Gender stereotyping and nursing care

The effect of gender stereotyping on nursing care was examined. Eight conditions were created in a posttest-only experiment by completely crossing patient gender (male/female) by memory load (low/high) by patient health status (stable/unstable). One hundred sixty nurses read the same patient vignette. The vignette differed in patient gender, memory load, and patient health status. The nurses then estimated the minutes needed for specific nursing interventions with the patient. Nurses planned significantly more ambulation, analgesic administration, and emotional support time for the male patient, despite the presence of individuating information. More accurate, effective nursing care is possible when nurses are aware of the effect of gender stereotyping on nursing care.     

Computerization of patient acuity and nursing care planning. New approach to improved patient care and cost-effective staffing

Patient classification systems are essential for nurse administrators to justify nursing staff and to project budget. To answer these needs effectively, a computerized patient classification system must be customized to existing physical and human resources within each health care facility. Nursing administrators at Riverside Medical Center met this need by developing a computerized patient classification system that integrates patient acuity with patient care plans and nursing diagnoses. Direct cost accounting of nursing care according to patient needs and outcomes can be justified by correlating this management and practice data.     

Patient outcomes in the field of nursing: A concept analysis

PurposeThis paper reports an analysis of the concept of patient outcomes.MethodsThe Walker and Avant concept analysis approach was applied.ResultsThe attributes of patient outcomes include (1) patient functional status (maintained or improved), (2) patient safety (protected or unharmed), and (3) patient satisfaction (patient reporting of comfort and contentment). These attributes are influenced by the antecedents of individual patient characteristics and health problems, the structure of healthcare organizations and received health interventions. Additionally, patient outcomes do significantly impact the quality of nursing care, the cost of effective care and healthcare policy making formulation.ConclusionProviding good nursing care to all patients is a central goal of nursing. Patient outcomes in nursing are primarily about the results for the patient receiving nursing care. This analysis provides nurses with a new perspective by helping them to understand all the components within the concept of patient outcomes.     

Patient colonization and environmental contamination by vancomycin-resistant enterococci in a rehabilitation facility

OBJECTIVES: To determine the frequency of environmental contamination in patient and common-use rooms and patient colonization by vancomycin-resistant enterococci (VRE). DESIGN: Cross-sectional study. SETTING: A 146-bed rehabilitation facility. PARTICIPANTS: Rectal cultures were collected from 74 (80%) of 93 patients. Environmental cultures were obtained from surfaces in 15 patient rooms (5 floors) and common-use areas on 8 floors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Gastrointestinal colonization of patients and environmental contamination of surfaces by VRE. RESULTS: VRE was detected from 13 (18%) of 74 patients and 32 (10%) of 319 surfaces. The frequency of positive environmental cultures varied by location; cultures were more likely to be positive in patient rooms (15%), followed by common areas on patient floors (9%) and common areas separate from patient floors (1.3%). Surfaces were more likely to be positive in rooms with a VRE-colonized patient (24%), compared with rooms in which patient colonization status was unknown (13%, P=.13) or the patient was not colonized (0%, P=.002). Surfaces were more likely to be contaminated in a room that housed an incontinent compared with continent patients (22% vs 7%, P=.01). CONCLUSIONS: Although environmental contamination by VRE was common in patient rooms, contamination of common-use areas separate from patient floors was infrequent. Despite use of common-use areas by colonized patients, isolation practices at this facility appear to have minimized environmental surface contamination in these areas.     

The patient educator role in nursing.

A stratified random sample (N = 1,230) of staff nurses, nurse administrators, and nurse educators were surveyed for their perceptions of the extent of nurses' responsibility for patient education and of the level of achievement of patient education by nurses. It was found that all three groups rated nurses' responsibility for patient education at a high level. Although the staff nurse group had statistically significant lower ratings (p = .0005) for nurses' level of responsibility for patient education, all three groups rated nurses' responsibility above 4 on a 5-point scale, with 5 reflecting primary (highest) responsibility. However, achievement of patient education was rated by all three groups below 3, the "good" rating on a 5-point scale, with 5 reflecting an excellent rating. The findings of this study indicate that the role of the nurse as patient educator needs to be strengthened. The satisfactory achievement of patient education is essential for the advancement of the nurse's role as patient educator.     

Patient advocacy in the USA: key communication role functions

Researchers have long documented the importance of patient advocacy programs as a means of providing customer service in health-care organizations. Yet, while effective communication is often acknowledged as key to effective patient advocacy, knowledge of the specific communication role functions enacted by patient advocates remains limited, as does our understanding of the function of patient advocacy at the organizational level. This qualitative investigation not only provides a typology of communication roles enacted by patient advocates while solving problems on behalf of patients and their family members, but also integrates scholarly research on "boundary-spanning" as a means of theoretically contextualizing the advocacy role at the organizational level.     

Physical therapist examination, evaluation, and intervention for a patient with West Nile virus paralysis

BACKGROUND AND PURPOSE: The incidence of West Nile virus (WNV) has increased in the United States since 1999. A small percentage of people with WNV develop West Nile neuroinvasive disease (WNND) with encephalitis and flaccid paralysis. The purpose of this report is to describe the physical therapist management and outcomes for a patient with WNND and the therapist's efforts to use an evidence-based practice approach in the management of a patient with this disease. CASE DESCRIPTION: The patient was an active 55-year-old woman in excellent health who became acutely ill with asymmetrical lower-extremity weakness. The physical therapist reviewed the available literature, consulted with medical and physical therapist experts and the patient, and elected to use a poliovirus "period of recovery" approach combining intensive strengthening and monitoring of fatigue. OUTCOMES: The patient progressed from an initial nonambulatory status to ambulation with a single-point cane at week 18 after onset of symptoms. She began to ambulate without an assistive device by week 20. The patient returned to work part-time by week 22 and full-time by week 43. DISCUSSION: These outcomes demonstrate the recovery of a patient with WNND after an intensive strengthening program.     

Comment aborder l’éducation thérapeutique d’un patient obèse ? La motivation du patient… et du médecin: une des clefs du succès thérapeutique ?

Losing weight is a long, complicated, fastidious process that can quickly become discouraging for both patient and doctor. A chief difficulty in the management of obesity, widely described by a number of authors, is arousing and maintaining patient motivation. In the educational therapy of the obese patient, the motivational interview is an extremely useful tool in this respect. The aim of this article is to provide general practitioners with tools for assessing the likely success of the treatment and also for helping patients change their behaviour in the long-term. The challenge for the doctor is to optimise treatment by making patient motivation the primary issue in a progressive, stepby- step behaviour modification program. This process is demonstrated by a practical example involving patient attitudes to physical activity, via a fast, simple questionnaire.     

Nursing care of the mechanically ventilated patient: What does the evidence say?: Part one

The care of the mechanically ventilated patient is at the core of a nurse's clinical practice in the Intensive Care Unit (ICU). Published work relating to the numerous nursing issues of the care of the mechanically ventilated patient in the ICU is growing significantly. Literature focuses on patient assessment and management strategies for patient stressors, pain and sedation. Yet this literature is fragmentary by nature. The purpose of this paper is to provide a single comprehensive examination of the evidence related to the care of the mechanically ventilated patient. In part one of this two-part paper, the evidence on nursing care of the mechanically ventilated patient is explored with specific focus on patient safety: particularly patient and equipment assessment. Part two of the paper examines the evidence related to the mechanically ventilated patient's comfort, the patient/family unit, patient position, hygiene, management of stressors, pain management and sedation.     

Safety in training and learning in the intensive care unit

Resident and subspecialty fellow trainees in the intensive care unit (ICU) present risks for patient safety because of their inexperience yet offer opportunities to promote safe patient care because of their around-the-clock presence and their involvement in frontline processes of care. Most trainees approach their ICU experiences without previous education in performance improvement or patient safety. This article reviews the barriers that are faced by residents in providing safe patient care and outlines the nature of a patient safety curriculum that could tap the opportunities that are presented by trainees to promote safer patient care.     

Comment aborder l’éducation thérapeutique d’un patient obèse ? La motivation du patient... et du médecin: une des clefs du succès thérapeutique ?

Losing weight is a long, complicated, fastidious process that can quickly become discouraging for both patient and doctor. A main difficulty in the management of obesity, widely described by a number of authors, is arousing and maintaining patient motivation. In the educational therapy of the obese patient, the motivational interview is an extremely useful tool in this respect. The aim of this article is to provide general practitioners with tools for assessing the likely success of the treatment and also for helping patients change their behaviour in the long-term. The challenge for the doctor is to optimise treatment by making patient motivation the primary issue in a progressive, step-by-step behaviour modification program. This process is demonstrated by a practical example involving patient attitudes to physical activity, via a quick, simple questionnaire.     

Perpetuating ‘New Public Management’ at the expense of nurses' patient education: a discourse analysis

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could ‘see’ neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for ‘things’ such as cost‐effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice.     

Effect of an anonymous reporting system on near-miss and harmful medical error reporting in a pediatric intensive care unit

Adverse event reporting is a key element for improving patient safety. This study describes a new voluntary, anonymous reporting system that facilitates reporting of near-miss and patient harm events and an assessment of patient harm by the bedside care provider in a pediatric intensive care unit. The results demonstrated the effectiveness of the Patient Safety Report as a method to capture near-miss and patient harm events.     

Hospital nursing organizational factors,nursing care left undone,and nurse burnout as predictors of patient safety: A structural equation modeling analysis

BackgroundPromotion of patient safety is among the most important goals and challenges of healthcare systems worldwide in countries including China. Donabedian’s Structure-Process-Outcome model implies that patient safety is affected by hospital nursing organizational factors and nursing care process. However, studies are imperative for a clear understanding about the mechanisms by which patient safety is affected to guide practice.ObjectiveThe objective of this study was to explore the impact of hospital nursing work environment, workload, nursing care left undone, and nurse burnout on patient safety.DesignThis was a cross-sectional study conducted in 23 hospitals in Guangdong province, China in 2014. Data from nurses (n = 1542) responsible for direct care on 111 randomly sampled medical and surgical units were analyzed.MethodsWork environment was measured by the Practice Environment Scale of Nursing Work Index. Workload was measured by day shift unit patient-nurse ratio and non-professional tasks conducted by nurses. Nursing care left undone was measured by 12 items addressing necessary nursing activities. Nurse burnout was measured by the emotional exhaustion subscale of the Maslach Burnout Inventory-Human Services Survey. Patient safety was measured by three items indicating nurses’ perception of overall patient safety and nine items addressing patient adverse events. Structural equation modeling was used to examine a hypothesized model that supposed work environment and workload have both direct and indirect effects on patient safety through nursing care left undone and nurse burnout.ResultsThe findings generally supported the hypothesized model. Better work environment was associated with better patient safety both directly and indirectly. Lower workload primarily indirectly related to better patient safety. Nursing care left undone and nurse burnout were mediators negatively associated with patient safety.ConclusionsImproving work environment, increasing nurse staffing levels, and providing sufficient support for nurses to spend more time on direct patient care would be beneficial to patient safety improvement.     

Improving patient satisfaction through multidisciplinary performance improvement teams

Hospitals today are challenged by high patient census, rising acuity, and workforce issues that can result in a serious decline in overall patient satisfaction. This article discusses how one hospital tackled the issue of declining patient satisfaction scores on five "troubled" patient care units through a performance improvement strategy that included MD-RN partnerships, co-mentoring, and unit staff development and involvement in the problem-solving process. The result was a steady improvement in patient satisfaction over a 6-month period.     

The quality of patient education evaluated by the health personnel

Scand J Caring Sci; 2010; 24; 548–556
The quality of patient education evaluated by the health personnel The purpose of the study was to describe the quality of patient education evaluated by health personnel. The sample consisted of 916 nurses and physicians working in one hospital in Finland. The data were gathered with a questionnaire developed specifically for this study. The questionnaire measured patient education quality as two dimensions: patient education resources and implementation. The data were analysed using basic and multivariate methods. The overall resources of patient education were quite good. The problems were related to the possibilities for patient education, such as the lack of time, the unsuitability of conditions and the shortage of equipment. In addition, 54% had inadequate knowledge of patients’ posttreatment condition and 29% of the impact the illness had on patients’ everyday lives. Furthermore, 47% were less skilled in supporting self‐care. On the other hand, health personnel’s attitudes towards patient education were positive. They were able to use verbal and individual patient education very well, whilst other methods of patient education were used less well and more infrequently. The patient education was implemented largely as patient‐centred and interactive. However, the patient was not always taken into account in the planning and evaluation of patient education. Several background variables of the health personnel had a statistically significant connection to patient education resources and implementation. These findings indicate that patient education is largely well implemented, although the resources need to be developed somewhat further.     

Risk factors for acquisition of multidrug-resistant Pseudomonas aeruginosa producing SPM metallo-beta-lactamase

To evaluate risk factors for colonization or infection due to multidrug-resistant Pseudomonas aeruginosa (MDRPa) carrying the bla(SPM) gene (SPM-MRDPa) among hospitalized patients, we undertook a case control study at a 480-bed, tertiary-care university hospital. Two different case definitions were used. In the first definition, a case patient (SPM case patient) was defined as a patient who had at least one isolate of SPM-MDRPa (14 patients). In the second, a case patient (non-SPM case patient) was defined as a patient who had at least one isolate of non-SPM-MDRPa (18 patients). For each case patient, we selected two controls, defined as a patient colonized and/or infected by a non-MDRPa isolate during the same study period and with the closest duration of hospitalization until the isolation of P. aeruginosa as cases. The use of quinolones was the single independent predictor of colonization and/or infection by bla(SPM) MDRPa (odds ratio [OR] = 14.70, 95% confidence interval [95% CI] = 1.70 to 127.34, P = 0.01), whereas the use of cefepime was the single predictor of colonization and/or infection by non-bla(SPM) MDRPa (OR = 8.50, 95% CI = 1.51 to 47.96, P = 0.01). The main risk factor for MDRPa was a history of antibiotics usage. Stratification of risk factor analysis by a precise mechanism of resistance led us to identify a specific antibiotic, a quinolone, as a predictor for SPM-MDRPa.     

Reconstructive goals for children with burns: are our goals the same?

It is often difficult if not impossible to include a pediatric patient in the planning of burn reconstruction. To give the patient greater input into his or her reconstructive plan, we developed a survey tool to evaluate the different reconstructive goals of the patient, the parent, and the physician. Each patient, parent, and physician were requested to complete a separate goal form. Each form consisted of a simple line drawing of a child that shows both anterior and posterior views. The patient, the parent, and the physician were each asked to circle the desired reconstruction site or sites. The responses were collated and compared by sex, age, size of burn, and evaluator (patient, parent, or physician). Patients indicated fewer and different desired reconstruction sites than the physicians or the parents. Before reconstruction is planned, the patient should be consulted. The desires of the parents and the physician may differ significantly from those of the patient.