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1.
Sharon McKinley Kathleen Dracup Barbara Riegel Hendrika Meischke Tom Buckley Michele Pelter 《International journal of nursing studies》2009,46(8):1037-1046
Background
Coronary heart disease (CHD) and acute coronary syndrome (ACS) remain significant public health problems. The effect of ACS on mortality and morbidity is largely dependent on the time from symptom onset to the time of reperfusion, but patient delay in presenting for treatment is the main reason timely reperfusion is not received.Objectives
We tested the effect of an education and counseling intervention on knowledge, attitudes and beliefs about ACS symptoms and the appropriate response to symptoms, and identified patient characteristics associated with changes in knowledge, attitudes and beliefs over time.Methods
We conducted a two-group randomized controlled trial in 3522 people with CHD. The intervention group received a 40 min, one-on-one education and counseling session. The control group received usual care. Knowledge, attitudes and beliefs were measured at baseline, 3 and 12 months using the ACS Response Index and analyzed with repeated measures analysis of variance.Results
Knowledge, attitudes and beliefs scores increased significantly from baseline in the intervention group compared to the control group at 3 months, and these differences were sustained at 12 months (p = .0005 for all). Higher perceived control over cardiac illness was associated with more positive attitudes (p < .0005) and higher state anxiety was associated with lower levels of knowledge (p < .05), attitudes (p < .05) and beliefs (p < .0005).Conclusion
A relatively short education and counseling intervention increased knowledge, attitudes and beliefs about ACS and response to ACS symptoms in individuals with CHD. Higher perceived control over cardiac illness was associated with more positive attitudes and higher state anxiety was associated with lower levels of knowledge, attitudes and beliefs about responding to the health threat of possible ACS. 相似文献2.
Sermeus W Gillet P Gillain D Grietens J Laport N Michiels D Thonon O Vanden Boer G Van Herck P Van den Heede K 《International journal of nursing studies》2009,46(2):256-267
Background
Internationally, nursing is not well represented in hospital financing systems. In Belgium a nursing weight system exists to adjust budget allocation for differences in nurse staffing requirements, but there is a need for revision. Arguments include the availability of a nursing minimum dataset and the adverse consequences of the current historically based nursing weight system.Objectives
The development and validation of nursing resource weights for the revised Belgium nursing minimum dataset (NMDS).Design
Two independent cross sectional Delphi—surveys.Setting and participants
A convenience sample of 222 head nurses from 69 Belgian hospitals participated in the cross sectional survey methods. To assess validity 112 patient case records from 61 nursing wards of 35 Belgian general hospitals representing general, surgical, pediatric, geriatric and intensive care were selected.Methods
Nursing resource weights were constructed based on Delphi survey results by NMDSII intervention. The patient case Delphi survey results were used as the primary source for validation. A series of additional validation measures were calculated, based on the different patient classification systems. Finally, three validated nursing resource weighting systems were compared to the constructed NMDSII weighting system: the use of ‘Closon’, ‘Ghent’ and WIN weights.Results
A coherent set of nursing resource weights was developed. The comparison of nurse resource weights, based on the survey per NMDS intervention versus the survey on patient cases, yielded high correlations: r = 0.74 to r = 0.97 (p < 0.01) between three case rating questions, as an indication of reliability in terms of internal consistency, and r = 0.90 (p < 0.01) between summed intervention weights and patient case weights, as an indication of criterion validity in terms of concurrent validity. Other concurrent validity measures based on summed intervention weights versus patient classification dependency weights showed a correlation ranging from r = 0.14 to r = 0.74. The correlation of summed intervention weights with the Closon, Ghent and WIN weights ranged from r = 0.93 to r = 0.96 (p < 0.01), as a third indication of concurrent validity.Conclusions
A system of valid nursing resource weights has been developed. The system should be further validated within an international context. 相似文献3.
Background
Experts recommend staff training to prevent and manage aggressive situations involving patients or their relatives. However, in many countries this subject is not covered in pre-registration nursing education. In addition, the evidence regarding its impact on practical placements remains weak.Objective
This study examines the influence of an aggression management training programme for nursing students on their performance in de-escalating aggressive patients.Design
Pretest-posttest within-and-between-groups design.Setting
A School of Nursing in Germany.Participants
Convenience sample out of six classes of nursing students at differing educational levels (10th to 28th month of nursing education, n = 78, mean age = 22).Methods
In a cross-sectional and longitudinal two groups before and after design nursing students encountered two scenarios (A or B) with simulation patients. After completing the training, each student was confronted with the unknown other scenario. De-escalation experts from three German-speaking countries evaluated 156 video scenes using the De-escalating Aggressive Behaviour Scale (DABS), not knowing whether the videos had been recorded before or after the training. Mean values and statistical significance tests were computed to compare the results.Results
The performance levels of students who had been trained rose significantly from 2.74 to 3.65 as measured by the DABS on a 5-point Likert scale (Wilcoxon test p < .001). The trained students managed scenario A significantly better than the untrained students (untrained 2.50, trained 3.70; Mann-Whitney-U-test p < .001,). Similar results were found for scenario B (untrained 3.01, trained 3.61; Mann-Whitney-U-test p < .001). No significant differences were found in the pretest results irrespective the students’ age or duration of previous nursing education.Conclusions
Aggression management training is able to improve nursing students’ performance in de-escalating aggressive behaviour. A maturation-effect on the de-escalating performance due to general nursing education or age is unlikely. 相似文献4.
Huizing AR Hamers JP Gulpers MJ Berger MP 《International journal of nursing studies》2009,46(4):459-469
Background
Although there is an urgent need for restraint-free care, the number of randomized clinical trials on preventing or reducing physical restraints has been limited.Objectives
To investigate the effectiveness of an educational intervention to prevent the use of physical restraints on residents newly admitted to psycho-geriatric nursing home wards.Design
Cluster-randomized trial.Setting
Fourteen Dutch psycho-geriatric nursing home wards.Participants
138 residents admitted to 14 psycho-geriatric nursing home wards after baseline measurement of the trial were selected, out of which 33 residents died or informed consent had not been obtained. A total of 105 residents were included in the analyses.Methods
The nursing home wards were randomly assigned to either educational intervention or control status. The educational intervention consisted of an educational programme for nurses combined with a nurse specialist's consultation. The data were collected at 1, 4 and 8 months post-intervention. The use of physical restraints was measured by blinded, trained observers on four separate occasions over a 24-h period. The Minimum Data Set was used to determine residents’ characteristics, such as their cognitive status.Results
During the study period, no statistically significant differences between the experimental group and the control group regarding restraint status, restraint intensity, multiple restraints and types of restraints were found. One month post-intervention, 38% of the residents newly admitted to the experimental wards were restrained. Bilateral bedrails were the most frequently used restraints at Post-test 1 (24%), Post-test 2 (23%) and Post-test 3 (28%), followed by the use of infrared systems at Post-tests 2 and 3.Conclusion
An educational programme combined with the consultation of a nurse specialist does not prevent the use of physical restraints on residents newly admitted to psycho-geriatric nursing home wards. Although other studies have shown promising results with the effectiveness of these types of intervention on restraint reduction, the development of additional interventions to prevent restraint usage is recommended. 相似文献5.
Background
Worldwide pandemics of influenza virus caused extensive morbidity and mortality around the world and influenza vaccination is the most effective method for preventing influenza virus infection and its potentially severe complications. A large proportion of the Hong Kong elderly population has not undergone influenza vaccination. An exploration of the correlates will provide significant information to help identify ways of improving vaccination uptake among Chinese elderly people.Objectives
To explore the prevalence and correlates of influenza vaccination Hong Kong Chinese elderly people aged 65 or above. To investigate any differences in attitudes toward influenza vaccination among Hong Kong elderly people with different levels of cognitive and physical functioning.Design
An exploratory cross-sectional survey with two objective assessments was employed. Settings: Fifteen elderly centers in Hong Kong Special Administrative Region. Participants: A total of 816 Hong Kong Chinese elderly participants were recruited.Methods
Face-to-face interviews were adopted to explore the demographic characteristics, perceptions, health status, knowledge, and resources of, and the influence of disease outbreaks on, influenza vaccination. Two objective validated instruments, the Chinese Mini-Mental State Examination (CMMSE) and the Barthel Index-Modified Chinese Version (MCBI) were used to assess the cognitive status and physical functioning of the participants.Results
Approximately two in three individuals (62.4%) had undergone influenza vaccination. Lower cognitive and physical functioning scores were found among the non-vaccinated participants. Multivariate logistic regression analyzes revealed the significant correlates associated with influenza vaccination to be consideration of vaccination in the subsequent years (aOR = 7.877; p < 0.001); consideration of vaccination if all people aged 65 or above were eligible to receive free vaccination (aOR = 3.024; p = 0.002); the belief that there is a need to receive influenza vaccination following the Severe Acute Respiratory Syndrome (SARS) and avian influenza (aOR = 2.413; p = 0.001); receiving advice from nursing staff of elderly centers (aOR = 7.161; p < 0.001); the medical staff of elderly centers (aOR = 3.771; p < 0.001) or family members or friends (aOR = 3.023; p = 0.001).Conclusions
The prevalence of elderly Chinese people undergoing influenza vaccination remains suboptimal. The government can promote vaccination by educating the public about the advantages, by publicizing locations where vaccinations are available, and having nursing, other medical staff, family and friends encourage elderly people to be vaccinated. A high vaccination coverage rate must be ensured to achieve international goals. 相似文献6.
M.X. Patel D. Robson N.M. Ramirez T.C. Memon D. Bressington 《International journal of nursing studies》2009,46(11):1467-1474
Background
In the United Kingdom, mental health nurses (MHNs) can independently prescribe medication once they have completed a training course. This study investigated attitudes to mental health nurse prescribing held by psychiatrists and nurses.Method
119 MHNs and 82 psychiatrists working in South-East England were randomly sampled. Participants completed a newly created questionnaire. This included individual item statements with 6-point likert scales to test levels of agreement which were summated into 7 subscales.Results
Psychiatrists had significantly less favourable, albeit generally positive attitudes than MHNs regarding general beliefs (63% vs. 70%, p < 0.001), impact (62% vs. 70%, p < 0.001), uses (60% vs. 71%, p < 0.001), clinical responsibility (69% vs. 62%, p < 0.001) and legal responsibility (71% vs. 64%, p < 0.001). More MHNs than psychiatrists believed that nurse prescribing would be useful in emergency situations for rapid tranquilisation (82% vs. 37%, p < 0.001), and that the consultant psychiatrist should have ultimate clinical responsibility for prescribing by an MHN (42% vs. 28%, p < 0.001). Approximately half of all participants agreed nurse prescribing would create conflict in clinical teams.Conclusions
The majority of both groups were in favour of mental health nurse prescribing, although significantly more psychiatrists expressed concerns. This may be explained by a perceived change in power balance. 相似文献7.
Do not attempt resuscitation (DNAR) orders have been shown to be subject to misinterpretation in the 1980s and 1990s. We investigated whether this was still the case, and examined what perceptions doctors and nurses had of what care patients with DNAR orders receive.
Methods
Using an anonymous written questionnaire, we directly approached 50 doctors and 40 nurses from a range of medical specialities and grades in our teaching hospital.Results
All 50 physicians and 35/40 nurses took part. Using McNemar's test, there were highly significant differences (p < 0.0001) in what doctors believed ‘should’ take place and what they perceived ‘in practice’ occurred on patients with DNAR orders in all areas questioned (e.g., frequency of nursing observations and contacting medical staff in the event of a patient's deterioration). Using Fisher's exact test, there were significant differences between what nursing staff thought occurred and what doctors thought should occur, for example, frequency of nursing observations (p < 0.001), contacting the medical team (p = 0.01) and giving fluids (p < 0.005).Conclusions
Despite widespread use of DNAR orders, they are still misunderstood. This article highlights the frequency with which DNAR orders are interpreted to mean that other care should be withheld. In addition, it shows that although some doctors know that this should not be the case, they believe that DNAR orders affect the care that their patients receive. We propose that options for more detailed care plans should be embedded within the resuscitation decision and documentation to improve communication and understanding. 相似文献8.
Aim
To describe the development, implementation and evaluation of an undergraduate nursing simulation program for developing nursing students’ competency in assessing, managing and reporting of patients with physiological deterioration.Method
A full-scale simulation program was developed and implemented in a pre-registered nursing curriculum. A randomized controlled study was performed with 31 third year nursing students. After a baseline evaluation of all participants in a simulated environment, the intervention group underwent four simulation scenarios in a 6 h education session. All participants were then re-tested. The baseline and post-test simulation performances were scored using a validated tool. The students completed a survey to evaluate their learning experiences.Results
The clinical performances mean scores for assessment and management of deteriorating patients improved significantly after the training program compared to baseline scores (t = 9.26; p < 0.0001) and to post-test mean scores of the control group (F = 77.28; p < 0.0001). The post-test mean scores of the intervention group in reporting deterioration was significantly higher than the baseline mean scores (t = 4.24; p < 0.01) and the post-test means scores of the control group (F = 8.98; p < 0.01). The participants were satisfied with their simulation experiences, rated positively on features of the simulation and valued the program in developing their self-confidence.Conclusion
The nursing students’ competency in assessing, managing and reporting of deteriorating patient can be enhanced through a systematic development and implementation of a simulation-based educational program that utilized mnemonics to help students to remember key tasks. 相似文献9.
Tim Mitchell Peter B. O'Sullivan Angus F. Burnett Leon Straker Cobie J. Rudd 《International journal of nursing studies》2009,46(5):678-688
Background
Occupational low back pain is a significant problem among nurses. Recent literature suggests current occupational preventative strategies for nurses have not been effective. Given low back pain is already prevalent before commencing employment, nursing students should be the target of preventative interventions. Modifiable personal factors which contribute to low back pain have proven difficult to identify, but are thought to play an important role in the biopsychosocial nature of low back pain.Objectives
To evaluate the contribution of personal biopsychosocial factors to low back pain in nursing students.Design
Cross-sectional study comprising physical testing and questionnaires.Settings
Two university undergraduate nursing schools in Western Australia.Participants
170 female undergraduate nursing students.Methods
Low back pain and control subjects were compared across social, lifestyle (physical activity), psychological (stress, anxiety, depression, back pain beliefs, coping strategies and catastrophising) and physical (spinal postures and spinal kinematics in functional tasks, leg and back muscle endurance, spinal repositioning error and cardiovascular fitness) characteristics. Low back pain was considered as either “minor” or “significant” depending upon pain severity, duration, impact and level of disability.Results
Over 30% of all subjects (mean age 22.5 ± 4.5 years) reported “significant” low back pain in the preceding 12 months. Univariate analysis: social measures did not distinguish between groups. Subjects with “significant” low back pain were more physically active (p = 0.04), had higher stress scores (p = 0.01) and used passive coping strategies (p < 0.001) more than other subjects. “Significant” low back pain subjects held their lower lumbar spine in a more extended posture during transfers at bed height than other subjects. No differences between groups were found for sagittal spinal mobility, static spinal posture, muscle endurance, spinal repositioning error, cardiovascular fitness or other psychological measures. Multivariate analysis: regression analysis revealed stress, coping, physical activity, spinal kinematics, and age all contributed independently to the presence of low back pain, representing a significant 23% of variance.Conclusions
Modifiable lifestyle, psychological and physical factors were independently associated with low back pain in nursing students. Targeting personal factors associated with low back pain in nursing students, rather than occupational factors in working nurses may help improve the impact of low back pain in nurses. Prospective studies are required to confirm the relevance of these findings for risk of future low back pain in nurses. 相似文献10.
Roberto Giacominelli-Stuffler Laura Liberatoscioli Enrico Dainese Mauro Maccarrone 《Clinical biochemistry》2009,42(15):1512-1516
Objectives
To set-up a method for a direct evaluation in human serum of paraoxonase enzymatic activities, establishing a possible correlation with Q192R genotype polymorphism.Design and methods
101 different human serum samples were genotyped for paraoxonase Q192R polymorphism by PCR restriction analysis, and evaluated spectrophotometrically with regard to paraoxon and 2-coumaranone hydrolytic activities. Both activities of paraoxonase were assayed, quantified through normalization by arylesterase activity, and compared with the data concerning Q/R genetic polymorphism.Results
The mean normalized paraoxonase activity was found to be significantly higher in RR than in QQ human sera (3.99 ± 0.6 versus 1.32 ± 0.44; P < 0.0001); instead, the 2-coumaranone hydrolysis showed an opposite trend (0.10 ± 0.02 versus 0.23 ± 0.04, in RR and QQ sera respectively; P < 0.0001).Conclusions
These methods were successfully applied to the whole serum, suggesting a possible use of this approach for a clinically relevant phenotypic characterization. 相似文献11.
12.
Morales-Asencio JM Morilla-Herrera JC Martín-Santos FJ Gonzalo-Jiménez E Cuevas-Fernández-Gallego M Bonill de Las Nieves C Tobías-Manzano A Rivas-Campos A 《International journal of nursing studies》2009,46(2):189-196
Background
The information generated by nurses through standardised nursing languages is insufficiently evaluated and exploited, mainly in home care services, as is its potential impact on outcomes.Objectives
To find out how often nursing diagnoses are made during nursing home care visits, and to explore their relation with use of resources, mortality, institutionalisation and satisfaction.Design
Observational, longitudinal follow-up study.Settings
Home care services delivered by Primary Healthcare Districts in Málaga, Costa del Sol, Almería and Granada, in Spain.Participants
Patients and caregivers who initiated the Home Care Programme.Methods
The accumulated incidence of nursing diagnosis was analysed over 34 months of follow-up. Diagnoses were made by nurse case managers in their daily practice. Several regression models were devised to analyse their linkage with the use of resources, mortality, institutionalisation and satisfaction.Results
Two hundred and forty-seven subjects were included (129 patients and 118 caregivers). 93.8 had been diagnosed (2.8 diagnoses per subject). Risk of caregiver strain and mobility impairment accounted for 40% of total home visits (p = 0.033). Significant differences were observed in the use of physiotherapy and rehabilitation services. The home visits for caregivers were, in 78% of cases, due to the recipient’s baseline functional status. No relation was detected for institutionalisation or for patient satisfaction. There was a higher rate of anxiety diagnosed in the caregiver when the recipient was at greater risk for mortality (RR: 2.08 CI 95%: 1.26-3.42) (p = 0.012).Conclusions
These data confirm results from other studies which find nursing diagnoses to be sound predictors of resources use. Their synergy with other case-mix systems in home care should be investigated. 相似文献13.
Ching-I Teng Yea-Ing Lotus Shyu Hsiao-Chi Fan 《International journal of nursing studies》2010,47(11):1442-1450
Background
Global nursing shortages have exacerbated time pressure and burnout among nurses. Despite the well-established correlation between burnout and patient safety, no studies have addressed how time pressure among nurses and patient safety are related and whether burnout moderates such a relation.Objectives
This study investigated how time pressure and the interaction of time pressure and nursing burnout affect patient safety.Design-setting participants
This cross-sectional study surveyed 458 nurses in 90 units of two medical centres in northern Taiwan.Methods
Nursing burnout was measured by the Maslach Burnout Inventory-Human Service Scale. Patient safety was inversely measured by six items on frequency of adverse events. Time pressure was measured by five items. Regressions were used for the analysis.Results
While the results of regression analyses suggest that time pressure did not significantly affect patient safety (β = −.01, p > .05), time pressure and burnout had an interactive effect on patient safety (β = −.08, p < .05). Specifically, for nurses with high burnout (n = 223), time pressure was negatively related to patient safety (β = −.10, p < .05).Conclusion
Time pressure adversely affected patient safety for nurses with a high level of burnout, but not for nurses with a low level of burnout. 相似文献14.
Background
A growing number of health care organizations are implementing a system of electronic patient records (EPR). This implies a change in work routines for nursing staff, but it could also be regarded as an opportunity to improve the quality of care.Objective
The objective of this paper is to obtain more insight into the usefulness of EPR as perceived by nursing staff and to clarify the determinants of nursing staff's acceptance of EPR. Determinants were tested using an extended version of the Technology Acceptance Model.Design
Nursing staff members (NAs and RNs) completed a survey questionnaire about the use of EPR in health care, and their experiences, perceptions and attitudes regarding EPR.Settings
All nursing staff members were working in Dutch hospitals, psychiatric organizations, care organizations for mentally retarded people, home care organizations, nursing homes or homes for the elderly.Participants
The study population is a nationally representative Dutch research sample, further referred to as the Nursing Staff Panel. The Panel consists of a permanent group of Nursing Assistants (NAs) and Registered Nurses (RNs), who are prepared to fill in a postal questionnaire twice a year on average. In January 2009, 685 participants completed the questionnaire.Results
Nursing staff members associate EPR with improved care, especially qualitatively better and safer care. They also expect an increase in costs of care, while anticipating only a relatively small rise in the number of patients that can be cared for. In general, the effects of EPR on the work circumstances of nursing staff are expected to be negative. Job-related characteristics were found to be determinants of attitudes towards using EPR. A relatively positive attitude towards EPR was found in three categories of nursing staff in particular, i.e. staff working at least 30 h per week, staff already using EPR and staff working in hospitals. Nursing staff in management positions also tend to have a more positive attitude. When the Technology Acceptance Model was tested, attitudes towards EPR were primarily associated with job-related characteristics and perceived usefulness with respect to quality of care.Conclusions
The implementation strategies for EPR need to take account of the job characteristics of the intended future users. If implementation is to be successful, it is important that the users understand the beneficial effects of EPR on the quality of care. 相似文献15.
Pfeifer R Jung C Purle S Lauten A Yilmaz A Surber R Ferrari M Figulla HR 《Resuscitation》2011,82(9):1168-1173
Background
We investigated whether the use of therapeutic hypothermia improves the outcome after cardiac arrest (CA) under routine clinical conditions.Method
In a retrospective study, data of CA survivors treated from 2003 to 2010 were analysed. Of these, 143 patients were treated with hypothermia at 33 ± 0.5 °C for 24 h according to predefined inclusion criteria, while 67 who did not fulfil these criteria received comparable therapy without hypothermia.Results
210 patients were included, 143 in the hypothermia group (HG) and 67 in the normothermia group (NG). There was no significant difference in mortality between the groups; 69 (48.2%) in the HG died in the first four weeks, compared to 30 patients (44.8%) in the NG (p = 0.659). Patients in the NG were older and more seriously ill, and CA occurred more often in-hospital. Binary logistic regression revealed ventricular fibrillation (p = 0.044), NSE serum level <33 ng ml−1 (p < 0.001), age (p = 0.035) and witnessed cardiac arrest (p = 0.043) as independent factors significantly improving survival after CA, whereas hypothermia was not (p = 0.69). The target temperature was maintained for a significantly longer time (19.5 h vs. 15.2 h; p = 0.003) in hypothermia patients with a favourable outcome than in those with an unfavourable outcome.Conclusion
There was no improvement in survival rates when hypothermia was added to standard therapy in this case series, as compared to standard therapy alone. The time at target temperature may be of relevance. We need better evidence in order to expand the recommendations for hypothermia after CA. 相似文献16.
Sue Latter Andrew Sibley Sue Cradock Marie-Therese Lussier Denis Roberge 《International journal of nursing studies》2010,47(9):1126-1138
Background
Nurse prescribers are in a key position to promote medicine-taking in diabetes. Although patients’ beliefs about medicines are important predictors of medicine-taking, evidence suggests nurses do not routinely explore these.Objectives
To evaluate a theory-based intervention designed to increase nurse prescribers’ exploration of medicines’ beliefs with people with diabetes.Design
Mixed methods concurrent triangulation design.Settings
Nurse prescribers were recruited from 7 Trusts in England.Participants
A purposive sample of 14 nurse prescribers attended four 1 day workshops.Methods
Audio-recordings of each nurse prescribers’ consultations with diabetes patients were collected at baseline, 1 week, 3 months and 6 months after the intervention. Nurse prescribers were interviewed at 1 month and 6 months post-intervention. Changes in medicines’ discussion and participation in consultations were analysed using MEDICODE. Interview data were analysed using Framework Analysis.Results
MEDICODE themes of ‘attitudes towards medication’ showed a significant rise at 1 week (p < 0.01) and 3 months (p < 0.05). ‘Asks patient opinion about medication’ significantly increased at 1 week (p < 0.01). Discussion on ‘concerns about medication’ rose significantly at 1 week (p < 0.001) and 6 months (p < 0.01). Discussion on ‘expected effects of medication’, ‘action of medication’ and ‘reasons for medication’ showed no change. There were no significant changes in Dialogue Ratio. However, the Preponderance of Initiative moved towards more patient initiative at 1 week (p < 0.0001), 3 months (p < 0.0001), and 6 months (p < 0.0001). In interviews, nurses reported increased attention to patients’ medication beliefs and adoption of patient-centred skills. Contextual factors that positively influenced ability to explore medicines beliefs in practice settings were: support of colleagues and practicing new skills. Inhibiting factors included: patients’ perceived lack of receptivity, time constraints, and concerns about opening a ‘can of worms’. Six months interviews revealed using skills in practice enhanced nurses’ confidence and sustainability of skills requires a nurse-patient relationship. Method triangulation illuminated how the intervention was implemented in practice contexts.Conclusions
The intervention was effective at changing some key dimensions of prescribing consultations. The use of a self-efficacy framework in the intervention, to promote nurses’ confidence in working in a different way, may have been instrumental in effecting the changes found. Contextual factors influencing beliefs exploration in medicine-taking consultations were identified. 相似文献17.
Background
Deep tissue injuries are severe damages underneath the intact skin caused by long-endured, unrelieved pressure or shear forces. Empirical evidence regarding the magnitude of this health problem is limited.Objective
Investigation of the prevalence, characteristics of persons affected and identification of the most affected body locations.Design
Two cross-sectional studies in 2008 and 2009.Settings
Nursing homes and hospitals throughout Germany.Participants
6919 (year 2008) and 8451 (year 2009) hospital patients and nursing home residents.Methods
Trained nurses conducted full skin assessments and collected demographic data based on written data collection forms. The Braden scale was used to measure pressure ulcer risk.Results
Pressure ulcer prevalence including grades 1-4 and deep tissue injuries ranged from 4.3% (95% CI 3.8-4.9) in nursing homes to 7.1% (95% CI 6.2-8.0) in hospitals. Point prevalence rates of deep tissue injuries were 0.4% (95% CI 0.2-0.5) in hospitals and less than 0.1% in nursing homes. In total, 30 persons were affected by 38 deep tissue injuries. The mean age was 73.4 and the mean Braden scale sum score was 12.8. The most frequently affected anatomic sites were heels (n = 24) and ischial tuberosities (n = 6).Conclusions
Nurses must be aware that deep tissue injuries exist in clinical practice. Deep tissue injuries seem to be more common in hospitals than in nursing homes and heels are more prone to this kind of injuries than other body sites. Whenever such a lesion is suspected, optimal pressure relief is required to enable the affected tissue to heal. 相似文献18.
Koen Milisen Joke Coussement Steven Boonen Annelies Geeraerts An Van Wesenbeeck Eddy Dejaeger 《International journal of nursing studies》2011,48(2):193-203
Background
Hip fractures represent an increasing public health burden with a simple fall to the floor as the most common cause. Because nursing home residents are particularly at risk, nursing homes should implement a broad range of fall prevention strategies. However, not all fall incidents can be avoided and external hip protectors may contribute to prevent hip fractures. A major problem in studying the effectiveness of hip protectors is residents’ poor adherence. In nursing homes, adherence is dependent not only on the resident, but also on staff knowledge of and attitudes about hip protectors.Objectives
To describe (1) attitudes of day versus night shift caregivers towards the use of a soft hip protector, (2) residents’ adherence about the use of such protectors, and (3) differences in characteristics between adherent and non-adherent residents.Design
Survey and observational study.Setting
Nursing home.Participants/methods
: Survey of care staff (n = 37) in a nursing home after 8 months of continued application of a soft hip protector policy in residents (n = 68). Adherence to wearing the hip protector, measured by weekly unannounced, randomly determined checks during day and night in the 8 months after the start of the study.Results
Overall, 85% agreed to wear a hip protector. At 8 months, only 29% was still wearing their hip protector; with significant differences between day and night shifts. Although virtually all caregivers (97%) considered a hip protector policy in residential care as feasible, the attitude towards hip protectors was found to be significantly different between day and night caregivers. Pain and discomfort, patient insight in the usefulness of these devices, interference with incontinence materials, and the overall resident mix and care acuity were reported as major barriers.Conclusion
Implementing a hip protector policy for injury prevention in long-term care is not an issue of whether or not to use the devices. Rather, it is a continued clinical nursing decision process about when and when not, by whom and by whom not, why and why not, for how long, and to what clinical benefit - considering both the needs of the individual resident and the feasibility of such a policy in the context of resident mix and nursing staff. 相似文献19.
Echevarria-Guanilo ME Dantas RA Farina JA Faber AW Alonso J Rajmil L Rossi LA 《International journal of nursing studies》2011,48(1):47-55
Background
Pain and anxiety are a common problem in all recovery phases after a burn. The Burns Specific Pain Anxiety Scale (BSPAS) was proposed to assess anxiety in burn patients related to painful procedures.Objectives
To assess internal consistency, discriminative construct validity, dimensionality and convergent construct validity of the Brazilian-Portuguese version of the Burns Specific Pain Anxiety Scale.Design
In this cross-sectional study, the original version of the BSPAS, adapted into Brazilian Portuguese, was tested for internal consistency (Cronbach's Alpha), discriminative validity (related to total body surface area burned and sex), dimensionality (through factor analysis), and convergent construct validity (applying the Visual Analogue Scale for pain and State-Anxiety—STAI) in a group of 91 adult burn patients.Results
The adapted version of the BSPAS displayed a moderate and positive correlation with pain assessments: immediately before baths and dressings (r = 0.32; p < 0.001), immediately after baths and dressings (r = 0.31; p < 0.001) and during the relaxation period (r = 0.31; p < 0.001) and with anxiety assessments (r = 0.34; p < 0.001). No statistically significant differences were observed when comparing the mean of the adapted version of the BSPAS scores with sex (p = 0.194) and total body surface area burned (p = 0.162) (discriminative validity). The principal components analysis applied to our sample seems to confirm anxiety as one single domain of the Brazilian-Portuguese version of the BSPAS. Cronbach's Alpha showed high internal consistency of the adapted version of the scale (0.90).Conclusion
The Brazilian-Portuguese version of the BSPAS 9-items has shown statically acceptable levels of reliability and validity for pain-related anxiety evaluation in burn patients. This scale can be used to assess nursing interventions aimed at decreasing pain and anxiety related to the performance of painful procedures. 相似文献20.