护士行为和患者健康促进行为的相关性研究

目的探讨护士行为和患者健康促进行为的相关性。方法采用描述性相关性研究,用护士关怀行为评估量表和健康生活方式量表对59例原发性高血压患者进行问卷调查。结果护士关怀行为评估量表得分最高的为满足基本需要,较低的为满足精神需求和营造支持保护性外部环境;患者健康促进生活方式量表得分较高的为药物治疗依从性、健康责任和营养,较低的为运动和锻炼、态度。护士关怀行为评估量表与健康促进生活方式量表评分存在相关性(r=0.542,P0.01)。结论护士行为和患者健康促进行为存在中等程度的正相关。从各方面加强护士的行为对患者健康促进行为的形成有着重要的意义。     

Patient satisfaction with triage nursing in a rural hospital emergency department

This study examined what relationships or differences exist between patient and nurse characteristics, satisfaction with triage nurse caring behaviors, general satisfaction with the triage nurse, and intent to return to a rural hospital emergency department (ED). The ED, located at a 401-bed teaching hospital in a small southern city, averages 28,000 visits annually. Samples of ED nurses (N = 11) and ED patients (N = 65) were asked to respond to demographic forms and the Consumer Emergency Care Satisfaction Scale (CECSS) Adapted. Findings indicated that the nurse's acuity rating and the patient's perception of condition had a positive relationship. The patient's perception of condition, patient satisfaction, and caring satisfaction were predictors of intent to return. When patients perceived themselves as seriously ill or injured, they expressed less intent to return to that ED.     

Mediating role of illness representation among social support, therapeutic alliance, experience of medication side effects, and medication adherence in persons with schizophrenia

The purpose of this cross-sectional research study was to examine factors affecting medication adherence in Thai individuals with schizophrenia. The Common-Sense Model of Illness Representation was used to guide the study. Two hundred twenty-five subjects met the inclusion criteria and were interviewed. Variables of interest focused on experience of medication side effects, therapeutic alliance, social support, illness representation, and behavior change with medication adherence. Results indicated that therapeutic alliance and the experience of medication side effects enhanced illness representation, which in turn led to an intention to change adherence behavior. Social support did not alter illness representation or adherence behavior. Because illness representation positively influenced patients' intention to change adherence behavior, mental health nurses should promote patients' perception about their illness to enhance medication adherence.     

Treatment considerations for the patient with borderline personality disorder

BPD is a major health problem. The high prevalence of patients with BPD in primary care and mental health settings contributes to their high use of resources in these practice settings. Recurrent suicidal behaviors and threats and self-injurious behaviors increase demands on nurses and other health care providers. Regardless of how often the patient presents with these behaviors, nurses must assess acute risk. Because suicidal behavior is often a cry of distress, nurses must avoid personalizing their reactions and monitor their own responses to ensure a therapeutic nurse-patient relationship. This article has focused on the challenge of caring for the patient with BPD. It has delineated important nursing interventions that enable the nurse to assess the patient's immediate needs and manage distressful and overwhelming emotional states and impulsivity.     

Noncompliance with medication regimens in severely and persistently mentally ill schizophrenic patients.

Medication noncompliance contributes significantly to recurrence of symptoms and readmission to the hospital of schizophrenic patients. The purpose of this study was to determine factors identified by patients, family members, and nurses for patients' noncompliance. The Health Belief Model provided a theoretical framework. The sample consisted of 11 triads with a noncompliant schizophrenic patient, a family member, and a primary nurse in each triad. A structured interview was developed to assess stated reasons for noncompliance and factors relating to the patient's illness, medication practices, stressors, life-style, and support systems. Results showed that many patients stated they did not need medication or needed less than the amount prescribed. Family members and nurses agreed that the majority of patients did not believe that they needed medication. When asked if they thought they had a mental illness, most patients denied that they were ill. Other stated reasons for noncompliance were drug/alcohol use, and, for one patient, medication side effects. Additional findings were patients' low self-esteem; lack of knowledge about medications; inability to identify stressors in patients' lives; inability to identify early symptoms of relapse; patients' need for support from families; and families' stress from patients' abusive, unpredictable behavior. Use of the Health Belief Model is appropriate to study noncompliance in mentally ill patients if perception of illness threat is assessed. Conclusions were that patients and families could benefit from more knowledge of schizophrenia and its treatment, more awareness of stressors and signs of relapse, and improved mutual problem solving. Studies are needed to assess the effects of patients' denial of illness, denial of need for medication, and self-image/self-esteem on medication noncompliance.     

The circle of caring model: medication adherence in cardiac transplant patients

This column employs a case study approach to examine the application of the circle of caring model in actual nursing practice as it pertains to a medication education teaching plan for a cardiac transplant patient. The circle of caring model is applied by experienced registered nurses. The tailored medication education plan is based on the patient's conceptualized database, understanding patient responses, using a holistic/broadened approach to therapeutics, and considering the patient's views of outcomes. Individualized teaching plans improve patient adherence to complicated medication regimens, thus improving long-term quality of life and survival in transplant recipients.     

What influences patients’ medication adherence? Mental health nurse perspectives and a need for education and training

This paper explores the role of mental health nurses in medication adherence and their perspective of what influences patients' medication non-adherence. Forty-eight mental health nurses with active patient caseloads completed a comprehensive questionnaire assessing a number of variables related to medications, including whom they felt was primarily responsible for monitoring the side-effects of medication, their knowledge skills and confidence in dealing with medication adherence and their prior education and training in medication adherence strategies. Lack of patient insight was endorsed as the strongest influence on patient non-adherence. Over 84% of nurses indicated they did not have any prior education or training in medication adherence strategies. Implications of the findings for education and training and nurses' roles in supporting medication adherence are discussed.     

Acts of caring: nurses caring for nurses

Caring behaviors displayed toward nurses by nurse managers and nurse peers play a significant role in establishing relationships that promote a healthy work environment. A qualitative study was done to identify behaviors perceived to be caring toward nurses. The theoretical background used for the study was Nursing as Caring by Boykin and Schoenhofer. Data were collected from focus groups consisting of registered nurses currently employed in the practice setting. Content analysis was used for the analysis. The overarching category that was identified was tending to a caring environment. The following emergent categories were also found: caring through helping and supporting, caring through appreciating, and acknowledging unappreciated caring. The findings suggest that nurses demonstrate caring behaviors toward their colleagues by coming to know them on both a professional and a personal level. These behaviors form the foundation for an environment that supports a consistent demonstration of caring.     

When the patient causes the problem: the effect of patient responsibility on the nurse-patient relationship

A positive connection to the patient as a person within a nurse-patient relationship provides the context for ethical treatment. The relationship characterized by caring concern for the patient is also a clinically effective resource. Ethical analysis shows that a nurse's caring and other health care resources should not be allocated based on the degree to which the patient is responsible for the clinical condition. Interviews were conducted with 51 nursing students and nurses about their feelings toward hypothetical patients. The theme of 'patient responsibility for causing the clinical problem affecting the nurse-patient relationship' was identified and responses were categorized according to how the theme was illustrated. The categorization of the responses was validated by two nurse experts. When asked to briefly compare reactions to the vignettes 25 (49%) of the participants connected their feelings towards the patient with their perception of the patient's responsibility.     

Acceptance of nurse practitioners: patient behavioral indicators

Using the Delphi Technique, this study investigated the concept of acceptance and sought to identify behavioral indicators of patient acceptance of nurse practitioners. Thirty-four nurse practitioners participated in the study and came to consensus regarding 20 verbal and 16 nonverbal behaviors. This study was a step toward defining objective criteria of NP acceptance.     

Patients' perceptions of spirituality and the nurse as a spiritual care provider

This qualitative study explored patients' perceptions of spirituality and of the nurse as a spiritual care provider. Semistructured interviews were conducted with 8 adults older than 21, who were living at home, and had been discharged from the hospital within the past 3 months having had at least a 5-day length of stay. Participants agreed that during their hospitalization, nurses were kind and caring but these behaviors were not perceived as spiritual care. Study findings suggest that patients do not perceive spiritual care within the role of nursing and therefore they did not share their spiritual concerns with nurses. Study findings are limited by sample size; however, implications for practice are that nurses need to be aware of a patient's spiritual needs to provide spiritual care.     

Motivational interviewing: addressing ambivalence to improve medication adherence in patients with bipolar disorder

Poor adherence to psychotropic medication is a significant issue for patients with bipolar disorder. The effectiveness of medication treatment is limited by high rates of medication non-adherence among this population. Motivational Interviewing is an evidence-based intervention that has been efficacious in promoting behavioral health regimens and treatment recommendations, including medication adherence. By using a patient-centered approach, Motivational Interviewing has been shown to enhance patients' insight and attitudes toward treatment. This article aims to describe to mental health nurses how to use Motivational Interviewing with bipolar patients to address ambivalence and improve adherence to psychotropic medication regimens.     

Perception of caring behavior and associated factors among nurses and midwives working in public hospitals in Southern Ethiopia

ObjectiveThis study aimed to assess the perception of caring behaviors and associated factors among nurses and midwives who provided maternal health care services at Sidama region public hospitals, Hawassa, Ethiopia.MethodsAn institutional-based cross-sectional study design was used on a sample of 269 nurses and midwives working in maternity wards in Sidama region public hospitals. A self-administered questionnaire was used to collect data. Bivariate and multivariable logistic regression analysis was used to identify factors associated with nurses’ and midwives’ perceptions of caring behaviors.ResultsTotally 261 nurses and midwives participated the survey. Based on the mean score, participants’ perception of caring behavior was classified as higher and lower. According to this study, 75.1% (196/261) of nurses and midwives demonstrated a higher perception of caring behavior. Respondents’ age, professional satisfaction, personal satisfaction, midwife/nurse-doctor relationship and workload were significantly associated with their perception of caring behavior.ConclusionsAssessing the nurses’ and midwives’ perception of caring behavior and related factors is crucial for providing high-quality nursing and midwifery interventions. It is suggested to create a positive and conducive caring behavior in the organization by reducing excessive workload of nurses and midwives, as well as enhancing nurse/midwife-doctor relationship, and increasing their job satisfaction by providing recognition and reward will improve nurses’ and midwives’ caring behavior.     

Comparisons between patients' and nurses' assessment of pain and medication efficacy in severe burn injuries

In order to provide burn patients with adequate pain relief, the nurses must be able to accurately evaluate the patients' pain levels and to assess whether sufficient analgesia is achieved or not. The present study examined this issue by comparing the pain ratings in 42 patients hospitalized for burn injuries and 42 nurses. The patient and the attending nurse were asked to rate, independently of each other, the intensity of the pain felt by the patient during a therapeutic procedure and at rest. When analgesic medication was given prior to the procedure, both the patients and the nurses were asked to estimate the degree of pain relief. All ratings were obtained using visual analogue and verbal scales. The results revealed significant but small correlations between the nurses' and patients' ratings. Frequently, the nurses underestimated or overestimated the patients' pain. Discrepancies were also observed in the evaluation of pain medication efficacy, the nurses showing a tendency to overestimate the degree of pain relief. The accuracy of the nurses' perception did not vary as a function of the patients' age, socioeconomic status or burn severity. However, the number of years of experience in burn-nursing had a significant influence on the nurses' estimation of the patients' pain during therapeutic procedures. Theoretical and clinical implications of these results are discussed with a particular emphasis on the need to implement systematic procedures to assess pain and success of analgesia. Additional recommendations to optimize pain management in burn patients are also made.     

A performance improvement plan to increase nurse adherence to use of medication safety software

Nurses can protect patients receiving intravenous (IV) medication by using medication safety software to program "smart" pumps to administer IV medications. After a patient safety event identified inconsistent use of medication safety software by nurses, a performance improvement team implemented the Deming Cycle performance improvement methodology. The combined use of improved direct care nurse communication, programming strategies, staff education, medication safety champions, adherence monitoring, and technology acquisition resulted in a statistically significant (p < .001) increase in nurse adherence to using medication safety software from 28% to above 85%, exceeding national benchmark adherence rates (Cohen, Cooke, Husch & Woodley, 2007; Carefusion, 2011).     

Patient-family-nurse interactions in the trauma-resuscitation room.

BACKGROUND: Controversy about the presence of patients' family members in the emergency department has centered on the trauma-resuscitation room. Little is known about interactions of patients' family members with the patients and with nurses or about the ramifications of the presence of patients' family members at the bedside. OBJECTIVES: To describe behavioral responses offamily members of patients and the interactions of thefamily members with nurses and the patient in the trauma room. METHODS: A secondary analysis was done of 193 videotapes of trauma room care. Of these, 88 tapes showed the presence of patients' family members, for a total of 42 hours. Qualitative ethology and a model of suffering as a scaffold were used to analyze verbal and nonverbal interactions between nurses, patients' family members, and patients. Behaviors and verbal interactions of patients and their families were coded as to persons who were enduring and persons who were emotionally suffering. Categories were described. RESULTS: Whether a patient's family members entered the trauma room depended on the patients condition, the patient's behavioral state, and the nature of the treatments. Categories of interactions were families learning to endure, patients failing to endure, family emotionally suffering and patient enduring, patient and family enduring, and resolution of enduring. The interaction style of the nurses involved was particular to each of these states. Two instances of inappropriate interactions occurred. CONCLUSIONS: Nurses can use the Model of Suffering as a framework to assess behavioral and emotional states and to select appropriate strategies to comfort patients' family members.     

Elderly pain assessment and pain management knowledge of long-term care nurses.

The purpose of this study was to determine the knowledge base of long-term care nurses regarding pain assessment and management in the elderly. Three specific themes related to long-term care nurses were investigated: personal beliefs regarding patients' self-reports of pain, documentation of patients' self-reports of pain, and choice of pain medication and dose. Eighty-nine long-term care nurses, from 6 rural counties in California, responded to a questionnaire that consisted of 2 patient scenarios. The scenarios portrayed 1 patient as smiling and showing no objective signs of pain and the other patient as grimacing. Three questions followed up the scenarios related to elder pain assessment and management. Nurses were asked to indicate their pain assessment on a 0 to 10 scale and to choose the correct pain medication and dose. Frequencies and means were used to analyze demographic data; frequencies, t tests, and chi 2 testing compared nurse responses with the different questions. Results indicated that nurses were more likely to believe and document the grimacing patient's self-report of pain than the smiling patient. Older nurses with more experience were less likely to believe or document their patient's self-report of pain than younger nurses with fewer years of experience. Less than half of the nurses would increase the analgesic dose for either patient scenario. Nursing implications include the importance of ongoing pain assessment and management education tailored to the geriatric population and long-term care.     

The role of the inpatient mental health nurse in facilitating patient adherence to medication regimes

Non-adherence to antipsychotic medication is associated with relapse of psychiatric symptoms and readmission to inpatient mental health services. The important role of the mental health nurse in facilitating adherence has been acknowledged, however, there has been little exploration of how nurses themselves perceive this aspect of their role. A qualitative study was conducted to explore the perceptions of mental health nurses employed in inpatient settings regarding their role in facilitating medication adherence. Focus groups were conducted with 22 nurses from three inpatient settings in metropolitan Melbourne. The main themes to emerge from the data were: nurses' responsibilities in medication management; ways in which nurses are educated about antipsychotic medication; barriers to the provision of medication management, and barriers to effective patient adherence. Recommendations for more effective practice are discussed.     

Fostering the coexistence of caring philosophy and economics in today's health care system

For the past decade, several health care systems are undergoing continuous administrative restructuring, whose main objective is cost reduction. These changes often result in the patients' needs not being met because nurses are continuously affected by widespread budget cuts and staff downsizing. Have we reached a point, where we are setting aside our prime directive of patient well-being for the sake of finances? If so, are we at risk of forsaking our professional identity as nurses? The authors believe that caring management and economical constraints can coexist while promoting quality patient care. The purpose of this article is to show how nurse managers and administrators can facilitate caring practices while maintaining their financial responsibilities within the health care organization. This article suggests several strategies for assisting nurse managers in promoting caring in the health care environment.