Nursing care protocol to the patient before and after bariatric surgery

This is a methodological study of innovative technology developed which aims to build up nursing care protocol to the patient in the pre and postoperative bariatric surgery. The proposed model of care was based on the General Theory Orem Self-Care and organized from the requirements of self-care (universal, developmental and health deviation). Within each requirement, it is presented nursing diagnoses, expected outcomes and nursing interventions that were identified in a survey conducted with 31 clients suffering from morbid obesity, assisted by the Gastroenterology Outpatient Clinic of a university hospital in the period from April to June 2009. The development of the protocol is considered an important resource both to organize the guidelines provided by nurses to the bariatric patient, aiming their self-care, and to provide subsidies to systematize nursing care to be provided.     

The struggle to improve patient care in the face of professional boundaries

Professional boundaries make inter-professional communication, collaboration and teamwork more challenging and can jeopardise the provision of safe, high quality patient care. This in-depth interview study conducted in three UK acute hospital organisations in 2003-2004 explored how professional boundaries affected efforts to improve routine practice by acute pain services (small specialist teams set up to drive improvements in postoperative pain management through education, training, standard-setting and audit). The study found that many anaesthetists and to a lesser extent nursing staff saw postoperative pain management as a new and unjustified addition to their professional role. Professional identities and strong fears about the risks of treatments meant that health professionals resisted attempts by the acute pain services to standardise practice and to change medical and nursing roles in relation to postoperative pain management. Efforts by the acute pain services to improve practice were further hindered by inter-professional boundaries (between the medical and nursing professions) and by intra-professional boundaries (within the medical and nursing professions). The inter-professional boundaries led to the acute pain services devoting a substantial part of their time to performing a 'go-between' function between nurses and doctors. The intra-professional boundaries hindered collaborative working among doctors and limited the influence that the acute pain service nurses could have on improving the practice of other nurses. Further work is needed to address the underlying fears that can lead to resistance around role changes and to develop effective strategies to minimise the impact of professional boundaries on patient care.     

Concern about AIDS among hospital physicians, nurses and social workers

In this study, the authors examine the worry and discomfort experienced by direct care health professionals in treating AIDS patients and how their profession, attitudes, knowledge, experience and demographic characteristics influence their emotional reaction to those patients. The research focuses on experienced emotion as distinct from expressed emotion, as an important factor in explaining health behaviors among professionals. To address these issues 536 health care professionals comprising 132 physicians, 378 nurses and 26 social workers employed at a University teaching hospital in Chicago were surveyed. The findings suggest that health care workers' emotional reactions to HIV depend on the type of patient interaction. We found for all three professions, as the invasiveness of contact increased, the level of worry and amount of discomfort also increased. Nurses however, on the whole were the most adversely affected by their patient contacts. We conclude that emotional reactions in the workplace cannot be explained by cognitions, beliefs and attitudes alone. This study suggests that work roles, work assignments, and professional authority contribute to emotional reactions to patients with AIDS.     

A taxonomy of nursing care organization models in hospitals

ABSTRACT: BACKGROUND: Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. METHODS: This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units' profile data. RESULTS: The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses' professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses' perceptions that the practice environment is less supportive of their professional work. CONCLUSIONS: This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an ideal|| nursing professional practice model described by some leaders in the contemporary nursing literature. While the two professional models appear closer to this ideal, the two functional models are farther removed.     

What knowledge-accessing modes tell administrators about interdisciplinary crises and conflicts.

In hospitals administrators work with two major groups of medical professionals: physicians and nurses. Together, these three groups of professionals are primarily responsible for the care of patients. The quality of the service they provide is dependent on the working relationships among these disciplines. Potentially, the more harmony among administrators, physicians, and nurses, the better care patients can receive. The research reported in this article addresses the issue of interdisciplinary misunderstanding among these groups of professionals. The research was premised on the assumption that hospital administrators, physicians, and nurses differ in the way they access knowledge. That is, administrators, physicians, and nurses access knowledge in dissimilar ways and, by doing so, set the stage for crises and conflicts. Using a standardized instrument to assess knowledge-accessing modes, data were collected from samples of health administration, medical, and nursing students. The data indicated that the three groups did differ in the way they accessed knowledge. The individual discipline profiles generated from the data also revealed a finding common to the three disciplines, a finding may help resolve a very real problem for hospital patients. Based on the research results, the article discusses ways that administrators may be able to prevent crises and conflicts and enhance harmonious relations among the three disciplines, and thereby improve patient care. Avenues for further research are also suggested.     

Professional competence and contraceptive care

OBJECTIVE: To evaluate the technical competence of professionals carrying out activities related to contraceptive care. METHODS: Evaluative research in the field of health was conducted in eight districts of the State of Ceara from July to September 2003. Data was collected by means of interviews with 29 nurses working in the Family Health Care Program within these districts and 50 people being attended by this program. Observations of the Family Health Care Units were a complementary source of data within this study. RESULTS: The majority of nurses had received some form of training regarding contraception and the technical norms regulating their use. However, professional barriers were reported by the nurses and others were identified by lay persons being attended by the program, that indicate the need to provide better training for professionals engaged in this area of care. The nurses recognized they had deficits in information and communication skills as well as technical deficits in dealing with contraception. CONCLUSIONS: There are gaps in professional competence with regard to contraceptive care that, when associated to the lack of systematization of team work, generates distortions in the quality of care. Team work was characterized by the lack of definition of team members' specific attributions and tasks.     

The nurse interacting and relating: the context of nursing care in a semi-intensive unit

This study aimed to understand the meaning of nursing care to nurses in the hospital. This is a qualitative research, based on theoretical and methodological assumptions of symbolic interaction. It was performed in a semi-intensive unit of a tertiary public hospital in Fortaleza-CE, Brazil. Eleven nurses participated on it. For data collection, it was used semi-structured interviews and field observation simple and, in data processing it was performed thematic category. The ethical aspects have been respected. It was observed that the nursing care means the establishment of the nurse's interpersonal relationships with other health professionals, patients and their accompanying persons. It was understood that, for nurses of the hospital, nursing care means social interaction with people.     

Nurses' professionalism in Canada: a labor process analysis.

This article draws on a body of research conducted by the author over the past ten years on the social organization of nursing work. It explores questions surrounding nurses' contemporary labor process control and its meaning for nurses' professionalization and proletarianization. Both are dynamic processes, changing as public administration of the Canadian health care system changes and as nurses are successful in winning more complete self-regulation. Nurses are currently being articulated more and more securely to dominant ideas of public sector management through textually mediated technologies. Nurses find new upwardly mobile careers and challenging, responsible, and more respected work. However, as the generation of objective information for professional accountability, cost-accounting, and managerial decision-making becomes unified in computerized patient information systems, producing and using such information becomes a central and determining core of everyday nursing work. It organizes nurses into a "managed" practice of patient care, contradictory for them in many ways. Outstanding among these contradictions is a new professionalized standpoint of cost-efficiency that subordinates nurses' traditional interests and grounding of their work in the standpoint of care.     

The health and wellbeing of mental health professionals

We examine dimensions of job satisfaction, occupational burnout and general health of a sample of 123 mental health care professionals (psychiatric nurses and nursing assistants, and smaller professional groups such as social workers, occupational and recreational therapists and psychologists) employed at a large Canadian psychiatric hospital. Psychiatric nursing assistants exhibit more of the consequences of job-related stress (less job satisfaction, greater occupational burnout, greater incidence of negative physical and psychological symptoms of stress) relative to the other professional groups in the sample. This may be linked with their position within the hospital organization (having less authority and professional autonomy relative to the other groups), affecting their ability to cope with job-related problems and stresses experienced by all direct care workers. We examine attitudes of mental health professionals towards organized support groups at the hospital, which could provide one forum for the open discussion (and potential resolution) of job-related stresses and problems experienced in hospital settings.     

Nurses' perceptions of inter- and intra-professional relationships: an analysis of support from nursing and physician colleagues in rural hospitals.

Nurses employed in ten rural hospitals in Canada completed questionnaires designed to examine their perceptions of the strength of the professional relationship which existed among nurses and between nurses and physicians. Four questions addressed the availability of nursing education programs and the attendance of nurses and physicians at such programs. Seven questions examined the nurses' perception of physician interest in nursing education and the encouragement received from their nursing colleagues to participate in learning activities and medical management decision making. Chi square analysis was undertaken to determine whether the colleagial relationships differed by hospital or medical staff characteristics. Forty percent of the nurses felt that the majority of of physicians were supportive of continuing nursing education. Sixty-three percent indicated their nursing colleagues encouraged them to attend educational programs. The results indicate that physician participation in nursing continuing education was greatest in communities with the fewest health resources (an acute hospital with fewer than 50 beds). In contrast, encouragement to participate in continuing nursing education was highest in settings where the hospital provided both acute and extended care services, had more patient admissions and a greater availability of educational programming.     

Emergency unit nurse of private hospitals: several considerations

The qualifications of the professionals who work in emergency care units in Brazil became a relevant aspect since the 80s; therefore, the scarcity of nursing studies in the national literature on this theme determines the need of further investigations. This study aimed at presenting the activities performed by the emergency care unit nurse of a private hospital and making considerations on the leadership as a strategy to improve the management of the nursing care delivered to the patient/client. In view of the experienced reality, authors pointed out the importance of these professionals to rethink about their professional practice and of leadership as a way to implement the required changes.     

Why Bangladeshi nurses avoid 'nursing': social and structural factors on hospital wards in Bangladesh

In response to concerns that nurses spend less than 6% of their time on direct patient care, this study explored factors that influence nurses' behaviour in the provision of 'hands on' care in hospitals in Bangladesh. Through in-depth interviews with female nurses and patients and their co-workers in six hospitals, we identified conflicts between the inherited British model of nursing and Bangladeshi societal norms. This was most evident in the areas of night duty, contact with strangers, and involvement in 'dirty' work. The public was said to associate nursing activities with commercial sex work. As a consequence, their value on the 'bride market' decreases. To minimise the stigma associated with their profession, nurses in government hospitals distance themselves from patients, using nurse surrogates in the form of patients' relatives and hospital support workers to carry out their work. These adaptations are supported and sustained through unofficial activities developed over time within hospitals. In contrast nurses in NGO hospitals give more direct patient care themselves and do not rely on carers as much because of tight supervision and limited visitor hours. Initiatives undertaken to improve the quality of patient care, such as enlarging the nursing workforce or providing clinical instruction, which do not take into account the prevailing culture in hospitals and social conflicts faced by nurses, are unlikely to succeed. Fundamental decisions on how to care for the sick in Bangladesh are required. If the present nursing curriculum is followed, adequate supplies, supervision and accountability are prerequisites for its implementation.     

Nursing in the hospital accreditation process: practice and implications in the work quotidian

The aim of this study was to investigate the role and influence of nursing in the hospital accreditation process. It is a qualitative study, conducted in a private hospital of Belo Horizonte. The study subjects were nine nurses and 15 nursing technicians. Data collection was through semi-structured interviews, which were subjected to content analysis. The results showed that the role of the nursing team in the accreditation involves care, administrative, educational and research issues. The study subjects presented different perceptions regarding the influence of the accreditation process in their work. The positive aspects of personal growth and valorization of the curriculum were highlighted as well as negative aspects such as stress and little professional valorization. Therefore, it is necessary that the professionals understand the logic of the process and act with a view to the interdisciplinarity and overcoming the fragmentation of care, thus achieving integral healthcare and the quality of care desired.     

The Brazilian Universal Health System and the delivery of nursing care in a Brazilian hospital]

There are few studies on the delivery of nursing services in hospitals participating in the Brazilian universal public health system (Sistema Unico de Saúde), which was put in place in 1988. This study, which examined possible changes in the delivery of these services since universal health care was implemented, was based on interviews carried out between July and September 1995 with 31 nurses working at a teaching hospital in the city of Ribeir?o Preto, in the state of S?o Paulo. The nurses had begun working at the hospital between May 1980 and May 1987. Thematic analysis was used to assess their answers. According to the nurses, patients treated after the universal system was implemented have had more complex medical needs and a higher socioeconomic status. In addition, nurses reported an increase in the complexity of patient demands and in the variety of medical specialties offered by the hospital, as well as a decrease in the length of inpatient stays. Forty-six percent of the interviewees reported a change in the work done by nursing staff (for example, nurses have less time available for each patient). Not all of the problems the nurses mentioned are related to the public health system (understaffing is one example). It is essential that nurses examine national health policy and that they engage in the (re)construction of the practice of health care delivery. Nurses ought to understand the reality of their institutions and carry out a management process geared towards the expectations of patients and of health care workers.     

Health staff perception regarding quality of delivered information to inpatients.

BACKGROUND: Accreditation usually requires that healthcare staff assess the quality of care delivered to patients in their own hospitals. It is unknown whether this assessment depends on the workplace rather than on the professional category of health personnel. OBJECTIVE: We aimed to identify major determinants of the perception of various categories of healthcare professionals concerning the quality of delivered information to inpatients in their ward, with a perspective to help the development of recommendations on how to compose self-assessment teams for the accreditation process. METHOD: A self-administered questionnaire survey was conducted in nine wards from five short-stay hospitals in Paris, France. Three hundred and fifteen healthcare professionals (physicians, nurses and nursing assistants) were included. The views of various categories of healthcare professionals regarding the compliance with a set of quality standards were compared by nonparametric statistical analyses. Determinants of the self-assessment of quality of care, including ward effect, were identified by fitting the data to a hierarchical model. RESULTS: The participation rate was 86%, with 272 respondents (58 physicians, 149 nurses and 65 nursing assistants). Overall perceptions of various categories of healthcare professionals were not different. The final hierarchical model showed a strong ward effect (intracluster correlation coefficient=0.06, P<0.01) and a significant relationship between age of professionals and their opinion about quality of care. CONCLUSION: We observed a ward cluster effect on healthcare staff perception of quality, but the category of healthcare professional was not a determinant. A satisfactory representativeness on age of professionals selected into the teams in charge of self-assessment during hospital accreditation is recommended.     

A randomized intervention to improve heart failure outcomes in community-based home health care

This study examines the effects of a home health intervention designed to standardize nursing care, strengthen nurses' support for patient self-management and yield better CHF patient outcomes. Participants were 371 Medicare CHF patients served by 205 nurses randomized to intervention and control groups in a large urban home healthcare agency (HHA). The intervention consisted of an evidence-based nursing protocol, patient self-care guide, and training to improve nurses'teaching and support skills. Outcome measures included home care,physician and emergency department (ED) use, hospital admission, condition-specific quality of life (QoL), satisfaction with home care services and survival at 90 days. The intervention was associated with a marginally significant reduction in the volume of skilled nursing visits (p = .074), and a reduction variation in the typical number of visits provided (p < .05), without a significant increase in physician or ED use or patient mortality. Hypothesized improvement in other outcomes did not occur.     

Creating the future. Nurses can shape their profession by getting involved in healthcare reform

To remain relevant in a reformed healthcare system, nurses will have to redefine and remake themselves. Three aspects of the new healthcare age--megahospitals, managed care, and redefined professional roles--will have a significant impact on healthcare professions, including nursing. Across the United States hospitals are merging to form sophisticated networks that provide a continuum of care. Under this delivery model, nurses will play a variety of new roles and work collaboratively with the entire spectrum of health social service professionals. A related development--the growth of managed care--is an increasingly attractive option among large employers. It will also accelerate changes in the way healthcare professionals work. Managed care will force physicians to enter into appropriate group affiliations and hospitals to reconfigure themselves to meet the needs of a dynamic system that no longer requires yesterday's beds or management structures. The future will force healthcare professionals to go through regular, radical changes in their job requirements. But it will also allow nurses and others to emerge from their task-oriented past and take on work that requires them to think, judge, and intervene.     

Coordinated hospital-home care for kidney patients on hemodialysis from the perspective of nursing personnel

OBJECTIVE:

To examine, from the nursing perspective, the needs and challenges of coordinated hospital-home care for renal patients on hemodialysis.

METHODS:

A qualitative analysis was conducted with an ethnographic approach in a hemodialysis unit in San Luis Potosi, Mexico. Semistructured interviews were conducted with nine nurses, selected by purposeful sampling. Structured content analysis was used.

RESULTS:

Nurses recounted the needs and challenges involved in caring for renal patients. They also identified barriers that limit coordinated patient care in the hospital and the home, mainly the work overload at the hemodialysis unit and the lack of a systematic strategy for education and lifelong guidance to patients, their families and caregivers.

CONCLUSIONS:

This study shows the importance and necessity of establishing a strategy that goes beyond conventional guidance provided to caregivers of renal patients, integrating them into the multidisciplinary group of health professionals that provide care for these patients in the hospital to establish coordinated hospital-home care that increases therapeutic adherence, treatment substitution effectiveness and patient quality of life.     

The relationship between general practitioners, hospital consultants and community nurses when caring for people in the last year of their lives.

The general practitioners, hospital consultants and community nurses who had cared for a random sample of people who died were asked about their relationships with the other professional groups and for their views and experiences of specialist domiciliary terminal care services. Many of the general practitioners and the nurses were critical of hospital communication over discharge. The most frequent criticism made by community nurses of general practitioners was that they did not ask for nursing help early enough for people who were dying. This may be because many general practitioners regarded the community nursing services as overstretched. General practitioners were rather less enthusiastic than the other two professional groups about specialist medical or nursing domiciliary terminal care services. They were, however, more convinced of the helpfulness of these services if they had some experience of them.