A family assessment tool for hospitalized elders

This article describes the development of the FAMILY card, a family assessment instrument used in the Nursing Care Quality Initiative (NCQI) to assess the involvement and needs of family members of hospitalized elders. Through the NCQI project, particular attention has been paid to integrating both clinical expertise in geriatric nursing care and the principles of family-centered care into the nursing care provided by staff on the NCQI study units. Two case studies illustrating use of the SPICES geriatric assessment instrument and the newly developed FAMILY assessment card are included as exemplars.     

以家庭为中心儿科护理模式创建与评价

目的：探索以家庭为中心儿科护理模式,提升患儿及家长的满意度和患儿安全。方法：创建以家庭为中心儿科护理模式,包括制定以家庭为中心儿科护理政策,配备数量充足和资历合格的护理人员,明确总责护士和责任护士的具体职责,对临床护理人员进行以家庭为中心儿科护理理论和实践的培训与考核,研制工具以评价护理人员执行以家庭为中心护理措施的情况,评价以家庭为中心儿科护理模式的实施效果。结果：患儿家长对以家庭为中心儿科护理模式的总体满意度为93.5%,患儿安全指标如给药错误发生率、跌倒/坠床发生率明显下降。结论：把以家庭为中心儿科护理理念转化为行动,深入到儿科护理实践的方方面面是一个长期持久的过程。而在患儿危机时刻,让家长和孩子在一起更是一个巨大的挑战,需要医护人员和患儿家长共同努力。     

芬兰老年护理发展经验对我国的启示与建议

人口老龄化现已成为一个世界性问题。健康老龄化观点的提出,使老年人的医疗预防保健工作对老年护理的可持续发展问题提出了更高要求。芬兰老年护理的政策、制度、人员培养及服务颇具特色,文章介绍了笔者在芬兰交流学习期间对芬兰老年护理工作的见闻与体会,分别从芬兰的养老保障制度、老年护理服务、老年护理人员培养等方面介绍芬兰老年护理概况,并结合我国老年护理工作的现状提出建议,从医疗保障体系、卫生保健工作、老年护理教育等进行思考,对发展和完善我国老年护理体系具有一定的借鉴和启迪。     

The parent-nurse relationship from the perspective of parents of children with cancer

Research to date has overlooked the specific relationship between parents and nurses, particularly in the context of family-centered care for a hospitalized child with cancer. The purpose of this study was to describe how parents perceive the relationship with the pediatric staff nurse necessitated by the hospitalization of their child with cancer. Using a symbolic interactionist framework and a modified grounded theory methodology, this study explored the parent-nurse relationship when a child with cancer is hospitalized. A purposive, theoretical quota sampling method was used to recruit 16 parents. Both parents' and nurses' care were examined from the parents' perspectives; mothers and fathers were interviewed separately. Analysis of the data led to the development of a substantive theory describing parent care (Making it Better), nursing care (Going Through the Motions, Caring Incompletely and Caring Completely), and the parent-nurse relationship (Working Together). Conditions influencing the care provided by parents and nurses and in turn the parent-nurse relationship were also identified. This research describes strategies nurses use to enhance the family-centered care they provide and reveals the effect nursing care has on parents' hospital experiences. Recommendations are made for nursing research, practice, and education.     

The effect of care programmes on the dependency status of elderly residents in an extended care setting

This paper presents data gathered in an operational research project undertaken in a geriatric centre providing care for approximately 400 long-term residents. The centre supplies nursing, medical, paramedical, day hospital and home care services. Programmes of social and diversional activities are provided and residents are also visited by various community groups. However, the long-term residents participating in this project represent a section of the population unable to utilize or participate in the social and diversional programmes usually offered. The aim of the study was to determine whether the dependency status of residents receiving long-term care is affected by nursing and/or medical patterns of institutional management. The project was carried out in two stages: 1 a habit training toileting programme intended to improve continent status; 2 activity programmes at differing levels of intensity and specifically designed to increase mental, social and physical stimulation.     

Quality of institutional care of older people as evaluated by nursing staff

Aims. The aim of this paper was to report on the quality of institutional nursing of older people as evaluated by nursing staff in 2001 and to compare the responses with those obtained in 1998. Background. The healthcare division of one Finnish city authorised an outside survey of long‐term geriatric care in the hospitals providing such care in 1998. Based on the results, recommendations concerning the development of care of older people were issued. A re‐survey was conducted in 2001, using the same criteria of quality assessment. Methods. A survey research method was used. All the seven institutions providing long‐term geriatric care, including a total of 53 wards, participated. In 1998, a total of 607 questionnaires was returned. The response percentage was 78·6%. In 2001, a total of 573 questionnaires was returned. The response percentage was 76·8%. Results. The staff considered their possibilities to help geriatric patients best in the domain of physical care and slightly less good in the domain of psychosocial care. The differences in staff estimates between the two years were very small. More than 90% of the respondents considered their knowledge of physical care adequate. The nursing staff's evaluations were roughly similar in 1998 and 2001. More than 98% of the respondents considered the helping of older people important or moderately important in the other subdomains except sexual expression. According to the nursing staff, intentional or unintentional negligence in care was more common than physically or psychically offensive conduct. Observations concerning maltreatment had increased from 1998 to 2001. The staff reported both physical and mental fatigue. Nevertheless, the nursing staff appeared to be quite content with their current workplaces. Relevance to clinical practice. The findings indicated that geriatric care mostly aims to respond to the physical needs of older people. Nursing should, therefore, be developed and improved because mere satisfaction of physical needs is not enough to guarantee a good quality of life for older people in long‐term institutional care.     

Practice change: the process of developing and implementing a nursing care delivery model for geriatric rehabilitation

The authors describe a participative management approach was used to develop and implement a nursing care delivery model for geriatric rehabilitation. This approach led to a sense of shared decision making and established consensus among the majority of staff. An integrated primary and modular nursing model that incorporated a geriatric resource nurse role was developed to maximize accountability and continuity of care. Ongoing evaluation will further clarify the impact of this model on staff and patient outcomes.     

The role of support staff in pediatric palliative care: their perceptions, training, and available resources

Pediatric palliative care requires the orchestrated efforts of a multidisciplinary care team of medical staff, nursing, psychosocial staff, and other healthcare professionals. Augmenting this team are support staff including financial counsellors, volunteers, secretaries, and others not involved in the direct administration of medical services. Prior research in palliative care has studied the perceptions, training, and professional resources of medical staff and social workers, but neglected to investigate such factors in support staff. Our study examined the effect of involvement in end-of-life pediatric care on support staff. We found this community to consist of a heterogeneous population of hospital employees, who develop numerous, substantial, direct interactions with dying children and their families. They indicated that such experiences had caused some adverse outcomes in their lives, and that few felt they had sufficient knowledge or training in palliative care. Our respondents voiced noteworthy opinions on symptom control, cultural issues, and spirituality pertinent to pediatric palliative care. Support staff play a key role in the palliative care team; research and resources need to be directed to educating, training, and supporting them.     

An audit of oral care practice and staff knowledge in hospital palliative care

Mouth care is considered one of the most basic of nursing activities, and palliative care patients are especially vulnerable to oral problems (Macmillan Practice Development Unit, 1995). This article describes a project on developing oral care practice and staff knowledge, by nursing staff and Macmillan nurses at a hospital in central England. A baseline audit (audit I) was carried out to examine all aspects of current oral care practice and nursing knowledge, including assessment, implementation, prescribing and evaluation of care. Oral care guidelines and a programme of ward-based teaching were then introduced. Several months later a follow-up audit (audit II) was conducted. Results showed an improvement in all aspects of oral care and staff knowledge. Additional benefits of this process included improved professional relationships and the promotion of further audits in hospital palliative care. Recommendations include the need for further nursing research into oral care to build the evidence base further. Additionally, it is suggested that nurses must recognize their important and central role in improving this aspect of palliative care. Education and training is pivotal to this process.     

Nurses' beliefs about family involvement in a children's hospital.

Children's hospitals throughout North America have implemented many changes during the past 15 years. In recognition of the central role of parents in the lives of their children, policies and procedures have been implemented to enable parents to participate in various aspects of their children's care. However, the extent to which attitudes of nurses have changed to support a more active parental role is less evident. In a project to formulate a philosophy of nursing for a children's hospital, 22 nurses were asked a wide range of questions about nursing and family-centered care. Although all nurses expressed explicit support for the concept of family-centered care, some of their practices and beliefs suggested otherwise. This article describes their responses and suggests recommendations for future research, education, and nursing practice.     

Knowledge of and attitudes toward assisting patients with dementia during mealtime among nursing staff in acute care settings: A cross-sectional study

BackgroundMealtime difficulties are exacerbated in acute care settings, which further complicate health issues in people with dementia (PWD). Understanding staff knowledge and attitudes is crucial for providing better care for PWD in nursing home settings. However, little is known about the knowledge and attitudes of acute care staff in assisting dementia patients during mealtimes.AimTo explore the knowledge and attitudes of acute care staff in assisting dementia patients during mealtimes.MethodsWe conducted a cross-sectional study between August and December 2020 at three acute care hospitals in Illawarra region, New South Wales, Australia. Surveys were distributed to nursing staff including registered nurses, enrolled nurses, and nurse assistants, who worked in geriatric wards. Medical practitioners and casual staff were excluded from the survey. Demographics, knowledge, attitudes, and intentions toward mealtime assistance of PWD were included in the survey.FindingsA higher level of knowledge in mealtime assistance of PWD was found to be associated with positive attitudes toward mealtime assistance of PWD (r = 0.464, p < 0.001). No differences were found between educational levels and knowledge and attitudes of mealtime assistance for PWD.DiscussionThe need for mealtime assistance training to enhance knowledge of and attitudes toward assisting PWD during mealtimes is highlighted and needs more attention. Future studies could consider including a simulation training program and adopting a mealtime engagement scale to provide training and assess changes in nursing staff knowledge of and attitudes toward mealtime assistance for PWD in acute care settings.ConclusionsThe study findings can inform future research in raising awareness of the need for and developing mealtime assistance training programs for nursing staff in acute care settings.     

Geriatric mental health education in Canada SKIPs into the 21st century

The Skills Immersion Program (SKIP) provides an educational opportunity for staff nurses who face the challenge of caring for residents who present with psychiatric and behavioral problems in long-term care (LTC) facilities within British Columbia, Canada. With the aging population and an increase in the number of individuals waiting for placement in care facilities, care providers are in substantial need of advanced education and training in the field of geriatric psychiatry nursing. Nurses working in LTC facilities in Canada are not prepared to manage the changing acuity levels and complex needs of their residents. The SKIP was developed by nurses, primarily for nurses, at St. Vincent's Hospital in Vancouver, British Columbia, Canada. Nurses who participate in the SKIP acquire an enhanced knowledge base in geriatric psychiatry nursing and gain access to assessment tools that will assist staff to increase the quality of care for their residents.     

Development of a family liaison model during operative procedures.

The essence of family-centered care is the provision, by all health professionals, of psychosocially supportive care that fosters family integrity and functioning. Data from a hospital-based satisfaction survey at The Children's Hospital of Philadelphia (CHOP) indicated that the primary reason for parents being "less than completely satisfied" was lack of communication. A search of recent literature suggests also that breakdown in family-centered care in intensive care units is neither new nor unique. The purpose of this article is to describe how efforts to improve communication with parents and families led to the development of a family liaison program and an expanded role for staff nurses in the Cardiac Intensive Care Unit (CICU). The goals of this family liaison program were three-fold: to facilitate establishment of a relationship between CICU nursing staff, parents, and families at the earliest possible point in time; to ensure communication with parents and families at regular intervals during their child's surgery; and to promote practice that incorporates principles of family-centered care within the CICU. The design and implementation of such a program presented nurses in the CICU with both a challenge and an opportunity to take an innovative approach to meeting the fundamental need for information reported by parents and families, and echoed throughout nursing literature. This family liaison program serves to educate parents and families, communicate updates, provide physical and emotional support, and establish continuity of care for the patient and family. Additionally, nurses involved in the program have given positive feedback regarding their expanded role in this family-centered care model.     

Collaboration in care and research

This article focuses on psychiatric mental health nursing care and research, with particular attention to collaboration with other health professionals in the area of geriatric mental health. Various components of the NIMH Task Force on Nursing report and recommendations are emphasized. These include research focused on: (a) improving the understanding, treatment, and rehabilitation of the mentally ill; (b) preventing mental illness and promoting mental health; (c) continuous care of persons who are acutely or chronically mentally ill or who are at risk for mental illness; (d) therapeutic interventions with ill persons or those at risk; and (e) the design, implementation, and evaluation of new and existing models of care delivery. An illustrative model of research in geriatric mental health nursing is presented. Particular attention is given to collaborative relationships developed by the primary nursing research team and the nursing staff in an acute care setting, colleagues providing nursing home care, and physician colleagues in geriatric mental health, gerontology, and neurology. Strategies to enhance collaboration and develop collegial relationships for better patient care are presented.     

江门地区老年专科护理联盟平台的建设与实践

目的 探讨建立地区老年专科护理联盟,提升区域老年专科护理的专业水平,为医养结合试点城市的建设打下基础.方法 以三甲医院为盟主建立江门地区老年专科护理联盟,共纳入本地区34家医疗机构,通过建立沟通制度,培训联盟医院专科护士,指导和协助建立老年专科小组,建立老年专科护理技术工作指引、培训、查房,定期在联盟医院开展个案讨论等...     

A system-level approach to improving the care of the older critical care patient

As the population continues to age, the specialized needs of older adult patients warrant the close attention of the critical care nurse. The combination of critical illness, age-related changes, multiple comorbidities, and the hospital environment can make the diagnosis and management of the older adult's critical illness challenging. The NICHE (Nurses Improving Care for Healthsystem Elders) program provides a framework to create an aging-sensitive care environment in the critical care setting. The Geriatric Resource Nurse model is the foundation of the program. The goals of NICHE are to support nursing departments to (1) bring evidence-based geriatric practice to the bedside; (2) build patient- and family-centered environments; (3) cultivate healthy and productive practice environments aligned with meeting the specialized needs of older adults and their families ("geriatric nursing practice environments"); and (4) conduct comprehensive measurement of geriatric initiatives.     

A model long-term care hospice unit: care, community, and compassion

The purpose of this study was to investigate the factors that influenced the quality of care of terminally ill nursing home residents on a hospice unit in a city and county long-term care facility. The findings disclosed that the hospice team had created a cultural environment in which care, community, and compassion were the predominant components of their philosophy of palliative care. Communication at all levels-among staff, family, friends, and residents-was found to be a core hospice value, essential to community development. The results of this study illustrate that exemplary palliative care can be provided when an interdisciplinary team is dedicated to creating an environment where the principles of palliative care can be fully implemented. The authors conclude that there is a developing role for geriatric nurses to participate in further defining and providing palliative care for older people in their homes, hospitals, nursing homes, and residential care.     

以家庭为中心的护理模式在我国儿科护理研究的文献计量学分析

[目的]分析以家庭为中心的护理(FCC)模式在我国儿科护理的相关研究文献,为该模式的进一步研究和发展提供参考依据。[方法]在中国知网数据库、维普数据库、万方数据知识服务系统、中国生物医学数据库上全面检索从建库至2016年9月30日国内公开发表的有关FCC模式在儿科护理研究的文献,用文献计量学方法分析文献的年份、期刊分布、科研基金资助情况及研究方法。[结果]共纳入文献197篇,总体呈上升趋势,分布在91种期刊上,但核心期刊较少,基金资助率相对较低,研究方法以实验性研究为主。[结论]FCC模式在我国儿科护理研究的应用广泛,但在研究的质量上有待提高。