A comparison between patients' experiences of how their caring needs have been met and the nurses' patient classification--an explorative study

AIM: To examine whether patient classification carried out in accordance with the Oulu Patient Classification (OPC) method can measure the patient's caring needs in a reliable manner as seen from the patient's perspective. BACKGROUND: On the basis of earlier research it can be established that there are differences between nurses' and patients' assessments of patients' caring needs. Research on patients' assessments of perceived caring needs and the care they receive in connection with patient classification does not seem to have interested researchers in caring science. METHODS: The reliability from the patient's perspective is gauged by comparing the patient's perceived caring needs with the nurse's patient classification during a 24-h bed-day. Data was collected during a semi-structured interview with a total of 73 patients. Documentary analysis was carried out on the basis of patient classifications by 30 ward nurses. FINDINGS: On the basis of the degree of correspondence between nursing care intensity experienced by the patients and the nurses' patient classification it was decided whether the patients' caring needs had been met. The results indicate, however, that patient classification as a gauging method has a built-in reductive function regarding the patient's need for care and nursing care intensity. CONCLUSIONS: Nevertheless the OPC offers possibilities from a patient perspective of providing an overall picture of the patient's nursing care intensity and can therefore serve as a reliable basis for decisions concerning staff planning.     

ICU护士对患者家属需求的认知及相关因素调查

目的 调查ICU护士对家属需求的认知程度及相关因素,以便对护理人员进行有针对性的培养,从而提高ICU的护理质量.方法 采用方便抽样的方法对上海市2所三级甲等医院中的60名ICU护士进行问卷调查.结果 ICU护士对家属需求的认知程度最高的3项为:在第一次进入ICU时,能向家属主动介绍ICU的规章制度,能保证给患者最好的照顾,能用通俗易懂的话向家属解释有关患者的病情;在对探视需求的认识上比较不同学历和不同工作年限的护士均有统计学意义(P<0.05),其中本科及本科在读学历和4年以上的认识程度最高;在对于患者病情信息的需求的认识上不同学历和不同工作年限均有差异,本科及本科在读学历和4年以上的认识程度最高(P<0.05);在对于患者家属对ICU条件与环境需求认识程度上仅不同工作年限有统计学意义4年以上的认识程度最高(P<0.05).结论 提高了对不同年龄段及学历层次的ICU护士的针对性培养、完善相关的配套服务措施.     

Contract systems and grading policies.

The contract system can be a motivating factor to student learning. Caution is necessary to ensure the students who are graduating from the program have the knowledge base to pass the SBTPE. The faculty of one program believe their contract system which has evolved from five years of experience meets these criteria. Furthermore, patient care ultimately benefits. The nursing student exposed to an educational system in which his individual worth is recognized and learning needs met can respect the patient's rights and his individual health needs.     

Unmet nursing care needs of home-based disabled patients

BACKGROUND: In Taiwan, family members care for 80-90% of disabled people, but most have no professional training or knowledge of care for the disabled. Therefore, the adequacy of care received by the disabled needs to be assessed. AIMS: To evaluate the unmet nursing care needs of physically disabled patients and determine the relevant factors. METHODS: All 322 subjects were over 18 years of age, had a Barthel Index of less than 80 and became disabled 2 years prior to the commencement of this study. All subjects were outpatients of hospitals in central Taiwan and were contacted by phone to schedule an interview. Based on activity of daily living (ADL) scores, patients were divided into three groups: complete dependency, severe dependency and moderate dependency. After training, nurses evaluated the patients' ADL and completed the 20-item Assessment of Nursing Activity (ANA) questionnaire. Based on the ANA, subjects' unmet needs and caregivers' knowledge requirements were assessed. FINDINGS: The results showed the mean number of unmet needs was approximately five. Percentage of unmet needs was 44.8%. For complete dependency patients, the unmet needs score of patients and the needs score of caregiver's knowledge was highest, followed by the severe dependency group, and the moderate dependency group. Based on multiple linear regression, the factors that affected unmet need were as follows: age of patient, ADL score, education level of the caregivers, average daily duration of care and need of caregiving knowledge. Our findings indicate that the provision of counseling and educational support for family caregivers is required to promote quality of care for the disabled.     

Swedish forensic nursing care: nurses' professional contributions and educational needs

Nurses (registered nurses, RN, and licensed mental nurses, LMN) working in five Swedish forensic psychiatric units filled in a questionnaire designed for general psychiatric nursing, but modified for forensic use. In this report, data regarding how nursing care could contribute to improved care and the organizational changes needed and what knowledge the nurses need, in order to be able to meet the demands in the future, were analysed by means of content analysis. The salient findings were: (i) an interpersonal patient-nurse relationship based on trust, empathy, respect and responsibility for the patients' personal resources and knowledge seems to be the essence of nursing care and a way to improve care; and (ii) the nurses' educational needs emanate from different treatment modalities, how to perform different treatments, how to establish developing relationships and in-service training adapted to the ward-specific problems.     

Undertaking the role of patient advocate: a longitudinal study of nursing students

Patient advocacy has been claimed as a new role for professional nurses and many codes of ethics for nurses state that they act as patient advocates. Nursing education is faced with the challenge of preparing nurses for this role. In this article we describe the results of a study that considered the tendencies of a cohort of nursing students at the Kocaeli University School of Nursing to act as advocates and to respect patients' rights, and how their capacities to do so changed (or not) as a result of their nursing education. This longitudinal study used a questionnaire consisting of 10 statements relating to patient care. It was performed both at the start (1998) and at the end (2002) of the nursing training. At the beginning of their course 77 students participated; in the study. After four years, only 55 students participated, the reason for this drop in number being unknown. The questions asked nurses if patients should have: the right to receive health care; the right to participate in the decision-making process about their treatment; the right always to be told the truth; and the right to have access to their own medical records. They were also asked: if quality of life should be a criterion for discontinuing treatment; if patients have the right to die and the right to refuse treatment; if patients should be assisted to die or helped to undergo active euthanasia; and if severely disabled newborn babies should be allowed to die. The student nurses demonstrated considerable insight into contemporary nursing issues and were ready to act as patient advocates. Professional responsibility demands that good nurses advocate strongly for patients' choices.     

Nursing documentation in nursing homes--state-of-the-art and implications for quality improvement

This study was designed to gain information on the quality of nursing care based on the comments in nursing records. The specific aims of the study were to find out if the patients' (i) individual needs are assessed, the goals for nursing care are set, and the nursing interventions are determined; (ii) if the patients' needs are met and (iii) if goal achievement is regularly evaluated by including comments in nursing documents. In addition, the study aimed to describe the up-to-dateness of nursing care plans as well as the frequency of making daily notes. The data were collected on 36 wards of four residential homes. A 30% sample of the nursing documents on each ward was collected (n=332) using the Senior Monitor instrument. The documents studied were mainly nursing care plans and daily note sheets. Seventy-three per cent of the nursing home residents had an up-to-date nursing care plan at the time of data collection. The main results demonstrated that a written statement on the patient's mental ability was lacking in every fourth document although 75% of the patients suffer from at least moderate dementia in Finnish long-term care institutions. Development activities should also be targeted to the documentation of clear and concrete means by which patients' independent functioning is supported. In addition, evaluation was the area that warranted attention and development activities since only every fourth record included information on changes in the patients' functional capability. Although a lot of in-service training has been focused on improving the documentation practices, there is still a need for development. The means by which knowledge is transferred to guide the practice should be carefully considered. Also forms should be developed to meet the special requirements for recording nursing care in long-term care settings.     

The end-of-life nursing education consortium (ELNEC) experience

The End-of-Life Nursing Education Consortium (ELNEC) is a train-the-trainer educational program to help nursing faculty integrate care of the dying patient and the patient's family in the nursing curriculum. The authors describe the ELNEC experience, which prepares nurse educators to competently teach end-of-life care, and provides them with the necessary knowledge, skills, and resources to effectively integrate end-of-life content into existing nursing curricula.     

The nursing process according to Orem. A concrete very simple example explains how to follow this nursing process]

The author shows how Orem's theory, based on self care, can be applied to the nursing care of a patient with severe cardiac illness. To do so, she explains in detail what is looked for in the patient's history to delineate problems, and then uses a systematic care plan approach to solve them. In the patient's history, the nurse looks for information on each need, and on the specific factors in the patient's life and health history that will have an impact on the patient's capacity to meet Orem's goal of self care. Inabilities are labelled self care deficits. When the self-care deficit is well understood, it is important then to determine the source of the patient's difficulty. Orem states that there are two main phases to self-care: the decision and the action. The author illustrates this through a discussion of the patient's difficulty to stop smoking. She then explains a particular method to write a nursing diagnosis that directs the nurse to work, not on the deficit itself, i.e. in this case smoking, but rather on the patient's lack of knowledge. The "SMART" approach to writing nursing care objectives (specific to the patient and the current situation, measurable, attainable by the client in a reasonable period of time, realistic for the current situation, and truthful or having clear significance for the patient at the moment) is detailed along with interventions that respect Orem's concept of nurse-patient contracts. The nursing process based on Orem's conceptual framework is not difficult to manage.(ABSTRACT TRUNCATED AT 250 WORDS)     

A study to evaluate the pain knowledge of two sub-populations of final year nursing students: Australia and Philippines

BACKGROUND: Pain management is an essential and important aspect of nursing care. Deficits in pain knowledge and attitudes continue to be reported despite a growth of educational programmes. A lack of basic knowledge of pain at an undergraduate level may limit nurses from effectively developing their knowledge after graduation. AIM OF THE STUDY: To assess the type and level of knowledge of basic aspects of pain mechanisms and treatment principles in complete classes of final year nurses, at three nursing schools. METHOD: Data were collected in 1999, from 150 students (81 Australian and 69 Philippine) via a 23-item pain knowledge test questionnaire, previously used to assess undergraduate health professionals including nurses. RESULTS: The mean score of concordant answers for all students was 38.6%, scores ranged from 0% to 70%, 95% Confidence Interval of the mean was 36-41%. There were few significant differences between the groups for individual questions and no significant difference in overall mean scores. Common questions answered poorly included those related to complex regional pain syndrome, pharmacology and central sensitization. Most students perceived their undergraduate pain education to be minimal. Thirty-six per cent of Australian students compared with 50% Filipino students perceived their pain knowledge was adequate for their clinical needs. Additionally, most students believed that graduating doctors should be able to answer the test questions correctly. CONCLUSION: The results demonstrate consistently low levels of knowledge and also knowledge gaps about basic pain mechanisms, terms and treatment amongst these three final year nursing classes. Such information is useful to define levels of basic knowledge about this topic, and can be explored further as to whether some or all of these facts are deemed necessary for inclusion in nursing curriculum by reference to documents such as the International Association for the Study of Pain curriculum.     

Evaluation of the case method in nursing education

The case based learning (CBL) is a problem-based learning which engaging students and presenting them with learning-related and cognitive challenges. The purpose of the study was to elucidate nursing students experiences of the CBL as an educational tool in order to find out if it supports their learning. Qualitative content analysis was used and performed on the statements from nursing students' course evaluations. Students perceived the CBL as an approach combining theory with practice which provides an overview of upcoming profession. Students gain adequate knowledge about patient care in reality and thereby enabling them to obtain a holistic understanding of patients health problems. Reflections related to case seminars widen students perspectives, improve their capacity for cooperation and help them to achieve long-lasting knowledge. This learning method offers nursing students an opportunity to enhance their judgement and critical thinking skills by applying theory in practice. Students gain adequate knowledge about patient care which may benefit patient care due to students acting professionally in their future role.     

Retention of nursing students with English as a second language

The purposes of this study were to: (a) determine nursing students' perceptions of the learning activities which contribute the most to their knowledge and skills; (b) determine students' perceptions of their learning difficulties; (c) compare the perception of English as a second language (ESL) and non-ESL students; (d) determine nursing faculty perceptions of ESL students' learning difficulties; (e) compare the perception of ESL students and faculty; and (f) indentify needs for educational and/or supportive programmes for faculty and students. Differences in perceptions of faculty and students regarding areas of difficulty and studetnts' needs may influence the services provided to students and therefore contribute to their lack of success and attrition.
A questionnaire was given to students in the first and second years of the University of British Columbia (UBC)/Vancouver Hospital (VH) Nursing Programme to collect data regarding their high school and post-secondary education, date of arrival in Canada, first language, and their perceptions of helpfulness and difficulty of learning activities. A similar questionnaire was given to faculty members working with these students to collect data about their perceptions of areas of difficulty and activities that contribute the most to the learning of ESL students. Data analysis consisted of t -test for statistical comparison of the responses of ESL and non-ESL students, and ESL students and faculty. The results indicated statistically significant differences between the perceptions of faculty and ESL students, particularly in the areas of difficulty. The need for educational programmes for both faculty and students was identified.     

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.     

肿瘤科实习护生死亡教育需求的质性研究

目的：明确在肿瘤科实习的护生对死亡教育的需求,为对其开展死亡教育提供理论依据。方法：采用目的性抽样法,选取17名实习护生进行一对一深度访谈,采用主题分析法分析资料、提炼主题。结果：提炼出3个主题：死亡教育知识的需求、死亡教育技能的多样化需求、提升自我关怀能力的需求。实习护生自述他们接受的死亡教育内容不全面,未充分掌握死亡相关理论知识和技能,无法满足其临床实践需求,不能有效应对患者死亡,且经历患者死亡后表现的自我照护能力较差。结论：建议医学院校为实习护生提供系统、全面的死亡教育相关课程;建议临床带教老师为实习护生适当提供临终护理实践机会,同时关注实习护生经历患者死亡后的自我关怀能力,帮助其树立科学的死亡观,提高其自我关怀能力,满足实习护生的死亡教育需求。     

马斯洛需要层次论在骨科截肢术护理中的应用

目的 探讨马斯洛需要层次论在骨科截肢患者护理中的应用效果.方法 选取98例截肢患者随机分为研究组与对照组,每组各49例.研究组参照马斯洛需要层次论施行整体护理;对照组采用常规护理.采用抑郁自评量表(SDS)及焦虑自评量表(SAS)、相关知识掌握情况表、患者对护理工作的满意度表,评价两组患者抑郁、焦虑发生率情况和基本知识掌握情况及患者的满意度.结果 研究组患者的焦虑、抑郁发生率明显低于对照组(P＜0.05),研究组患者对护理工作的满意度和知识掌握程度明显高于对照组(P＜0.05).结论 应用马斯洛需要层次论对截肢患者施行整体护理,收到满意效果,有利于患者的心理调适、满足了患者的知情权、从而提高了护理质量.