Reconceptualizing the Nurse-Patient Relationship

Purpose: To review assumptions inherent in the nurse-patient relationship as historically described and practiced, and to propose an alternate framework for nurse-patient interaction that is congruent with current health care environments.
Organizing Constructs: The theory of human relatedness and the nurse-patient relationship.
Methods: Analysis of assumptions inherent in the current theoretical and empirical literature on nurse-patient relationships and evidence from observation of nurses engaged in practice. Proposal and discussion of the theory of human relatedness as an alternative model for conceptualizing nurse-patient relationships.
Conclusions: The theory of human relatedness framework provides new insights and opportunities for assessment, intervention, and research within the context of nurse-patient relationships.     

Physical restraints and older adults

Physical restraints are used to restrain-clients whose physical or mental state could endanger their safety or that of others. Divergent opinions can be found in the literature on this subject. On the one hand, restraints are necessary to ensure the client's protection. On the other, they are perceived to be a form of physical and psychological abuse. Restraints can also have psychological consequences on clients and their families. They may also cause injuries that can be life-threatening. This paradox concerns both nurses and their clients' families. The goal of this article is to make nurses aware of the physiological and psychosocial factors involved in the use of restraints. The authors use Callista Roy's conceptual model to illustrate their point. In their conclusion, they emphasize the implications of restraints for nursing practice, education and research.     

Access to cervical screening for women with learning disabilities

Evidence shows that the uptake of cervical screening is much lower in women with learning disabilities compared to other women. A literature review was conducted, including published and unpublished international empirical research, discussion articles and reports written in English from 1990 to October 2007, to identify what factors are preventing women with learning disabilities from accessing cervical screening, and what can be done to encourage uptake. From the literature reviewed, factors that prevent women with learning disabilities from accessing cervical screening fell into the following categories: administration errors; access to a GP; assumptions made by healthcare professionals about women with learning disabilities; perceived difficulties obtaining consent; attitudes of carers; the beliefs and experiences of women themselves; lack of accessible information; and physical difficulties. Findings on how cervical screening uptake can be improved in women with learning disabilities were categorized into: preparation with the women; working in partnership; and encouraging good practice. The literature review showed that there are many factors that may be preventing women with learning disabilities from accessing cervical screening, many of which can be overcome by healthcare professionals adhering to good practice guidelines, thus ensuring that women with learning disabilities have their right to access cervical screening services acknowledged.     

Genital piercings: what is known and what people with genital piercings tell us

General and subjective information about those who chose to obtain genital piercings was presented. Particularly, the assumptions made from the literature are refuted by objective and subjective data collected from intimately pierced individuals themselves. Professional nurses must not base practice decisions on assumptions but on the "best evidence with clinical experience, research, (as well as) associated patient values" (Sackett, Strauss, Richardson, Rosenberg, & Haynes, 2001, p. 10). Thus, providing clinically competent care is driven by the latest knowledge and evidence from research and patient sources. Data found here provide further empirical evidence that may help to improve client outcomes by advancing evidence-based nursing practice in relation to people with genital piercings.     

An argument for pragmatism as a foundational philosophy of occupational therapy

BACKGROUND: In 1986, Estelle Breines argued that occupational therapy identity problems could be resolved by acquiring tools that enable therapists to analyze their profession in a sophisticated manner. Breines identified philosophical inquiry as one of these tools. PURPOSE: This study examined how pragmatism can provide a philosophical framework for occupational therapy practice and knowledge. METHOD: An analysis of a sample of occupational therapy literature, philosophy of pragmatism literature, and Slagle lectures delivered between 1955 and 1995 was completed. Themes underlying the assumptions, principles, and values articulated in the literature and the Slagle lectures were identified and compared. RESULTS: Findings of the analysis indicate that some of the core assumptions, principles, and values of occupational therapy as identified in occupational therapy literature and the Slagle lectures are conceptually consistent with those of the philosophy of pragmatism. PRACTICE IMPLICATIONS: Pragmatism may provide a philosophical framework to organize the knowledge and practice of occupational therapy and assist with clarifying the profession's identity.     

The impact of education on the use of physical restraints in the acute care setting

BACKGROUND: Physical restraints have become an acceptable standard of practice for managing safety and behavior control in acute care settings. Although the primary intent for using physical restraints is for patient protection, there are many negative outcomes related to their use. Heightened awareness by recent Joint Commission on Accreditation of Healthcare Organizations and the Center for Medicare and Medicaid Services standards for restraint use has led health care administrators and nursing staff to explore methods of reducing or eliminating the use of restraints. An educational program was planned and implemented for nursing staff emphasizing the risks of physical restraints and the benefits of innovative optional measures including nonrestraint devices. The program was tested to determine whether increased awareness through education would reduce the use of restraints. METHOD: After current practice patterns and restraint utilization were established, a comprehensive educational program was provided to all nursing personnel. Twenty-three formal classroom inservice offerings were provided with follow-up reinforcement of self-study modules. Education included nursing assessment strategies and practical restraint optional interventions for managing patients exhibiting disruptive behaviors. FINDINGS: After the educational program, the overall use of physical restraints decreased as well as the length of time patients were restrained. CONCLUSION: Results of this study reinforce the need to increase staff awareness and knowledge of nonrestraint interventions to manage disruptive behaviors in the acute care setting.     

ICU护士实施身体约束行为的现状及相关因素分析

目的了解ICU护士身体约束行为的状况,并探讨其相关影响因素。方法采用问卷调查法,对衡阳市5家三级医院150名ICU护士进行调查。结果ICU护士身体约束知识得分属于中上水平,总答对率为78．70％;对身体约束的使用呈中性态度;身体约束行为较恰当,其影响因素有：年龄、护龄、身体约束适应性知识、职称、身体约束的感受、ICU工作时间和接受约束教育的情况。结论护理管理及教育者可通过加强身体约束知识的继续教育,使护理人员建立正向地身体约束感受,从而采取适当的身体约束行为,提高照护质量。     

Booster Seat or Seat Belt? Motor Vehicle Injuries and Child Restraint Laws in Preschool and Early School‐Age Children

ISSUES AND PURPOSE: Despite numerous interventions to reduce motor vehicle injuries and deaths in children living in the United States, unintentional motor vehicle injuries continue to be the leading cause of death of U.S. children. CONCLUSION: Even though child restraint laws have been enacted, many children 5 to 9 years of age continue to be injured in motor vehicle crashes. These injuries are related to the improper use of child restraints. Reasons for injuries in this age group were explored by a review of the current literature. PRACTICE IMPLICATIONS: Nurses have a unique role in educating families about proper restraint and in contributing to the evidence base for practice.     

Make No Assumptions: Communication Between Persons With Disabilities and Clinicians

Fundamentally improving health care quality requires providing care that respects patients' preferences, needs, and values. This goal holds special resonance for persons with disabilities, many of whom find others defining and circumscribing their lives and opportunities. Achieving patient centeredness demands open communication between patients and clinicians, unhampered by prior and often erroneous assumptions about patients' goals, aspirations, and abilities. Building on this communication, optimal care involves collaboration between patients and clinicians, each bringing his or her particular expertise to the table. Interviews with individuals with diverse disabilities revealed a common theme of faulty communication between patients and clinicians. Some shortfalls relate to basic failures to accommodate communication needs, whereas others result from clinicians' erroneous perceptions of medical aspects of persons' underlying conditions, the role of assistive technologies, and how disability affects people's daily lives. Crafting collaborative care partnerships between patients and clinicians requires transforming traditional patient-clinician relationships. Following two basic precepts immeasurably improves communication between clinicians and patients with disabilities: first, make no assumptions, and second, just ask patients about their needs and preferences.     

Theoretical and empirical perspectives on anger

This article reviews theoretical and empirical perspectives on anger as well as conceptualizations of anger through history. Although anger was once considered a sin or a madness to be avoided, Darwinian evolutionary theory and Freudian theory gave rise to a ventilationist approach that views expression of anger as an unequivocal good. However, global facilitation of anger can be harmful, and its benefits are not supported by research evidence. Other myths and assumptions about anger are challenged in this literature review. To the extent that psychiatric/mental-health nursing practice is based on inadequate theories or dated or flawed research, or both, our clients are not well served.     

Using Transformational Learning Principles to Change Behavior in the OR

Achieving the goal of “best practice” in the perioperative field requires continuous education and reflection. Applying transformational learning principles can improve perioperative nursing practice by allowing staff members to reflect on their current practices, discover faulty assumptions, and revise them.Using a proactive approach, leaders can apply transformational learning principles on a case-by-case basis to build professional teams that are effective and efficient. Leaders who use transformational principles and act as role models can influence other staff members to be accountable for their own practice and self-development. If leaders are effective and inspirational, individual practice and even departmental or institutional cultures can be changed. AORN J 89 (May 2009) 851-860. © AORN, Inc, 2009.     

Patient autonomy in physical restraint

Despite initiatives to raise the awareness of patient autonomy among healthcare providers, the use of physical restraints on frail or confused older patients continues to be a common practice in many healthcare settings. This paper examines the relationship between patient autonomy and the use of physical restraints by drawing on the literature contradicting its efficacy and the assumption that its use is necessary to protect the welfare of patients. It argues that the paternalistic use of physical restraints without patient's informed consent is morally unjustified and is an unequivocal violation of their autonomy. The duty to respect individual autonomy should be extended to a duty to respect the autonomy of older people who are being restrained. Only in this way can their human dignity and quality of life be enhanced.     

Evidence of collaboration,pooling of resources,learning and role blurring in interprofessional healthcare teams: a realist synthesis

Abstract

Interprofessional teamwork has become an integral feature of healthcare delivery in a wide range of conditions and services in many countries. Many assumptions are made in healthcare literature and policy about how interprofessional teams function and about the outcomes of interprofessional teamwork. Realist synthesis is an approach to reviewing research evidence on complex interventions which seeks to explore these assumptions. It does this by unpacking the mechanisms of an intervention, exploring the contexts which trigger or deactivate them and connecting these contexts and mechanisms to their subsequent outcomes. This is the second in a series of four papers reporting a realist synthesis of interprofessional teamworking. The paper discusses four of the 13 mechanisms identified in the synthesis: collaboration and coordination; pooling of resources; individual learning; and role blurring. These mechanisms together capture the day-to-day functioning of teams and the dependence of that on members’ understanding each others’ skills and knowledge and learning from them. This synthesis found empirical evidence to support all four mechanisms, which tentatively suggests that collaboration, pooling, learning, and role blurring are all underlying processes of interprofessional teamwork. However, the supporting evidence for individual learning was relatively weak, therefore there may be assumptions made about learning within healthcare literature and policy that are not founded upon strong empirical evidence. There is a need for more robust research on individual learning to further understand its relationship with interprofessional teamworking in healthcare.     

Reflective practice in nursing care: embedded assumptions in qualitative studies

Qualitative nursing researchers have long recognized that reflective practice (RP) seems to be a valuable tool in nursing care. The aim of the present meta-study was to analyse current qualitative research on RP in nursing care, in order to create and synthesize the knowledge and the understanding of registered nurses' RP. Using a meta-study synthesis approach, embedded assumptions were identified in qualitative studies that have influenced the way researchers have interpreted and made sense of RP in nursing care. Despite empirical focus in research on RP in nursing care, it was found that assumptions about RP were predominantly based on theory. The reflective movement within the practice of nursing care has mainly a constructivist epistemology, based on learning from experience. The individual nurse's RP capability is essential in providing and improving ethical and holistic nursing care.     

Review of the literature on constipation to enable development of a constipation risk assessment scale

Introduction: Constipation presents as a perpetual problem in health-care with painful and debilitating consequences, however it is frequently preventable. A prerequisite to prevention is assessment of risk of a condition occurring so that interventions can be individualised in an attempt to prevent it. On analysis of published literature no objective comprehensive risk assessment tools for constipation were found.Study purpose: The purpose of this literature review was to identify and analyse risk factors for constipation recognised by previous empirical research. This enabled subsequent work to be performed to develop a risk assessment tool for constipation that could be used in clinical practice.Literature review: The literature search identified potential risk factors for constipation. These risk factors were systematically analysed and justification was provided for the risk factors' inclusion to or exclusion from the risk assessment instrument that was subsequently developed.Conclusion: The study appears to be the first within health-related literature that has extracted the risk factors for constipation from previous empirical research. This groundwork led the way for the subsequent development of a comprehensive objective tool to assess risk for constipation.     

Barriers to reducing the use of restraints in residential elder care facilities

Title. Barriers to reducing the use of restraints in residential elder care facilities Aim. This paper is a report of a study to compare perspectives of staff in residential elder care facilities with those of residents and family members from the same facilities about barriers to reducing the use of physical, chemical and environmental restraints. Background. There is growing research evidence of the potential risk of physical and emotional harm of restraining residents in residential elder care facilities. Despite the potential harms, restraints continue to be a common practice in facilities across Australia. Little research has been undertaken to explore the barriers to reducing the use of restraints. Method. Eighteen individual interviews were conducted with staff, general practitioners and a pharmacist and three focus groups were conducted with a total of 12 residents and 17 family members associated with three residential elder care facilities in Melbourne, Australia in 2004. Findings. The three participating facilities were committed to reducing the use of restraints, although physical, chemical and environmental restraints were used in all three facilities. Barriers to reducing restraint use included fear of resident injury, staff and resource limitations, lack of education and information about alternatives to restraints, environmental constraints, policy and management issues, beliefs and expectations (of staff, family and residents), inadequate review practices and communication barriers. Conclusion. Further education and support for staff and family members in evidence‐based practice in relation to resident care and restraint use is needed in at least some residential elder care facilities.     

Trauma Informed Care on an Inpatient Pediatric Psychiatric Unit and The Emergence of Ethical Dilemmas as Nurses Evolved Their Practice

Two case studies are presented reflecting the ethical dilemmas experienced by nurses who were striving to improve their practice in the provision of patient care. The cases are described in the context of finding alternatives to cohesive interventions such as chemical restraints and physical restraints. A summary of the literature on ethical dilemmas that was relevant to the issues arising in these cases is included. Discussion of the use of the American Nursing Association's (ANA, ) Nursing Code of Ethics with Interpretive Statements is highlighted for its relevance and support of the nurses experiencing the ethical dilemmas.