A randomised controlled trial of a community nursing intervention: improved quality of life and healing for clients with chronic leg ulcers

Aims and objective. The negative impact of chronic leg ulcers on quality of life is well documented. The aim of this study was to determine the effectiveness of a new community nursing model of care on quality of life, morale, depression, self‐esteem, social support, healing, pain and functional ability of clients with chronic venous leg ulcers. Background. Venous leg ulcers are slow to heal, frequently recur and are associated with pain, restricted mobility and decreased quality of life. Although chronic wound care consumes a large proportion of community nursing time and health care resources, there is little evidence available on the effectiveness of differing models of community care for this population. Design. Randomised controlled trial. Methods. We recruited a sample of 67 participants with venous leg ulcers referred for care to a community nursing organisation in Queensland, Australia after obtaining informed consent. Participants were randomised to either the Lindsay Leg Club^® model of care (n = 34), emphasising socialisation and peer support; or the traditional community nursing model (n = 33) consisting of individual home visits by a registered nurse. Participants in both groups were treated by a core team of nurses using identical research protocols based on short‐stretch compression bandage treatment. Data were collected at baseline, 12 and 24 weeks from commencement. Results. Participants who received care under the Leg Club model demonstrated significantly improved outcomes in quality of life (p = 0·014), morale (p < 0·001), self‐esteem (p = 0·006), healing (p = 0·004), pain (p = 0·003) and functional ability (p = 0·044). Conclusion. In this sample, the evaluation of the Leg Club model of care shows potential to improve the health and well‐being of clients who have chronic leg ulcers. Relevance to clinical practice. These results suggest further evaluation and implementation of this model is warranted by community health organisations involved in the care of this population.     

Client perceptions of quality of life in accredited and nonaccredited community residential facilities

Consumer satisfaction as an indicator of quality of life relative to the certification/accreditation level of community residential facilities was examined using three separate measures. One hundred forty six subjects residing in 47 separate Centers for the Developmentally Disabled (CDD's) were surveyed. Results indicated that residents of nationally accredited CDD's rated their quality of life as superior to those clients living in nonaccredited facilities. Suggestions for changes in program evaluation methods utilizing consumer satisfaction as a major variable are offered.     

Protocol-driven care in the intensive care unit: a tool for quality

Advances in organization and patient management in the intensive care unit (ICU) have led to reductions in the morbidity and mortality suffered by critically ill patients. Two such advances include multidisciplinary teams (MDTs) and the development of clinical protocols. The use of protocols and MDTs does not necessarily guarantee instant improvement in the quality of care, but it does offer useful tools for the pursuit of such objectives. As ICU physicians increasingly assume leadership roles in the pursuit of higher quality ICU care, their knowledge and skills in the discipline of quality improvement will become essential.     

Standardized nursing vocabularies: a foundation for quality care

OBJECTIVES: To describe the importance of standardized nursing vocabularies as a foundation for quality in health care decision-making. DATA SOURCES: Literature, online sources, and committee documents. CONCLUSIONS: Several standardized vocabularies are recognized by the American Nurses Association Committee for Nursing Practice Information Infrastructure. Vendors also have integrated the vocabularies into their information systems. Future efforts include developing an international nursing reference terminology. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses face quality of care issues that impact decision-making at the point of care. To describe their practice, oncology nurses must strive to use nursing data that are standardized, documented, and made visible by inclusion in computer-based systems.     

Health care and the quality of life: a review

The increasing requirement for evaluation of health care, either for purposes of quality assurance or deciding resource distribution issues, has brought into question a number of ideas concerning the aims of the health care enterprise. This article suggests that the ultimate aim is to improve the quality of life, and examines the feasibility of adopting this as an evaluation criterion. Difficulties concerning the concept and definition of the quality of life are outlined, and a plea made for the adoption of the broadest possible therapeutic aims. Social indicators and subjective evaluations are considered in turn as measures of the quality of life, and their inadequacies and strengths exposed. Relationships between the measures are discussed, and their uses outlined. It is finally suggested that nurses should participate in the formulation of quality of life concepts and evaluations which reflect the values which underpin their own practice.     

Public Health Nurses and the delivery of quality nursing care in the community

Aim. The aim of the study was to explore factors which impact on quality nursing care in the community from the Public Health Nurse's (PHN) perspective. Background. Public Health Nursing has significantly evolved over the past few years with the delivery of quality nursing being a focus point. This study explores factors that impact upon the delivery of quality care in Public Health Nursing in Ireland. The findings provide an opportunity for an additional perspective to be included in the existing international findings and act as a starting point from which further research can be built. Method. A qualitative method using semi‐structured interviews were conducted. Interviews were taped and content analysed. Findings. Four main categories emefrged from the data, namely role change, components of quality nursing care, barriers to quality nursing care and the factors that facilitate the delivery of quality nursing care in the community. PHNs strive for evidence‐based practice; they acknowledged their inability to achieve this and referred to factors that inhibited them from reaching their goal. Conclusion. Enhanced education for PHNs will equip them in the delivery of a quality service and have a positive impact on patient care. Better communication is required between PHNs, line managers and the multidisciplinary team. The delivery of community services need to be reviewed and developed further in accordance with the health strategy policy. Relevance to clinical practice. This study has identified the evolution in clinical practice associated with the changing role and scope of Public Health Nursing. Clinical practice has evolved over time to incorporate societal change, technological advances and the delivery of an evidence‐based service responsive to identified need. This study identified the presence of an increase in the specialist clinical work being undertaken as a result of new technological advances entering the community working environment.     

护理干预对养老院生活的老年人生活质量的影响

目的 分析在养老院生活的老年人影响生活质量的相关因素并进行护理干预.方法 采用自身对照法,对50例在养老院生活的老年人进行1年的护理干预,对老年人的睡眠、生活自理能力、与家人的关系等指标进行比较评价.结果 干预前后,睡眠情况的差异有统计学意义(P<0.01),生活完全自理率及与家人关系差异具有统计学意义(P<0.01).结论 护理干预能改善老年人的睡眠状况、生活自理能力等,能较好地提高老年人生活质量.对进一步加强养老院护理工作有一定的启示.     

The relation between quality of co-ordination of nursing care and quality of life in Dutch nursing homes

Quality of life of nursing home residents is a critical consideration in international health care policies and health care decisions. Yet, there is little relevant research to support decisions about client-tailored and effective nursing care for this population. Because of the permanency of their stay, the care received affects the quality of daily life. This study investigated the quality of co-ordination of care and the way it is related to gaps between needs and care supply, the quality of life and health status of residents living in Dutch nursing homes. To assess the perceived quality of life and experienced discrepancies between needs and care supply, 337 residents of 10 different nursing homes were interviewed. The quality of co-ordination of nursing care was assessed by judgements of the residents and nurses and by analysing the care documents. The results showed a relation between the co-ordination of care and care discrepancies; the higher the quality of co-ordination of care, the fewer the gaps between residents' needs and the care they received. The psycho-social aspects in particular showed a gap between the needs and care supply. As regards the relation between co-ordination of care and quality of life, the strongest positive relations were found between taking case histories, patient allocation and dimensions of quality of life. No direct relations were found between the co-ordination of care and care discrepancies on the one hand and the health status of the residents on the other. In conclusion, this study showed that the quality of co-ordination of care can affect the perceived quality of life of nursing home residents. To meet the residents' needs it is important to assess their physical and psycho-social needs accurately. More research focusing on this assessment is needed in order to improve the quality of life of nursing home residents.     

Developing a reflection and analysis tool (We-ReAlyse) for readmissions to the intensive care unit: A quality improvement project

BackgroundReadmissions to the intensive care unit are associated with poorer patient outcomes and health prognoses, alongside increased lengths of stay and mortality risk. To improve quality of care and patients’ safety, it is essential to understand influencing factors relevant to specific patient populations and settings. A standardized tool for systematic retrospective analysis of readmissions would help healthcare professionals understand risks and reasons affecting readmissions; however, no such tool exists.PurposeThis study’s purpose was to develop a tool (We-ReAlyse) to analyze readmissions to the intensive care unit from general units by reflecting on affected patients’ pathways from intensive care discharge to readmission. The results will highlight case-specific causes of readmission and potential areas for departmental- and institutional-level improvements.MethodA root cause analysis approach guided this quality improvement project. The tool’s iterative development process included a literature search, a clinical expert panel, and a testing in January and February 2021.ResultsThe We-ReAlyse tool guides healthcare professionals to identify areas for quality improvement by reflecting the patient's pathway from the initial intensive care stay to readmission. Ten readmissions were analyzed by using the We-ReAlyse tool, resulting in key insights about possible root causes like the handover process, patient's care needs, the resources on the general unit and the use of different electronic healthcare record systems.ConclusionsThe We-ReAlyse tool provides a visualization/objectification of issues related to intensive care readmissions, gathering data upon which to base quality improvement interventions. Based on the information on how multi-level risk profiles and knowledge deficits contribute to readmission rates, nurses can target specific quality improvements to reduce those rates.Implications for clinical practice and researchWith the We-ReAlyse tool, we have the opportunity to collect detailed information about ICU readmissions for an in-depth analysis. This will allow health professionals in all involved departments to discuss and either correct or cope with the identified issues. In the long term, this will allow continuous, concerted efforts to reduce and prevent ICU readmissions. To obtain more data for analysis and to further refine and simplify the tool, it may be applied to larger samples of ICU readmissions. Furthermore, to test its generalizability, the tool should be applied to patients from other departments and other hospitals. Adapting it to an electronic version would facilitate the timely and comprehensive collection of necessary information. Finally, the tool’s emphasis comprises reflecting on and analyzing ICU readmissions, allowing clinicians to develop interventions targeting the identified problems. Therefore, future research in this area will require the development and evaluation of potential interventions.     

GIS(c): a scientific framework and methodological tool for nursing research

The purpose of this article was to bring to nursing science a theoretical framework and technology that can transport with it new ways of knowing by exploiting microperspectives and macroperspectives, both from "within the map" and globally. Nursing continues to find its voice, but it also must lend its voice to the forming of Geographic Information Systems and Science in a pan-disciplinary partnership with geography, cartography, sociology, public health, and information technology. It is proposed that nursing take advantage of the latest databases that hold "person" information and layer these over geographical maps holding "environment" and "health" information as a new way of seeing and applying the metaparadigms of nursing. By using Geographic Information Systems for understanding spatial, numeric, health, and population relationships as they relate to nursing practice, research, and teaching, nursing science will continue to evolve at a speed needed to be effective in the new millennia.     

社区老年人护理需求及生活质量的相关性研究

目的 了解社区老年人对社区护理服务的需求情况及对生活质量的影响因素,提出改进社区护理的对策,以提高老年人生活质量.方法 选择深圳市2个社区的388名老人作为研究对象,用自制的社区护理需求调查问卷及生活质量综合评定表(GQOLI-74),对其生活质量状况、社区护理需求情况及影响因素进行调查.结果 老年人生活质量得分为61.71±9.85;对社区护理需求得分为2.52±1.03,对健康促进需求最高(2.88±1.09)分.影响社区护理需求的主要因素是对社区护理的认识、患病数目、年龄等;影响老人生活质量的主要因素是患病情况、经济状况、文化程度、职业、婚姻状况、年龄等.老年人对社区护理各领域需求与生活质量的躯体功能、心理功能呈负相关关系(P＜0.05,P＜0.01);对疾病护理方面和护理需求总分与社会功能呈负相关关系(P＜0.05,P＜0.01).结论 社区老年人生活质量偏低,对社区护理需求较高,其生活质量和社区护理需求呈负相关关系,需针对老年人需求特点开展社区护理工作,提高其生活质量.     

社区护理干预对脑卒中患者生存质量的影响

目的:探讨社区护理干预对脑卒中患者生存质量的影响.方法:将151例脑卒中患者随机分为研究组78例和对照组73例,研究组在药物治疗及出院宣教基础上进行社区护理干预,由护师以上职称的护理人员到患者家中进行饮食指导、心理辅导和肢体功能训练.对照组仅进行药物治疗及出院宣教,患者自行康复训练.结果:研究组运动功能、日常生活能力、生活质量的改善以及生活满意度显著优于对照组(P<0.05).结论:针对性的社区护理干预能有效地改善脑卒中患者肢体功能恢复,增加患者的生活满意度,改善患者的生活质量.     

Demography, nursing and community care: a review of the evidence

Demography is a most powerful influence upon social policy making Policy making cannot be divorced from the constitution and the characteristics of the population for which it is intended This paper commences by identifying and reviewing the most potent of those trends, and then examines the implications, first for the capacity of the community to cope with its dependents and then for the supply of nurses, before illustrating the importance of community nursing to government policies on community care