A collaborative approach to diabetes nephropathy prevention

Diabetic nephropathy is one of the major complications of diabetes and is the leading cause of end-stage renal disease (ESRD) (40 percent). Diabetes and its complications take a huge toll on the quality of life of those affected. There are substantial costs for both individuals and the health-care system and projections of the increasing incidence of diabetes over the next 12 years serve to increase the sense of urgency of efforts to prevent diabetes and its complications. For people who develop diabetic nephropathy, the kidneys gradually lose the ability to function properly. Treatment of ESRD by renal replacement therapy (RRT), e.g. dialysis, results in a decreased quality of life and is costly and time consuming. However, clinical practice guidelines (CPGs) identify and provide evidence for early management and treatment to prevent diabetic nephropathy as well as heart attacks, strokes and retinopathy.     

A collaborative occupational therapy and nursing approach to falls prevention in hospital inpatients

A retrospective audit of inpatient falls at the Gold Coast Hospital was conducted in August 1996. This collaborative approach of occupational therapy and nursing staff aimed to reduce the number of patients falling while they were hospital inpatients. From the first audit a number of high risk patient groups, activities and ward environments were identified and a falls prevention program implemented. A second audit conducted 2 years later demonstrated a decrease in falls and related injuries. This paper discusses the findings of the falls audit and presents the 'Fall STOP' falls prevention program that was initiated.     

A collaborative approach to managing student malingering

The authors present a case study of a successful collaborative effort to reduce student malingering in a school-based health center and to address the academic and social problems related to overuse of center services. School-based health centers have been identified as important sources of support for teenagers who have emotional and psychological problems, and, in this case, the overuse of a school-based health center is linked to such challenges for a substantial subset of students. It demonstrates that it is possible to identify, based on their status as frequent center users, students with potentially serious academic, family, or personal problems who are at risk for academic failure. The case involves multiple professionals, from a variety of disciplines, who dealt successfully with the problems associated with overuse of center services.     

A collaborative approach to nursing field placement

The numbers of nursing students undertaking pre-registration education in higher education courses in South Australia has expanded rapidly over the last four years. This paper describes collaboration between Schools of Nursing to coordinate student placements in clinical venues. A computerised system has been developed which is unique in Australia and its positive results are identified.     

A collaborative approach to reducing stress among staff

Stress has been identified as an important issue among residential carers looking after individuals with learning disabilities. This article describes the implementation of a stress-management programme on a residential site for people with learning disabilities, which significantly reduced levels of anxiety and burnout.     

A collaborative approach to urgent mental health referrals

The National Service Framework for Mental Health was launched in October 1999 and detailed the standards required for an effective and robust service (DoH 1999). Within North Solihull, a quick response initiative for urgent referrals to the mental health team has been in operation for the past five years. It is a nurse-led service that appears to meet some of the standards set, including collaboration with primary care and suicide prevention. This article identifies the benefits of a nurse-led service to combat the growing need for urgent assessment. It also discusses the need for specific mental health practitioner involvement at the point of referral. Particular reference is made to clients in crisis and with suicidal ideation. Important liaison at the interface between primary and secondary care is presented, for the benefit of this client group and effective alleviation of referrer anxiety.     

A collaborative care approach to complex diabetic foot ulceration

This article highlights the complex issues that surround the management of diabetic foot ulceration. It describes how the disciplines of podiatry and tissue viability came together to care for a patient who required complex wound management. The importance of collaborative working is highlighted, which has been shown to reduce amputation rates by 50% (Edmonds, 2002). Through exploration of a case study, certain issues emerged--wound infection, wound management, psychosocial factors and teamworking--and these are discussed. The link between diabetic foot ulceration and amputation is explored and the argument put forward that amputation should have been the first choice for this patient bearing in mind that 30% of amputees lose their second leg within 5 years (Geary, 2002).     

A collaborative approach to the implementation of clinical supervision

AIM: This paper discusses a collaborative approach to implementing clinical supervision, which was initiated between a primary care trust and a school of nursing and midwifery. BACKGROUND: To enable clinical supervision to proceed successfully and to be perceived as beneficial, this necessitates a collaborative partnership between clinicians, managers and educationalists. KEY ISSUES: The different stages of the initiative will be explored and the paper will consider examples of the collaborative processes involved. The evaluation of the project is examined and suggestions for the future continuation of the initiative are discussed. CONCLUSION: There is evidence that this has been a successful initiative and that a collaborative way of working can be beneficial when implementing clinical supervision.     

An evidence-based approach to fall risk assessment, prevention, and management: lessons learned

Nurses at an academic medical institution undertook a fall safety initiative. Using an evidence-based approach, they created a risk stratification tool, developed a comprehensive protocol, investigated fall-prevention products and technologies, and piloted the protocol and products/technologies before the full implementation. This article describes their journey and lessons learned along the way, the most compelling of which is the need for a simple, guided, and time-efficient approach to implementing the best practices into clinical care.     

A collaborative approach to developing nursing skills to meet service needs

Academics, educators and health service managers came together to explore, within their local area, the nature of the perceptions of beginning registered nurses (BRNs) and Nursing Unit Managers (NUMs) to the skills utilised by BRNs within the first six months of practice. A group of 71 BRNs and nine NUMs participated in a cross-sectional survey. BRNs were also asked to rate their preparedness in each particular skill, dependent on the method of teaching--theory/lectures, nursing laboratories and clinical experience. Some 21 skills, relating to medication/fluid administration and skin and wound care, were perceived by 95 per cent or more of the graduates as being used within the first six months. Similar perceptions existed for NUMs and BRNs for 52.4 per cent of the listed skills. Differences in perceptions have led to academics altering the scope of skills being taught and focusing assessment on critical skills for BRNs, and managers increasing awareness among NUMs as to the source of the differences and developing programs to improve clinical interpretation skills. Improvements in the experience of the BRN are likely to occur when all parties work together to bring about positive change. By Barbara Somerville,     

护理人员跌倒预防知识-态度-行为状况的调查研究

目的通过调查了解护理人员对住院老年患者跌倒预防相关知识、态度和行为的现况。方法采用方便抽样法,选择2011年1月-2012年4月于复旦大学附属华东医院工作的护士208名,用自行设计的跌倒预防知识、态度和行为评估问卷进行调查。结果护理人员对预防跌倒的知识平均分为（14．66±4．52）分;态度平均分为（30．24±3．97）分;行为平均分为（55．01±10。05）分。护理人员对跌倒预防的知识、态度和行为均与文化程度、职务、职称、年龄和培训经历有关,差异有统计学意义（P〈0．05）;护理人员对跌倒预防的知识与态度呈正相关（r=0．190,P〈0．05）;态度与行为呈正相关（r=0．380,P〈0．05）,知识与行为呈正相关（r=0．106,P〈0．05）。结论护理人员在跌倒预防的知识、态度和行为方面都有待提高;需加强对护理人员跌倒预防相关知识的培训,有助于提高护理质量,减少不良事件的发生。     

A fall prevention program for the home environment

Falls are the leading cause of injury, death, and disability among people older than 65. When elders fall, they sustain such injuries as hip, spine, hand, and/or pelvic fractures. The prognosis after such a fall is poor--only half of older adults hospitalized for hip fractures are able to return home or live independently again. Even without injury, falls cause a loss of confidence that results in reduced physical activity, increased dependency, and social withdrawal. As a home care agency dealing with a geriatric population, our goal was to develop a user-friendly fall prevention program that would promote multidisciplinary assessment and intervention. We have developed a preventive approach through which clinicians and patients can collaborate on preventing falls in the home and maintaining our patients' first priority: quality of life.     

A collaborative approach to integrating outpatient and inpatient transplantation services

This article describes one hospital's experience in using a collaborative approach to integrate outpatient and inpatient care services for the management of end-stage organ failure by the use of a dedicated transplantation ambulatory outpatient service. Fostering multidisciplinary collaboration requires effective communication, sharing of expertise, interdependence, teamwork, and mutual goals. These five elements of collaboration have been an effective strategy to integrate care across different practice settings while promoting continuity of patient care. Although each healthcare member works independently, it is through the combined efforts of all team members that anticipated outcomes can be achieved. Collaboration has been a process by which we have enhanced the ability of different professionals to work together in achieving patient, system, and institutional goals.