision of nursing care and its teaching and research.     

Patients' experiences of being infected with MRSA at a hospital and subsequently source isolated

Scand J Caring Sci; 2010; 24; 101–107
Patients' experiences of being infected with MRSA at a hospital and subsequently source isolated
Background:  Patients infected with methicillin-resistant Staphylococcus aureus (MRSA) during a large outbreak of E-MRSA 16 between 1997 and 2001 at Sahlgrenska University Hospital, Sweden, were moved from their speciality ward to the Clinic of Infectious Diseases for care in source isolation as long as the patient needed hospital care.
Aim:  To get knowledge regarding patients' experiences who contracted MRSA at the hospital and subsequently source isolated at the Clinic of Infectious Diseases.
Method:  The interviews were designed according to qualitative research. Six patients, aged 35–76 years, who contracted MRSA at Sahlgrenska hospital and subsequently source isolated for at least 1 week were interviewed. The interviews were tape-recorded and an inter-subjective analysis was accomplished.
Findings:  The study found that the patients felt violated for having contracted MRSA at the hospital and the isolation was described as traumatic, albeit accepted because they took responsibility for not spreading MRSA. The patients felt that they did not receive rehabilitation on the same conditions as other patients and lacked information about MRSA. They felt vulnerable due to negative reactions from the nursing staff, family members and other patient's surroundings.
Conclusion:  Patients who contract MRSA need information about what the MRSA contagion involves. There is a great need for an elevated knowledge of MRSA among staff members. An increased awareness of how the contagion spreads will allay fears of MRSA among staff and patients. The source isolation should be as short as possible to minimise the feeling of confinement.     

Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay

Title.  Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay.
Aim.  This paper is a report of a study to explore gender differences in psychosocial aspects in the year prior to first-time myocardial infarction, and the association between these aspects and pre-hospital delay.
Background.  The time from symptom onset to hospital admission is critical for patient survival; therefore influences on pre-hospital delay are of interest. The prevalence of stressful psychosocial factors is higher among patients before acute myocardial infarction than among healthy controls.
Method.  Patients diagnosed with first-time acute myocardial infarction were recruited from five Norwegian hospitals over a 13-month period in 2003–2004. Of 738 eligible patients, 149 women and 384 men completed a self-administered questionnaire (response rate 72%).
Findings.  Depression, high family stress, high work stress and major life events had no statistically significant impact on patient delay or total pre-hospital delay. Depression, sleep disturbances and high family stress were reported among more women than men in the year prior to the event. Women and men aged 65 years and younger were more likely to report major depression and major life events than those older than 65. Low education and low partner education predicted prolonged patient delay in men but not in women. Low partner education also predicted prolonged total pre-hospital delay in men.
Conclusion.  The process between symptom onset and hospital admittance is complex, and more knowledge about factors influencing this process is vital to reduce pre-hospital delay. Significant others should be included in information-giving in relation to myocardial infarction as they seem to play a vital role in patients' decision-making processes.     

Continuity of care and monitoring pain after discharge: patient perspective

Title.  Continuity of care and monitoring pain after discharge: patient perspective.
Aim.  This paper is a report of a study conducted to evaluate, from the patients' perspective, a Liaison and Continuity of Care Programme coordinating care provision between a hospital and primary care centres.
Background.  Promoting continuity of care between hospitals and primary care improves quality of care, patient satisfaction and decreases further hospitalizations. However, inadequate pain management is common after discharge.
Method.  A sample of patients from the Liaison and Continuity of Care Programme were included in a longitudinal study in 2007. We conducted standardized telephone interviews at 24 hours, 7 days, 1 and 3 months after discharge. Outcome measures included readmission, time between hospital discharge and readmission, information level at discharge, patient satisfaction, queries about care and information related to perceived state of health and pain.
Results.  Eighty-three adult patients (average age 69·3, 50·6% males) who needed continued care at discharge were followed. Ten participants died during follow-up, and seven required readmission. A total of 49·4% of patients stated that they had understood the information given at discharge very well or perfectly. At 24 hours after discharge, 30% already had doubts about their state of health and the management of their condition. In relation to perceived health, only 25·3% stated that this was good or very good. Prevalence of pain 24-hours after discharge was 58·3% in surgical patients and 17·1% in other patients.
Conclusion.  The preparation and education of patients and family members should be improved before discharge, and appropriate written information must be given, especially if a patient has pain or requires complex care.     

Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study

Title.  Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study.
Aim.  This paper is a report of a study conducted to explore the comfort experiences of hospitalized patients during their admission to medical–surgical wards in an Iranian hospital.
Background.  Comfort has various definitions, ranging from a basic human need, to a process, function or an outcome of nursing. As comfort is a substantive need throughout life in health and illness, providing comfort is a major function and challenge for holistic nursing care.
Method.  This hermeneutic phenomenological study was conducted between July 2006 and April 2007 in six medical–surgical wards of one of a university hospital in Iran. Data were generated with 22 participants (16 hospitalized patients and six nurses), using in-depth interviews to capture their detailed experiences of comfort. Analysis based on the framework of Diekelmann enabled data interpretation and elaboration of shared themes.
Findings.  One constitutive pattern, 'Comfort: a need of hospitalized patients' and four related themes – A friend in hospital, Relief of suffering within a calm environment, Seeking God, and Presence among family – were identified in the data.
Conclusion.  These findings offer unique insight for planning and implementing appropriate clinical practices in Iran, especially in caring for Muslim patients. Two major implications are to: (1) consider comfort criteria during nursing assessment and planning of care during a patient's hospitalization and (2) note that Shiite people in particular are more comfortable and feel better when they are able to follow their religious principles.     

Staff-family relationships in nursing home care: a typology of challenging behaviours

Aim.  This paper draws on data from a study which investigated how Australian nursing home staff constructed staff–family relationships.
Background.  Working with the family in aged care to provide the best care possible is consistent with modern nursing philosophy which espouses holistic care. The quality and enjoyment of the experience however, is frequently fraught with problems and challenges for both the staff and the family involved.
Design.  A qualitative constructivist design as described by Guba and Lincoln [ Fourth Generation Evaluation . Sage Publications, London.] was used.
Method.  Thirty paid caregivers drawn from eight nursing homes were interviewed about their experiences of working with residents' families. A constant comparative method of data analysis was used to arrive at the findings.
Results.  This paper reports on seven themes under the category of 'unacceptable behaviours'. These themes describe a range of attitudes and behaviours exhibited by families which staff members found undesirable.
Conclusions.  Staff members found a number of family behaviours challenging. Nursing home staff perceives the family as subordinate to their needs and want to retain control of the work environment.
Relevance to clinical practice.  Nursing home staff need to move away from custodial models of care focused on 'getting the work done' and develop more family friendly work practices that are inclusive of the needs of the family and view them as equal partners in care.     

特需病房的临终关怀服务

目的提高临终病人及家属的生活质量。方法建立家庭式临终关怀病房,控制癌症晚期病人的疼痛,制定个性化临终护理计划,做好基础护理和心理护理,给予临终病人家属心理支持,尊重其民族习俗和宗教信仰,遵照病人生前愿望进行尸体料理,帮助家属办理后续事宜。结果提高了临终病人生命质量,满足了病人的心理需要,病人及家属满意度较高。结论在特需病房实施的临终护理模式提高了服务质量和特需医疗服务信任度,扩大了特需医疗服务的影响力。     

Psychosocial support of the burned patient

The goal of burn care should always be the return of burn patients to their optimal level of function in both the physical and psychosocial spheres. Burn nurses play an important role in the assessment of both patient and family problems while providing daily nursing care. The accurate identification of problem areas is essential to plan and implement the most appropriate actions that will encourage the achievement of the discharge goal. Nurses should be care providers, teachers, and counselors to burn victims and their families. These nursing endeavors can become as important as the technology available in the burn care setting.     

Psychosocial support as a counselling in improving health-related quality of life in patients with recent multiple sclerosis in Finland

Aim.  The aim of the study was to describe and explain psychosocial support provided by nursing personnel as experienced by people with multiple sclerosis.
Background.  The goal of providing psychosocial support is to understand and improve patients' health, self-care, initiative, commitment to care, resources, deal with emotions, social interaction and circumstances.
Design and methods.  Informants were individuals ( n  = 204) diagnosed using multiple sclerosis between the years 2003–2005 in Finland. Data were collected in 2005 by a posted questionnaire. The data were analysed with cross-tabulations, correlation coefficients, mean tests, a factor analysis and multiple regression analysis.
Results.  People with multiple sclerosis need psychosocial support from nursing personnel to promote health and self-care, strengthen emotional and mental resources and maintain social relationships. The support was to include information on multiple sclerosis and related treatment options, as well as discussion, listening to the patient and supporting them in the new situation in life caused by the illness.
Conclusion.  The psychosocial support received by the patients was sufficient and corresponded to their needs. Nursing personnel have the skills to improve the health-related quality of life of people with multiple sclerosis.
Relevance to clinical practice.  The results of this research may be applied in practical nursing, such as in planning of program of neuropsychosocial rehabilitation, in developing of home care and institutional care and in planning of content of nursing education.     

Discharge Planning: Comparison of Patients'and Nurses'Perceptions of Patients Following Hospital Discharge

Planning for hospital discharge is an important component of nursing. Results are presented of a study to determine how well primary nurses predict the functional ability of their patients following discharge and to assess whether patients and nurses agree about their patients' understanding of the post-discharge treatment plan. Comparing nurses' predictions with patients' reports of functional status 2 months following discharge, we found that nurses consistently underestimate the functional ability of their patients. Comparing nurses' perceptions of their patients' understanding of their post-discharge treatment plan with patients' reports about their understanding, significant differences were found between nurses' perceptions and patients' reports. Nurses' perceptions were that patients were much more knowledgeable than their patients reported. These preliminary data suggest that hospital discharge planning is an area for further investigation and intervention. Nurses should explore new paradigms for patient education as lengths of hospital stay decrease and care shifts from acute care to community care.     

Case Study: The Challenges of Self-Management of Exacerbation of Pulmonary Symptoms

PURPOSE.  This case study demonstrates the signs and symptoms of pulmonary exacerbation and the challenges of self-management for a female veteran.
DATA SOURCES.  Data were obtained through the author's clinical practice in primary care nursing and research literature sources.
DATA SYNTHESIS.  The appropriate nursing diagnosis, nursing interventions, and patient outcomes were identified through the use of NANDA-International, the Nursing Interventions Classification, and the Nursing Outcomes Classification.
CONCLUSIONS.  This case study illustrates the appropriate nursing diagnosis, interventions, and outcomes pertinent to an individual with pulmonary exacerbations. It provides a framework for nurses in primary care when caring for individuals with pulmonary exacerbations.
IMPLICATIONS FOR NURSING PRACTICE.  Employing the NANDA-International standardized nursing diagnoses, the Nursing Interventions Classification and the Nursing Outcomes Classification provided the needed constructs for improving care for a patient that had pulmonary issues in a primary care setting.     

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.     

Psychological adjustments made by postburn injury patients: an integrative literature review

Title.  Psychological adjustments made by postburn injury patients: an integrative literature review.
Aim.  This paper is a report of a review examining the variables that predispose individuals to significant psychological maladjustment following burn injury.
Background.  The psychological sequelae of burn injury are well documented; however, the variables that influence individuals' adjustment following burn injury lack consideration.
Data sources.  MEDLINE, Cumulative Index of Nursing and Allied Health, and Psychological Abstracts were searched using the keywords burn injury, psychological, psychosocial, rehabilitation, premorbid psychopathology, adjustment, reintegration, body image, post-traumatic stress disorder, depression, coping. Other sources were found from a manual search of nursing, medical and psychological literature and references of identified and related papers. The search strategy was limited to English-language research published between 1997 and 2008.
Review methods.  An integrative review of the studies was conducted over a 6-month time period during 2007–2008.
Results.  Burn patients are a heterogeneous group and typically have comorbidities. While preburn personality and coping strategies can influence long-term psychological adjustment, the relationship between postburn adjustment and burn size and severity, and gender are poorly understood. Much of the literature focuses on the prevalence of psychological maladjustment rather than on identifying variables that influence psychological adjustment.
Conclusion.  The diversity and complexity that characterize burn patients lead to unique adjustment difficulties. Recognizing these difficulties is the first step to offering appropriate intervention and treatment for this unique patient group.