Standards for neonatal intensive care nursing: unit directed management standards

The neonate has the right to quality nursing care and the Neonatal Intensive nursing care practitioner is professionally-ethically and personally liable for quality nursing care. The process of quality improvement is a structured, planned and purposeful action were standards are set and the nursing care is evaluated after which remedial steps are taken to improve quality nursing care. In this study the focus is on the first step in the quality assurance cycle:the setting of standards. The purpose of the study is to describe and formulate standards for Neonatal Intensive nursing care which can be utilised as an accreditation instrument for institutional selfevaluation to improve quality nursing care. Standards for Neonatal Intensive nursing care were developed and validated by utilising a three-phase research method. In phase one subjects for standards were identified by a panel of experts. The identification was done by means of a critical debate, after which a preliminary conceptual framework was formulated. During the second phase a literature control was done to refine the conceptual framework. It consisted of a conceptual framework pertaining to unitmanagement (article 1) and an conceptual framework pertaining to high incidency, high risk interactions in the Neonatal Intensive Care Unit. The conceptual framework pertaining to the high incidency, high risk interactions in the Neonatal Intensive Care Unit consisted of: assessment of the neonate preparedness for neonatal resuscitation mechanical ventilation humidification during ventilation physiotherapy and suctioning of the ventilated neonate weaning during mechanical ventilation ecstubation During the third phase, the standards were validated by means of a consencus debate. An accreditation instrument was developed for institutional selfevaluation to improve quality nursing care in the Neonatal Intensive Care Unit. The standards that were formulated consisted of standards for unitmanagement (article 1) and standards directed at high incidency, high risk interactions in the Neonatal Intensive Care Unit which is published in the second article in this series.     

How does executive staff of home care nursing services estimate the situation of palliative care?

Experts criticise heavily the current situation of palliative care in the home care setting in Germany. They claim that the education in palliative care of all involved professional groups should be improved and specialized services should be adjusted. Only few is known in this context about the perspectives and attitudes of nursing staff, who is significantly involved in palliative care. Therefore, interviews with executive stuff of home care nursing services in the Federal State of Brandenburg were performed in the context of an evaluative opinion survey. 88 of 100 planned interviews took place. The nursing services estimated the current situation predominantly good. This does not support the experts' opinions found in the literature. Nevertheless, the respondents saw serious needs for improvements, in particular concerning psycho-social issues. Although palliative patients numerically seem to be in the background of every day work life, great interest in further qualification and new concepts of care was shown. So far, only few home care nursing services employ palliative care-trained staff.     

Nursing unit: nurses co-ordinating hospital care--an answer to new challenges in acute medicine

Some patients at university hospital no longer need frequent medical treatment but complex professional nursing care. At University Hospital (Inselspital) Bern a Nursing Unit with six beds was run as a pilot project based on experiences in British Nursing Development Units. The care concept was specifically developed and based on a definition of professional nursing, an evidence-based practice approach, resource oriented self management, and caring. Primary nursing was used, and the primary nurse was responsible for the coordination and steering of patient care. The project was evaluated prospectively. During the pilot phase, 37 patients were cared for on the NU. On average, 85% of the beds were occupied, patients were hospitalized for 21.5 days and had a mean age of 68.9 years. They were older than the University Hospital's average patient, and cases were more complex than the University Hospital's average case. The nurses' experiences were mainly positive. Their enhanced responsibility and the structured care process were seen as a challenge allowing them to enlarge their abilities. With this project, the University Hospital built up innovative services for patients with complex nursing problems. The project showed that well trained nurses can take on more responsibility for this patient group than in the context of conventional care models.     

Community children's nursing in Northern Ireland: an evaluative review

All parents taking on the responsibility of providing care for their child with complex needs in the community setting need to feel competent, confident and supported. Despite policy recommendations that reinforce the value of community children's nursing in meeting child and family needs, numbers in Northern Ireland remain small. The development of community children's nursing in Northern Ireland is examined using an evaluative module published by the Royal College of Nursing paediatric oncology nursing forum (RCN 2000). Although these services fit with regional strategies, are evaluated well by parents and reduce hospital stays, they are still fragmented and underfunded. Children's nurses need to become more politically astute, pressing the government to take action, and taking every opportunity to report their views to the Children's Commissioner.     

An existential health care approach in hospital psychiatric nursing

The focus of Mental Health Care in Brazil has been on community psychiatric care services that replace the asylum model. However, individuals with mental disorders continue to shift between community services and psychiatric hospitals, besides becoming a target of the disciplinarization and violence that question the quality of the nursing care being delivered. The objective of this study is to understand the ontology of nursing care in psychiatric hospitalization. Participants were four individuals with mental disorders who attended a center for psychosocial care, who agreed to talk about their psychiatric hospitalization experience by means of a semi-directed interview. The subjects remembered about their psychiatric hospitalization and assigned meanings to it. Heidegger's Existential Analysis was used, and thus generated the Meaning Unit: Being-in-the-world cared with impersonality; which allowed to unveil the phenomenon through Dasein's structure, and thus made it possible to outline the ontological care in nursing in psychiatric hospitals.     

Evaluating the quality of patient care in district nursing

This paper examines the process of evaluating the quality of care provision in district nursing at a local level. The definitions of audit and quality assurance are considered, and the current situation in community nursing is briefly compared with that in hospital settings. Finally, the use of evaluative tools in practice is examined, together with ways in which district nursing evaluation can be improved.     

The nursing process: improving psychiatric admission assessment?

The nursing process is a philosophy of individualized patient care, which states that all care should be planned on the basis of a nursing evaluation of patients' problems. The first stage of the nursing process is assessment, which for good planning requires more information about patients than is usually collected. In this study, in a psychiatric setting, an exploratory first phase was carried out to investigate whether the current admission assessment procedure assisted systematic care planning. The results revealed that nurses were dissatisfied with the admission assessment procedure, although half of them had received no training in the patient-centred approach. During phase 2 of the study a structured assessment form was introduced into two wards in separate hospitals for a period of 3 months. In order to assess the form's usefulness in identifying patients' nursing needs, and its acceptability to patients, an evaluative third phase was undertaken. Respondents recorded satisfaction with the structured form in practice, whilst analysis of care plan statements suggested that assessment had improved. The patients interviewed found the questions acceptable and viewed the assessment as a valued opportunity to talk to their nurse.     

Box Hill Hospital Intensive Care Unit.

The Unit Profile of the Intensive Care Unit at Box Hill Hospital describes the Unit's history and the progression it has made through the past 26 years. Details are given on the type of patients received and the catchment areas this Unit services. The organisational structure and the educational services available are discussed. The breakdown of staff including the nursing and medical staff and the available ancillary services as stated. The critical care course is described in detail to give an outline of and to promote this tertiary based course. It is also hoped this will encourage other hospitals and tertiary institutions to structure such similar courses to provide a more professional education for nurses.     

Palliative care for children and young people: a community paediatric nursing perspective

Community children's nursing services are well placed to provide palliative care for children and young people living with life-limiting conditions. The provision of home support can make a real difference to the quality of life for these families. Yet families report that services are fragmented and difficult to access. The range of professionals involved in the care of a child with life-limiting conditions can be daunting for both the child and the family. The key worker role has been identified as advantageous in co-ordinating care. The community children's nursing team is in a prime position to take on this role. Best practice is achieved through an integrated approach to service provision.     

Safe, sound and supportive: forensic mental health services

Certain independent inquiries, the failure to implement the care programme approach, the new mental health strategy, the recent National Service Framework for Mental Health (Department of Health (DoH), 1999), and the Fallon Inquiry into the Personality Disorder Unit at Ashworth Special Hospital have all raised many questions about psychiatric care which remain unanswered. The issue of organizing and developing forensic services can be regarded as a key element if safer services are to be a reality. This article offers a model for forensic mental health services which is derived from policy statements, the published strategy, research, and discussion papers.     

Reflecting together: developing a new strategy for continuous user involvement in mental health nurse education

This paper explores the first issues encountered when establishing a method of service user involvement in the preparation of a cohort of mental health nursing students during their branch programme. The method involved the creation of a group of service users and students whose purpose was to jointly reflect upon mental health issues. To do this students are expected to use their experience from practice placements and the service users to use their experiences as recipients of mental health services. This approach is being investigated through research utilizing an evaluative case study with features of action research incorporated into the design. The findings to date, which concern the process of negotiation, pre-study attitudinal survey and the first group process, will be presented. This will offer mental health professionals the opportunity to gain insight into one approach of actively involving service users in programmes of higher education over a sustained period of time. Reflection on practice themes will include: collaborative strategy, evaluative case study, education, mental health nursing, reflection on practice, and service-user involvement.     

The development of a time-based nursing information system in dermatology outpatients and day therapy areas

Over the past 10 years the provision of dermatology services in Nottingham has moved away from inpatient care and towards nurse-led day therapy and outpatient care. The current nursing information system supplies nursing activity data for management information and is a ward-based patient dependency classification system. Recently, it became apparent that nursing activity in day therapy and outpatients was being measured with a tool that was not designed for the purpose and managers were using professional judgement to aid their decisions. An evaluative internal consultancy was conducted to investigate the situation and provide recommendations for the development of an appropriate system that would supply more accurate information for non-ward areas. The report recommended a 'time-based' system that avoided the fundamental philosophical mismatch between a reductionist, task-orientated system and the reality of holistic nursing care. The new system was developed on a departmental personal computer using Microsoft Excel spreadsheets. The full co-operation and input of the nursing staff was an essential ingredient in its success. The original consultancy concentrated on the day therapy unit but the time-based system was developed to include all dermatology non-ward areas.     

Measuring patient satisfaction with nursing care: experience of using the Newcastle Satisfaction with Nursing Scale

Patient satisfaction with care has frequently been used as a measurement of quality, especially in attempts to demonstrate the benefits of changes in nursing practice. Unfortunately such attempts have frequently failed as patient satisfaction ratings have lacked sensitivity, consistently achieving very high scores. They have also failed to isolate the nursing component from the whole health care experience. The Newcastle Satisfaction with Nursing Scale (NSNS) has been developed after extensive research work as an attempt to establish reliable and valid measures of patients' experiences of and satisfaction with nursing care. This study evaluated the use of the NSNS in practice and found that it was readily understood by patients and easily administered by clinical staff. However, several lessons were learnt which could help its administration. The results demonstrated a very high degree of satisfaction with nursing care which left the discriminatory ability of the scale open to question, although its potential benefits in standard setting were demonstrated. Further evaluative studies are needed if the potential benefits of the NSNS are to be fully realised.     

An overview of evaluation research in nursing

This paper attempts to explain some general issues in evaluation and evaluative research in the health care field with specific reference to nursing. The evaluation process and nursing process are contrasted and methods used in evaluative research discussed. The case is made for more emphasis to be placed on the evaluation phase of the nursing process and process-outcome evaluation is advocated as a means of encouraging progress in the hitherto neglected area of evaluative research in nursing.     

Exploring the usefulness of a recovery-based approach to dementia care nursing

Exploring new approaches to dementia care nursing is vital to enable services to cope with the expected rise in demand for healthcare due to an ageing population. A comparison between the current person-centred care approach in aged care and recovery-based approach that underpins mental health nursing was reviewed in the literature to determine which is more useful to dementia care nursing. The recovery model is the conceptual framework that underlies the recovery-based approach. It broadens the current person-centred care approach through the fostering of hope, facilitative rather than directive care, and enhances autonomy. This promotes positive outcomes for older people with dementia through empowerment to make choices in the way they wish to live within the community. This essay proposes that the recovery-based approach is more useful to dementia care nursing than person-centred models.     

Audits of nursing care in Britain: a review and a critique of approaches to validating them.

The literature on audits of nursing care shows a strong link between the quality of nursing care and nursing labour force issues. Early attempts to develop a universally applicable formula to set nurse staffing levels on the basis of variations in patient dependency were shown to have been based on unrealistic assumptions about the ability of scientific methods to remove the influence of judgement from such areas of decision-making. The extent to which the validity of audit instruments has been established is reviewed, showing the number of studies to be small, almost exclusively in relation to American instruments, and with inconclusive results. An extension of the concept of validity is discussed, based on House's approach [House, E.R. (1980). Evaluating with Validity. Sage Publications, London, Beverly Hills] towards establishing validity in educational evaluation. This approach explicitly acknowledges the role of judgement in the evaluative enterprise, and widens the debate about how to settle questions of validity for audits of nursing care.     

Nurse and midwifery prescribing in Ireland: A scope‐of‐practice development for worldwide consideration

For 10 years, select Irish nurses and midwives who pass a rigorous 6 month theory and practical program can prescribe medications and other medicinal products. Given the need for timely, accessible, and affordable health‐care services in all countries, this nursing/midwifery education and practice development is worthy of examination. Irish nurse/midwife prescribing occurred following long‐term deliberative nursing profession advocacy, nursing education planning, nursing administration and practice planning, interdisciplinary health‐care team support and complementary efforts, and government action. A review of documents, research, and other articles was undertaken to examine this development process and report evaluative information for consideration by other countries seeking to improve their health‐care systems. Nurse/midwife prescribing was accomplished successfully in Ireland, with the steps taken there to initiate and establish nurse/midwife prescribing of value internationally.     

Implications of multiple-choice testing in nursing education

The evaluation of knowledge/competence is understood as an essential component of nursing education and practice. As such, nurse educators have a plethora of existing evaluation strategies from which to choose. A common written evaluative format used across all higher education settings is multiple-choice testing. This evaluation approach is accepted as a 'user-friendly' strategy to assess knowledge. Researchers from the disciplines of psychology and education have long been concerned with the consequences of multiple-choice testing on learning outcomes, a discussion that is essentially absent from the nursing literature. The purpose of this paper is to address the professional implications of multiple-choice testing in nursing. The potential knowledge consequences for nurse-learners, and by extension the provision of care to healthcare recipients, resultant from use of this testing modality are addressed within the context of the implementation of best practice guidelines in a long-term care home in a mid-sized rural and northern Canadian community with both regulated and non-regulated care providers.     

Health economics in psychiatric nursing.

The potential benefits to psychiatric nursing of the new science of health economics are explored in this article, which stems from more extensive research carried out by the authors. It is suggested that an analysis of the relationship between costs and clinical outcomes of community psychiatric nursing interventions will enable an objective ratification of the costs and benefits of treatment to emerge. The new discipline must be incorporated into evaluative research processes to allow psychiatric nursing to have an influence over future changes in health care provision.