Nursing Diagnoses of Burned Patients and Relatives' Perceptions of Patients' Needs

PURPOSE.  The aims of this study were to identify the nursing diagnoses of burn patients in the period 1 week before hospital discharge and to determine whether their relatives had similar perceptions of the patients' problems.
METHODS.  A qualitative case study was conducted with 10 burn patients and 10 family members. One week before hospital discharge, the nursing diagnoses of the patients and the relatives' perceptions of the patients' were identified and compared.
FINDINGS.  Thirty different diagnoses related to physical and psychosocial aspects were identified. The family members reported concerns mainly related to physical care, specifically wound care and prevention of infection, and psychosocial aspects, while patients were primarily concerned with the latter.
CONCLUSIONS.  Nursing diagnoses for these patients and their relatives' perceptions frequently overlapped; however, the emphasis of the families' attention was on the physical aspects.
IMPLICATIONS FOR NURSING PRACTICE.  Anticipating family members' perceptions about the patients' problems is important in order to promote strategies that will improve patient care after hospital discharge.     

Patient satisfaction with nursing care: a concept analysis within a nursing framework

Title.  Patient satisfaction with nursing care: a concept analysis within a nursing framework.
Background.  Patient satisfaction is an important indicator of quality of care, and healthcare facilities are interested in maintaining high levels of satisfaction in order to stay competitive in the healthcare market. Nursing care has a prominent role in patient satisfaction. Using a nursing model to measure patient satisfaction with nursing care helps define and clarify this concept.
Data sources.  Rodgers' evolutionary method of concept analysis provided the framework for this analysis. Data were retrieved from the Cumulative Index of Nursing and Allied Health Literature and MEDLINE databases and the ABI/INFORM global business database. The literature search used the keywords patient satisfaction, nursing care and hospital. The sample included 44 papers published in English, between 1998 and 2007.
Results.  Cox's Interaction Model of Client Health Behavior was used to analyse the concept of patient satisfaction with nursing care. The attributes leading to the health outcome of patient satisfaction with nursing care were categorized as affective support, health information, decisional control and professional/technical competencies. Antecedents embodied the uniqueness of the patient in terms of demographic data, social influence, previous healthcare experiences, environmental resources, intrinsic motivation, cognitive appraisal and affective response. Consequences of achieving patient satisfaction with nursing care included greater market share of healthcare finances, compliance with healthcare regimens and better health outcomes.
Conclusion.  The meaning of patient satisfaction continues to evolve. Using a nursing model to measure patient satisfaction with nursing care delineates the concept from other measures of patient satisfaction.     

Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study

Title.  Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study.
Aim.  This paper is a report of a study conducted to explore the comfort experiences of hospitalized patients during their admission to medical–surgical wards in an Iranian hospital.
Background.  Comfort has various definitions, ranging from a basic human need, to a process, function or an outcome of nursing. As comfort is a substantive need throughout life in health and illness, providing comfort is a major function and challenge for holistic nursing care.
Method.  This hermeneutic phenomenological study was conducted between July 2006 and April 2007 in six medical–surgical wards of one of a university hospital in Iran. Data were generated with 22 participants (16 hospitalized patients and six nurses), using in-depth interviews to capture their detailed experiences of comfort. Analysis based on the framework of Diekelmann enabled data interpretation and elaboration of shared themes.
Findings.  One constitutive pattern, 'Comfort: a need of hospitalized patients' and four related themes – A friend in hospital, Relief of suffering within a calm environment, Seeking God, and Presence among family – were identified in the data.
Conclusion.  These findings offer unique insight for planning and implementing appropriate clinical practices in Iran, especially in caring for Muslim patients. Two major implications are to: (1) consider comfort criteria during nursing assessment and planning of care during a patient's hospitalization and (2) note that Shiite people in particular are more comfortable and feel better when they are able to follow their religious principles.     

Nurses' moral strength: a hermeneutic inquiry in nursing practice

Title.  Nurses' moral strength: a hermeneutic inquiry in nursing practice.
Aim.  This paper is a report of a study to interpret nurses' experiences of moral strength in practice.
Background.  Moral strength is said to be beneficial in providing nursing care for patients, thereby contributing to high qualitative care. However, few studies focus on the meaning of nurses' moral strength.
Methods.  This study included eight Registered Nurses working in different aspects of health care in southern Sweden. Individual interviews were conducted in 2006 and 2007. We recorded, transcribed verbatim, and interpreted the interviews by a method grounded in hermeneutics.
Findings.  Three themes were interpreted on three different levels: the action level as 'having courage to act on one's convictions', the relational level as 'being attentive and recognizing vulnerability', and the existential level as 'facing the unpredictable' . Overall, moral strength was understood as a driving force to be someone special in the care of patients, i.e. someone who makes a difference.
Conclusion.  The value of nurses' moral strength in patient care should be recognized. Attention must be given to aspects outside the individual, e.g. professional and institutional processes that influence the work environment. Clinical team supervision can help make such processes visible and supportive.     

Predictors of patients' experiences of nursing care in medical-surgical wards

The purposes of this study were to explore patients' opinions of nursing care and to identify predictors of patients' experiences of nursing care in medical-surgical wards. The sample of the study was 225 adult patients in medical-surgical wards in a major teaching hospital in Jordan. The experiences of nursing care total score in this study was relatively high. The findings showed that the majority of the participants had positive experiences regarding the time nurses spent with them as well as the respect nurses provided to patients' relatives and friends. Although the amount of information nurses provided to patients was found to be a significant predictor of patients' experiences, the provided information was perceived by the majority of the patients as inadequate. Identifying factors that enhance patients' experiences of nursing care is crucial as it assists nurses to provide better care.     

Orthopaedic patients' experience of motor vehicle accident in Singapore

Aim:  The purpose of this paper is to present a study that explored the experiences of orthopaedic patients injured in motor vehicle accidents (MVAs), from the time of the accident until 6 months after being discharged from hospital.
Background:  Trauma injuries from MVAs are increasing, with the number of deaths from such injuries continuing to rise. Victims often sustain open fractures to more than one part of their body and need rehabilitation and support to adjust to long-term chronic or permanent disability. In the last decade, research pertaining to trauma nursing has concentrated on neurologically injured patients. Although there is a paucity of research on the nursing perspective of psychological care for non-neurologically injured patients, the majority of studies located were mainly quantitative in nature and did not analyse the personal experiences of orthopaedic patients.
Method:  A qualitative naturalistic inquiry approach was used, which provided a first-hand account of the traumatic MVA event experienced by six orthopaedic participants in Singapore. Data were collected from face-to-face in-depth interviews. Participants were voluntarily recruited through purposeful sampling and 'snowballing'. Interviews were audiotaped and transcribed verbatim in preparation for analysis.
Findings:  The analysis of information explicated four main themes: the experience of the event, the effect of hospitalization, surviving the event and self-transformation.
Conclusion:  The study provided an understanding of orthopaedic patients' experience of MVA in Singapore. The findings of the study have the potential to contribute to the limited qualitative research available concerning victims' experiences of MVAs and nurses caring for MVA victims.     

北京市三级甲等医院住院病人对护理服务的满意度现状调查

目的调查北京三甲医院住院病人对护理服务满意度现状。方法采用多阶段抽样的方法选取北京市4家三级甲等医院即将出院的病人1520例,采用纽卡斯尔病人对护理服务满意度量表（NSNS）调查对护理服务满意度。结果调查的病人对护理服务整体评价中满意的比例占82．9％,NSNS平均得分为（79．25±15．48）分。满意度最高的条目是护士保护病人隐私的程度占91％,最低的是护士提供有关疾病和治疗的信息量占68．4％。结论护理服务的细节方面仍存在较多不足之处。根据满意度调查结果狠抓服务细节的管理,是实现全面质量改进,提高病人满意度的根本措施。     

Can a focused staff training programme improve the ward atmosphere and patient satisfaction in a forensic psychiatric hospital? A pilot study

Objective:  The main aim of the study was to describe whether staff training and lectures on milieu therapy to nursing staff can change the treatment environment, as perceived by the patients, in a desirable direction. The study was approved by the Regional Ethics Committee for Medical Research.
Method:  To measure the patients' perceptions of the treatment environment we used the Ward Atmosphere Scale (WAS). The ward atmosphere was evaluated three times during a 12-month period. Additionally, the patients completed five questions concerning satisfaction with the treatment environment. Between the first and the second ward evaluation the nursing staff was given 3 weeks of lectures on different aspects of milieu therapy. The nursing staff completed the WAS and three satisfaction items.
Results:  The study revealed a change in desired direction after education in five of the six key subscales of the WAS (Involvement, Support, Practical orientation, Angry and aggressive behaviour and Order and organization). Staff control was the only subscale with no changes. The patients also reported an increase in satisfaction. The study revealed no major changes in the staff scores. The present study included only a small number of patients and examined the changes in only one psychiatric department; hence it could be argued that the results cannot be generalized to equivalent populations within the forensic services.
Conclusions:  The study indicated that it is possible to improve the ward atmosphere in a desirable direction by a 3-week training programme for nursing staff about important aspects of milieu therapy.     

Nursing needs of acutely ill older people

BACKGROUND: Investigating older acutely ill hospitalized patients' nursing needs and quality of care is paramount, given the growing pressure on nurses to provide increasingly intensive levels of care to a growing older population while at the same time working with reduced staffing levels. AIMS: The aims of this study were to determine: (1) important aspects of nursing care as perceived by older patients, their family member/carer who observed care during hospitalization, and nurses; (2) satisfaction levels of patients, family/carers and nurses on nursing care received; and (3) mismatches between nursing care priorities and satisfaction with nursing care. METHODS: Two hundred and thirty-two acutely ill patients aged over 65 years, 99 carers/family members and 90 nurses completed the Caregiving Activities Survey, which measures importance of and satisfaction with various aspects of nursing care. Qualitative data, which qualified responses to survey items, were also obtained from participants. RESULTS: Patients, carers and nurses perceived that carrying out doctors' orders was the most important aspect of nursing care, followed by physical care, psychosocial care and discharge planning. Nurses and carers rated physical care, psychosocial care and discharge planning more highly than patients. Physical care was rated highly by patients in terms of importance, but rated moderately in terms of satisfaction. Carers' and patients' ratings of satisfaction with physical care were lower than nurses' ratings of opportunities to provide it. The importance of discharge planning was rated highly by nurses but all groups were only moderately satisfied with this aspect of care. STUDY LIMITATIONS: The findings do not apply to acutely ill older patients with confusion, mental illness or more than early stage dementia. CONCLUSIONS: Patients, nurses and family/carers were generally in agreement about the relative importance of particular aspects of nursing care. Nurses may need to communicate more effectively with older patients and their family carers about the particular roles they will play during the patient's hospital episode, the expectations they have of patients in the process of healing and recovery, and the reasons for the actions they take in aiding this process. The findings are useful in making nurses more aware of the expectations and needs of older hospital patients and their carers. They provide evidence for developing both new models of nursing care for this patient group, and nursing education programmes.