Analysis of nursing records of cardiac-surgery patients based on the nursing process and focusing on nursing outcomes

This study analyzed what nurses wrote in narrative nursing notes for cardiac-surgery patients. The nursing notes of 46 patients were analyzed based on the nursing process. Eight patterns were extracted according to different combinations of nursing process components, of which an assessment alone was the most frequent nursing phrase (45.8%), followed by assessment or diagnosis-intervention-outcome (25.9%). The content of the nursing notes was also classified into 15 categories, of which nursing outcomes were recorded more frequently in nursing care driven mainly by physician's order such as disease-related symptom management, insomnia care, respiratory care, and pain control, than in independent nursing care such as education and emotional care. A survey on the attitudes of nurses toward the nursing record revealed that they do not document nursing outcomes as much as they think they do. The main reasons for this discrepancy were insufficient time for recording and lack of knowledge about why, how, and what to evaluate. Even though there is room for improvement, nursing notes represent a useful resource for determining nursing contributions to patient outcomes.     

河南在校大学生对心理学认识的初步调查

目的了解在校大学生对心理学的认识现状,以便为心理学知识普及宣传及指导心理学工作者的工作提供依据,也为心理学的发展提供决策依据。方法采用不记名自填问卷方式,对河南在校大学生进行随机抽样调查。结果对河南在校大学生来说,很多人对心理学都非常感兴趣,他们渴望接触心理学,了解心理学的知识,但有不少人在对心理学的认识还存在不少误区,甚至有20%的人对心理学还存在很大的偏见。结论虽然近几年心理学在中国发展较快,但其社会影响力还远远不够,在大学生中加强心理学知识宣传势在必行。     

The moderating effects of demographic and individual characteristics on nurses' acceptance of information systems: A canadian study

ObjectivesThe purpose of this study was to educate on the moderating effects of demographic (i.e., educational level and age) and individual characteristics (i.e., years of nursing experience and computer knowledge) on nurses’ acceptance of information systems (IS). The technology acceptance model (TAM) with its constituent variables such as perceived usefulness (PUSS) and perceived ease of use (PEOU) was the theoretical framework used for this study.MethodsA cross-sectional study was conducted in Nova Scotia, Canada. Usable data was collected from 197 registered nurses (RNs). Relevant hypotheses were formulated and the partial least squares (PLS) technique was used for data analysis.ResultsThe results of the hypothesized relationships showed that education and computer knowledge have positive moderating effects on the influences of PEOU and PUSS on nurses’ attitudes toward IS (ATTI). The factors of nurses’ years of nursing experience and age did not yield meaningful results. ATTI impacted behavioral intentions to use IS, which positively impacted nurses’ use of IS. The nurses sampled in the study have positive IS use behaviors.ConclusionsThis study demonstrates that relevant demographic factors and individual characteristics, if incorporated into frameworks used for investigating nurses’ acceptance of IS, could permit the emergence of useful insights for practitioners and researchers. Specifically, this study showed that nurses with higher educational attainments and more basic computer knowledge readily accept implemented IS at work. Hospital administrators benefit from insights such as the one presented in this study.     

Clinical psychology service provision and ethnic diversity within the UK: a review of the literature

There is substantial evidence to suggest that clinical psychology services are failing to meet the psychological and clinical needs of people from minority ethnic groups. This paper reviews current knowledge and understanding of factors that may be contributing to this, by examining the diversity of clinical psychology service provisions for minority ethnic groups in the United Kingdom (UK). Research that focuses on the poor utilization of clinical psychology services by minority ethnic groups is identified, and this is related to the limitations offered by mainstream psychological services. References to developments from abroad are also included where they enhance understanding of the current situation affecting minority ethnic groups in the UK. The findings show that minority ethnic groups are generally marginalized and excluded from mainstream clinical psychology services on a number of different levels. These are often influenced by referral conventions, professional misunderstandings of psychological distress and an over‐reliance on ethnocentric and eurocentric conceptual frameworks. Cultural factors are also implicated. This review illustrates that the profession needs to be more considerate in its provision of services for minority ethnic users and indelible steps taken to increase the accessibility and credibility of clinical psychology services to Black and other minority ethnic groups. Copyright © 2006 John Wiley & Sons, Ltd.     

Knowledge and Attitude of 851 Nursing Personnel toward Depression in General Hospitals of Korea

Our study aimed to examine the knowledge and attitude of nursing personnel toward depression in general hospitals of Korea. A total of 851 nursing personnel enrolled at four university-affiliated general hospitals completed self-report questionnaires. Chi-square tests were used to compare the knowledge and attitude of registered or assistant nurses toward depression. In addition, binary logistic regression analysis was used to adjust for the following confounders: age-group and workplace. Registered and assistant nurses differed in their knowledge and attitude toward depression. The proportion of rational and/or correct responses were higher in registered nurses than assistant nurses for the following: constellation of depressive symptoms defined by DSM-IV (adjusted odds ratio [aOR], 3.876; P<0.001); suicide risk in depression recovery (aOR, 3.223; P=0.001) and psychological stress as a cause of depression (aOR, 4.370; P<0.001); the relationship between chronic physical disease and depression (aOR, 8.984; P<0.001); and other items. Our results suggest that in terms of the biological model of depression, the understanding of registered nurses is greater than that of assistant nurses. Moreover, specific psychiatric education programs for nursing personnel need to be developed in Korea. Our findings can contribute to the development of a general hospital-based model for early detection of depression in patients with chronic medical diseases.

Graphical Abstract

相似文献   

某基层医院护士急救能力培训需求分析

目的 了解基层医院护理人员对急救能力的培训需求,为基层医院护理人员开展急救知识和技能培训方案提供依据。方法采用自行设计的调查问卷对某县级基层医院的141名护理人员对急救培训的内容和方式的需求进行调查。结果 6项急救能力需求中,认为“非常需要”比例占最大的项目为“解决问题”“配合协作”“发现问题”能力需求,其中“技术操作”“理论联系实际”“发现问题”3项“需要”比例大,分别为55.32%、51.06%、47.52%。护士期望的培训方式则以示范教学和短期培训（14.12%）、情景模拟（12.57%）、经验交流（10.83%）为主。不同学历之间的技术操作、不同科室之间的配合协作需要程度比较,差异均有统计学意义（P＜0.05）。专科学历护士对技术操作的需求程度高于本科学历护士,普通病房和急诊护士对配合协作能力的非常需要程度均高于ICU,差异具有统计学意义（P＜0.05）。结论 发现问题在急救能力需求中受到关注,基层护士需要发现疾病问题的能力,也是早期开展急救工作的关键。专科学历护士对技术操作的需求程度较高,普通病房和急诊护士对配合协作能力的需求程度较高,基层护士对急救能力培训方式期望程度依次为示范教学、短期培训、情景模拟、经验交流、案例分析、专题讲座、上级进修等。     

Exploring nurses’ confirmed expectations regarding health IT: A phenomenological study

Health information technology (IT) benefits both patients and providers with respect to health care quality and perceived usefulness. Although existing research provides a preliminary understanding of nurses’ perception of health IT, perceptions do not guide actions. This phenomenological study explored nurses’ perceptions regarding electronic health records and bar code medication administration four months post implementation on a medical–surgical unit in an academic medical center. Ten staff nurses (8 females and 2 males) participated. We categorized the results into five themes from personal-level to organizational-level confirmed expectations: (1) nurses’ interaction with computer, (2) nursing performance regarding task accomplishment, (3) unit-specific teamwork, (4) interdisciplinary teamwork, and (5) quality of care. We discovered that effective health IT must be congruent with nursing expectations. IT professionals, nursing and organizational leaders may use findings to structure an environment supportive of effective health IT in nursing practice.     

Lectures are such an effective teaching method because they exploit evolved human psychology to improve learning

Lectures are probably the best teaching method for many students in many circumstances; especially for communicating conceptual knowledge, and where there is a significant knowledge gap between lecturer and audience. However, the lack of a convincing rationale has been a factor in under-estimating the importance of lectures, and there are many who advocate their replacement with written communications or electronic media. I suggest that lectures are so effective because they exploit the spontaneous human aptitude for learning from spoken (rather than written) information. Literacy is a recent cultural artefact, and for most of their evolutionary history humans communicated by direct speech. By contrast with speech, all communication technologies--whether reading a book or a computer monitor--are artificial and unnatural. Furthermore, learning is easier during formal, quiet, real-time social events. The structure of a lecture artificially manipulates human psychology to increase vigilance, focus attention, and generate authority for the lecturer--all of which make communications more memorable for the student. Instead of trying to phase-out lectures, we should strive to make them better by understanding that lectures are essentially formal, spoken, social events.     

Commentary on Perkins,Burns, Perry,and Nielsen's “behavior setting theory and community psychology: An analysis and critique”

This commentary on the accompanying article by Perkins, Burns, Perry, and Nielsen (1988) recognizes it as an important contribution in developing a better awareness and understanding of the usefulness of Barker's behavior setting theory (Barker, 1968; Price, 1976; Wicker, 1979a) in addressing problems in community psychology. Issue is taken with the authors' person-centered, heavily psychological orientation, which appears to have interfered with their understanding of behavior setting theory and research not concerned with the behavior or experience of the individual but rather with understanding the structure and functioning of the preperceptual, ecological environment of molar behavior. The laws governing the operation of the ecological environment are fundamentally different from and incommensurate with the psychological laws that govern individual behavior. Barker places behavior setting theory and research outside the domain of psychology and within the realm of eco-behavioral science. Other issues considered in the commentary include the authors' criticism of the definition of community in behavior setting work, the crudeness of measures of behavior in standard behavior setting procedures, the claim that behavior setting research is concerned only with influences from settings to behavior and not the reverse, the inadequacy of behavior settings in understanding community change, and the dominance of form over function in behavior setting research.     

A comparison of traditional and computer-generated psychological reports in an adolescent inpatient setting.

Although individual personality tests and occasionally test batteries have been the focus of considerable research, the psychological report itself has largely escaped direct scrutiny. This study examined the perceived accuracy, utility, and specificity of traditional psychological reports and compared these values with those obtained for the computer-generated report for the Millon Adolescent Personality Inventory (MAPI). Analyses indicated no difference in rated accuracy by either therapists or nursing staff. Both reports were judged as mediocre in accuracy and usefulness. The MAPI was judged to offer more specific interpretations than was the traditional psychological report and to be superior in quality of writing. A variety of substantive and extraneous variables were examined and found not to alter these results.     

某三级甲等医院外科临床护士科研能力调查分析

目的 调查某三甲医院外科护士的科研能力,了解分析科研能力现状及影响因素,为提高我国护理人员的科研能力提供依据。方法 采用便利抽样法选取某三甲医院血管外科、肛肠外科、泌尿外科、胸心外科、胸心外科、骨创伤外科、整形外科、甲乳外科、烧伤监护室等131名护士为调查对象,使用自行设计的调查问卷对其进行护理科研能力调查。结果 131名外科护士中,学习过护理科研相关课程的有69人,主要是工作期间参加护理科研培训。能够熟练且经常运用中、英文文献检索、统计学知识、统计学软件的分别仅占3.05%、0.76%、2.29%、0.76%;对护理科研非常感兴趣仅占0.76%,对自己掌握的护理科研知识及能力不满意占77.10%,认为对护理科研知识的掌握程度缺乏的占54.96%;认为做护理科研很有必要的只占7.63%,只有4.58%的外科护士迫切需要提升自身科研能力。护理第一学历主要为大专（83.21%）,撰写过护理文章的占23.66%,主要为护师,工作年限为4~9年占45.16%。结论 外科护士的护理科研知识不足,科研能力偏低,科研意识不强,科研水平较低,其科研能力水平的提高可以提升临床护理质量,应使其认识护理科研的重要性,培养科研思维,丰富自身科研知识,提高护理科研水平。     

Challenging the information gap--the patients transfer from hospital to home health care

The purpose of this paper is to identify the information that nurses in hospitals exchange with nurses in home health care (HHC), and what nurses perceive to be the most significant information to exchange. METHOD: Nurses have an obligation to support and ensure continuity of patient care and to prevent an information gap when patients are transferred from one organizational of health care delivery to another organizational level, for example, from hospital to home health care. In an ongoing prospective study, nurses' pre-electronic nursing discharge note and their assessment of the information it was necessary to exchange at the same time was audited and analyzed. The results show variation in the completeness and content of the nursing discharge note. Nurses' understanding of the scope and content of information to be transmitted varies widely according to the context and the organizational health care level they work within. The implementation of an electronic nursing discharge note creates the opportunity to identify the accurate information elements that must be documented and exchanged between the nurses to ensure patient safety and inter-organizational continuity of care.     

Attitudes of physicians, nurses and relatives towards end-of-life decisions concerning nursing home patients with dementia

OBJECTIVE: For many nursing home patients in the advanced stages of dementia, a decision to start or forgo treatment has to be taken at the end of their life. It is very important for the peace of mind of all involved in such decision-making that there is agreement on which decision is in the best interest of the patient. It is thus important to investigate the attitude of physicians, nurses and relatives towards medical end-of-life decisions concerning patients with dementia, so that the policy in nursing homes can be tuned to stimulate dialogue and understanding between all parties. METHODS: Fifteen statements about artificial nutrition and hydration (ANH), advance directives, hastening death, self-determination and euthanasia, and nursing home policy were presented to physicians, nurses and relatives of nursing home patients suffering from dementia. RESULTS: In general, physicians, nurses and relatives agree on many aspects of end-of-life decision-making for nursing home patients with dementia. However, on some issues the outcomes of the decision-making may differ. Relatives attach more importance to advance directives than physicians, and have more permissive attitudes towards hastening death. CONCLUSION: Although physicians, nurses and relatives are all guided by the best interest of the patient, it seems that differences in religious beliefs, perspective of the patient, and responsibility can lead to different attitudes towards end-of-life decisions. PRACTICE IMPLICATIONS: Physicians should discuss end-of-life decisions more openly. Physicians should be aware of the influences on attitudes and incorporate them into communication about end-of-life decisions.     

Cardiovascular reactivity: mechanisms and pathways to cardiovascular disease.

Researchers in physiology, psychology, and medicine have held the idea that risk for cardiovascular disease is increased by exaggerated responses to stress. Some epidemiological evidence supports this view and shows that exaggerated blood pressure responses to stress add to disease prediction beyond that provided by standard risk factors. Most studies of reactivity and disease risk have taken a correlational approach to the reactivity-disease relationship. This paper presents a model of central nervous system control over peripheral response systems that provides a way of designating three sources of exaggerated stress reactivity that may vary across individuals. The top level in the model consists of the limbic system and prefrontal cortex as interacting areas that form psychological stress responses. These frontal-limbic interactions are a means of translating experiential and affective processes into bodily responses. The middle level consists of hypothalamus and brainstem areas that translate descending influences into bodily outputs. Activation levels in these structures can lead to enhanced reactivity to many forms of challenge. The final level consists of the peripheral effectors that create the response itself; altered effector function can be a source of enhanced reactivity. Study designs that involve both psychological and physiological challenges and that take account of self-reports of affect and activation provide a basis for separating these sources of responsivity. This organization may provide useful insights into the sources of stress reactivity that characterize specific groups at risk and allow inferences as to the source of the disease pathophysiology.     

Effects of video interaction analysis training on nurse-patient communication in the care of the elderly

This paper describes an empirical evaluation of communication skills training for nurses in elderly care. The training programme was based on Video Interaction Analysis and aimed to improve nurses' communication skills such that they pay attention to patients' physical, social and emotional needs and support self care in elderly people. The effects of the training course were measured in an experimental and control group. They were rated by independent observers, by comparing videotapes of nursing encounters before and after training. Forty nurses participated in 316 videotaped nursing encounters. Multi-level analysis was used to take into account similarity among same nurse encounters. It was found that nurses who followed the training programme, provided the patients with more information about nursing and health topics. They also used more open-ended questions. In addition, they were rated as more involved, warmer and less patronizing. Due to limitations in the study design, it could not be demonstrated that these findings can entirely be ascribed to the training course. Further research, incorporating a randomized controlled design and larger sample sizes, is recommended to determine whether the results can be attributed to this specific type of training.     

Bewertung der ärztlichen Ausbildung an der McMaster Universität,Kanada, anhand des Konzepts der „Fallmethode“

Summary Students of three different levels and the chairman of the MD-Program evaluated the educational system of McMaster University, Canada, using the six criteria of the case method as defined by Renschler. This analysis provided a very differentiated evaluation of the McMaster curriculum, demonstrating a systematic progress of learning methods from the second to the last phase.The instrument showed differences in the ratings of the demonstrative lectures between the chairman and the students. Free access to patients and responsibility, gradually growing during the 3-year program, are important features of the educational system. The problem-based system provides a unique integration of acquiring theoretical knowledge in the basic sciences through clinical problem solving which was highly rated in all analysed phases. Ratings given by the interviewed students for evaluation of documented work were lower than expected by the chairman and the authors. The results are discussed in relationship to the McMaster Philosophy and to the conditions of studying medicine in America and in Germany.

     

团队心理训练模式对手术室护士心理素质及自我和谐能力影响分析

目的：研究团队心理训练模式对手术室护士的心理健康及自我和谐能力的影响。方法：研究对象选取华北理工大学附属唐山市人民医院手术室(37名)和华北理工大学附属医院手术室(31名)护士共68名,采用随机数字法将其分为对照组和观察组,每组各34例,对照组护士给予常规心理指导和人文关怀,在此基础上,给予观察组护士8周团队心理训练干预,比较两组护士干预前后的心理素质评分和自我和谐能力评分。结果：训练后,观察组的人际关系、偏执、敌对、其他及总心理素质评分均明显低于对照组(P<0.05)和训练前(P<0.01),观察组的自我与经验不和谐、自我灵活性及总评分均明显低于训练前(P<0.05),观察组的自我与经验不和谐和总评分明显低于对照组(P<0.05)。结论：团队心理训练用于手术室护理中,可以明显增强护士的心理健康状况,同时改善护士的自我和谐能力,对于提高手术室护理质量具有非常重要价值,值得在临床中推广。     

Handouts as an educational support for the teaching/learning program in Clinical Anatomy

Handouts were developed to support the program of Clinical Anatomy in the Medical School of Porto, and since 1996/97 alterations have been made to improve their format and content with our educational objectives in mind. A questionnaire was designed to evaluate the opinion of second‐year medical students enrolled in the program. Students were asked about their approval of the way handouts were organized and their usefulness, especially for lectures and practical sessions on physical examination, sectional and imaging anatomy, anatomical variations and malformations and case studies. Of 152 students, 138 (90.8%) returned the questionnaire. To describe the relationship between the value of handouts and several aspects of their organization and adequacy, the Spearman rank correlation coefficient was used for lectures, and canonical correlation for the various practical sessions. Students fully approved the way the handouts of lectures and practical sessions were organized (81.8% and 87%, respectively), their presentation (74.6% and 86.2%), relevance (88.3% and 85.5%), usefulness in understanding the lectures (77.6%) and their value in preparing for practical sessions (83.3%). Handouts were considered highly useful for case studies (90%), physical examination (81.9%) and sectional anatomy (65.7%). Students stating a higher degree of utility of the handouts emphasized that they were useful—indeed essential—in preparing for sessions, and noted their objectivity. The evaluation of the handouts was highly favorable and showed that they can be used as a guide through the complexities of an innovative program of Clinical Anatomy. Clin. Anat. 12:337–344, 1999. © 1999 Wiley‐Liss, Inc.     

青年护士心理健康状况研究

目的 探讨青年护士的心理健康问题,为护士开展心理咨询提供依据。方法 采用症状自评量表(SCL-90)对97名护生和89名青年护士进行调查。结果 青年护士和护生比较,表现在焦虑、抑郁、人际关系敏感和强迫等心理问题,青年护士与常模比较,表现在焦虑、抑郁、强迫、敌对和精神病性等心理问题。结论 应加强对青年护士进行心理咨询,提高青年护士的心理健康素质。     

ASSERT: the effectiveness of a continuing medical education video on knowledge and attitudes about interpersonal violence.

PURPOSE: Developing ways to educate busy clinicians is especially challenging when the subject includes medical, social, and legal aspects, as is the case with interpersonal violence (IPV). Organizations such as the American Medical Association and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommend routine IPV screening for patients. Videotape efficiently provides training in multiple locations using experts from different fields. The authors created and evaluated a multidisciplinary continuing medical education (CME) videotape on IPV. METHOD: The video, ASSERT: A Guide to Child, Elder, Sexual, and Domestic Abuse for Medical Professionals, was developed by experts from medicine, social work, nursing, and law. The video featured role-plays to demonstrate different approaches to these difficult clinical encounters. Pre- and post-viewing questionnaires assessed the video's effectiveness. RESULTS: In all, 120 physicians and 172 other personnel (e.g., nurses, social workers) at 24 sites associated with four academic medical centers completed paired questionnaires. Using a conservative level of significance (p <.002), there was significant improvement for physicians in 77% of the knowledge items and 75% of the attitude items from pre- to post-viewing questionnaires. A total of 73% of viewers would recommend the video to colleagues. CONCLUSIONS: The IPV video, using experts from multiple disciplines, improved knowledge and attitudes about child, elder, sexual, and domestic violence, and was rated highly by clinicians. The video was useful for preparing for a JCAHO accreditation visit.