Sudden bereavement in acute care settings

AIM: This literature review examines best practice in caring for those who have been bereaved suddenly in acute care settings. Theories of bereavement are outlined in relation to sudden death. The evidence base for best practice is presented and the role of the nurse in this situation is examined. CONCLUSION: There are common psychological, physical and behavioural manifestations of grief, but people experiencing the sudden death of a loved one are at risk of more pronounced and prolonged grief reactions than those who had been expecting death. Nurses have an important role in facilitating bereavement in acute care settings. Preparation for bereavement care begins before an individual has died and continues through to identifying the appropriate person to provide follow-up care. Those who are unexpectedly and suddenly bereaved should receive practical and considerate evidence-based care.     

Effective assessment of use of sitters by nurses in inpatient care settings

Title. Effective assessment of use of sitters by nurses in inpatient care settings Aim. This paper is a report of the evaluation of the impact of adopting the Patient Attendant Assessment Tool (PAAT) on nurses’ requests for sitters, use of restraints, and falls and fall injury rates. Background. Staffing should be the primary issue in eliminating risks of patient falls during hospital stays. Method. Data were collected in two acute adult medical units of a Michigan hospital from August 2005 to February 2007. Data from three sources were merged for analyses: (1) study units’ monthly reports; (2) quarterly reports of the National Database of Nursing Quality Indicators and (3) PAAT reports collected from October 2006 to February 2007. The primary outcome variables were the use of sitters, number of restraints ordered and fall and fall injury rates. Independent t‐tests and correlation analyses were used for data analyses. The data before and after adopting this tool were compared using independent t‐tests. Findings. The PAAT helped improve the fill/request rates for sitters. The use of soft limb holders decreased after adoption of this tool. The results also showed that if the number of sitter requests was higher, the total number of restraints would be lower but the total fall rate would be higher. Conclusion. Hospitals should include a tool similar to the PAAT in guidelines related to provision of constant observation or use of sitters. Further investigations of the optimum combination of staffing patterns and infrastructure are needed to promote safer hospital stays.     

Individualised bereavement care.

The stories of nine women who have lost a child in the neonatal period were obtained using semi-structured interviews. Interviews were transcribed, 'anonymised' and sorted into categories. Although the data can be grouped in sections according to predominant themes such as 'discontinuation of treatment', 'photographs and memories', 'partners' and 'conflict over treatment', the stories highlight the individual nature of each bereavement experience. Some of the women were satisfied with the individualised care they had received, but there were examples of staff providing care based on assumptions that would be appropriate for most women, but not for the person concerned.     

Exploring training needs of nursing staff in rural Cretan primary care settings

The purpose of this exploratory study was to assess occupational profile, level of performance, and on-the-job training needs of nursing staff employed in all government primary health care centers in rural Crete, Greece. The translated, culturally adapted, and validated Greek version of the Training Needs Assessment questionnaire was used. There were no significant differences between 2-year degree graduates (LPNs) and 3- or 4-year degree graduates (RNs, midwives, and health visitors) in terms of importance for 28 of 30 assigned tasks, whereas level of performance did not differ in any tasks. Significant training needs were reported by all staff, mainly in research/audit and clinical skills. Systematic overview of skill deficits in relation to skill requirements should be implemented by regional health authorities to enhance delivery of on-the-job training targeting group-specific, local needs.     

Models of bereavement care

After briefly reviewing the advantages and disadvantages of three approaches to bereavement care which are found in the United States of America (professional care, mutual help, and hospice care) this paper describes a fourth type exemplified by the British organization cruse. This provides both individual and group counseling through a national network of selected and trained volunteer counselors backed by professional caregivers.     

Relationship between call light use and response time and inpatient falls in acute care settings

Aims and objectives. This exploratory study used archived hospital data to determine whether the call light use rate and the average call light response time contribute to the fall and the injurious fall rates in acute care settings. Background. Inpatients often use call lights to seek nurses’ attention and assistance. Although implied in patient safety, no studies have examined data related to the call light use or the response time to call lights collected via existing tracking mechanisms to monitor nursing practice. Design. The study was conducted in a Michigan community hospital and used archived hospital data for analyses for the period from February 2007–June 2008. The unit of analysis was unit‐week. Method. The call light use rate per patient‐day was calculated based on information retrieved from the call light tracking system. The average response time in seconds was used as generated from the tracking system. The fall and injurious fall rates per 1000 patient‐days were calculated based on the fall incident reports. spss was used for data analyses. One‐way anova and correlation analyses were conducted. Results. More calls for assistance related to less fall‐related patient harm. Surprisingly, longer response time to call lights also related to fewer total falls and less fall‐related patient harm. Generally speaking, more call light use related to longer response times. Conclusions. This study’s findings challenged the appropriateness of targeting the goals of reducing the frequency of call light use and the fall rates as two outcome indicators of conducting hourly patient rounds. Relevance to clinical practice. Encouraging call light use is a key to reducing injurious fall rates. Unit managers should routinely monitor the trend of the call light use rate and ensure that the call light use rate is maintained at least above the mean rate.     

Fall risk factors and the nature of falls in inpatient oncology and palliative care settings

Using a prospective design, this study examined falls risk factors and the nature of patient falls in oncology and palliative care settings. Two hundred and twenty seven patients admitted to the oncology and palliative care units at a private hospital participated in this study. Of these, 34 patients had a fall and 193 patients did not have a fall. Twenty-four nurses who attended to patients who fell were interviewed. Findings revealed that, when compared to patients who did not fall, fallers had a significantly higher mean age; were assessed as more physically dependent using the Eastern Cooperative Oncology Group scale; were less alert and more confused; were more likely to have responded incorrectly to orientation to person, time and place; were weaker pre-fall in arm muscle strength; and were more fatigued. These factors are worthy of further exploration to determine whether they are more sensitive than the currently used falls risk factors used in oncology and palliative care settIngs.     

Trauma‐informed care in inpatient mental health settings: A review of the literature

Trauma‐informed care is an emerging value that is seen as fundamental to effective and contemporary mental health nursing practice. Trauma‐informed care, like recovery, leaves mental health nurses struggling to translate these values into day‐to‐day nursing practice. Many are confused about what individual actions they can take to support these values. To date, the most clearly articulated policy to emerge from the trauma‐informed care movement in Australia has been the agreement to reduce, and wherever possible, eliminate the use of seclusion and restraint. Confronted with the constant churn of admissions and readmissions of clients with challenging behaviours, and seemingly intractable mental illness, the elimination of seclusion and restraint is seen to be utopian by many mental health nurses in inpatient settings. Is trauma‐informed care solely about eliminating seclusion and restraint, or are there other tangible practices nurses could utilize to effect better health outcomes for mental health clients, especially those with significant abuse histories? This article summarizes the findings from the literature from 2000–2011 in identifying those practices and clinical activities that have been implemented to effect trauma‐informed care in inpatient mental health settings.     

Introducing solution-focused approaches to staff in inpatient psychiatric settings

The authors describe several approaches to introducing solution-focused ideas to inpatient psychiatric nursing staff and psychiatric nursing students. The approach is intended to show the basic values of this approach in the process of helping participants become acquainted with concepts central to newer models of brief psychotherapy. The format uses humor, small group experiential case examples along with didactic approaches to facilitate new ways of thinking congruent with new models of therapy.     

浅谈我国居丧护理需求及其医疗机构实施居丧护理的方式

对居丧护理的国内外情况进行对比,对我国实施居丧护理的现实需求进行分析,并对医疗机构实施居丧护理的方式谈了自己的看法.     

Nurses experiences of delivering care in acute inpatient mental health settings: A narrative synthesis of the literature

Inpatient psychiatric care requires a balance between working with consumers' priorities and goals, managing expectations of the community, legal, professional and service responsibilities. In order to improve service delivery within acute mental health units, it is important to understand the constraints and facilitating factors for good care. We conducted a systematic narrative synthesis, where findings of qualitative studies are synthesised to generate new insights. 21 articles were identified. Our results show that personal qualities, professional skills as well as environmental factors all influence the ability to provide recovery focused care. Three overarching themes which either facilitated or hindered were identified. These included: (i) Complexity of the nursing role (clinical care; practical and emotional support: advocacy and education; enforcing aspects of the Mental Health Act. and, maintaining ward safety); (ii) Constraining factors (operational barriers; change in patient characteristic; and competing understandings of care); and (iii) Facilitating factors (ward factors; nursing tools; nurse characteristics; approach to people; approach to work and ability to self‐care). We suggest that the therapeutic use of self is central to the provision of recovery oriented care. However person‐centred practice can be fragile and fluid and a compassionate system of support is needed to enable an understanding of context and self. It is critical to have a work environment which fosters hope and optimism and is supportive of autonomy, ensures workload balance, and is safe.     

Self-harm behavior and no-suicide contracting in psychiatric inpatient settings.

Although negotiation of no-suicide contracts is common practice, research regarding the outcomes of contracting is inadequate. The purpose of this retrospective review of medical records was to examine how no-suicide contracting affected the likelihood of self-harm behavior in psychiatric inpatient settings. Thirty-one patients (4.8%) engaged in self-harm behaviors representing 2.64% of all patients admitted to both study settings during the 6 (1/2)-month period from which data were collected. Approximately half of those patients expressed suicidal intent. Logistic regression analysis suggested that patients with no-suicide contracts and with higher levels of restriction had a significantly higher likelihood of self-harm behavior (OR = 7.43 and 2.47, respectively, p = .005). Consistency of nursing assignment is likely associated with a lower probability of self-harm (OR = .07) but p.068 when this variable was included in the model. Prevention of self-harm behaviors by the use of no-suicide contracting is not shown. Negotiation of a contract is likely a reflection of staff assessment that the patient was at high risk for suicide. These findings confirm the need for thorough, ongoing assessment of suicidal risk, whether or not a patient has agreed to a no-suicide contract.     

Nurse staffing and patient outcomes in inpatient rehabilitation settings.

In rehabilitation nursing, the patient classification systems or acuity models and nurse-staffing ratios are not supported by empirical evidence. Moreover there are no studies published characterizing nursing hours per patient day, proportion of RN staff and impact of agency nurses in inpatient rehabilitation settings. The purpose of this prospective observational study was to describe rehabilitation nurse staffing patterns, to validate the impact of rehabilitation nursing on patient outcomes, and to test whether existing patient measures on severity and outcomes in rehabilitation could be used as a proxy for burden of care to predict rehabilitation nurse staffing ceilings and daily nurse staffing requirements. A total of 54 rehabilitation facilities in the United States, stratified by geography, were randomly selected to participate in the study.     

Survey of complementary and alternative medicine in pediatric inpatient settings

ObjectivesWhile use of complementary and alternative medicine (CAM) is common in children, we know little about its use for hospitalized children. This survey measured the rate of CAM use, specific modalities used, and policies related to CAM use for hospitalized children.DesignAnonymous survey of hospitals in the Pediatric Research in Inpatient Settings (PRĪS) networkSettingHospitals in the PRĪS network.Main outcome measuresRate of overall and specific CAM modality use, including whether these modalities are provided, permitted, or prohibited, and presence of a written policy on CAM use.ResultsOf 99 sites queried, 22 responded. Of these, 82% of sites reported some CAM presence, and 63% reported official provision of CAM therapies. Freestanding children’s hospitals provided more modalities than other types of hospitals. There was no difference in number of modalities by geographic location. The most commonly provided CAM modalities were massage and biofield therapies. The most commonly prohibited modalities were inpatient placebos outside of research settings, medical marijuana, and inpatient homeopathic preparations. Only one site reported having a written policy on CAM use.ConclusionsAmong responding institutions, the most reported some CAM presence with a wide variety of CAM modalities provided and permitted. Written institutional policies on CAM were rare.