The quality and management of written information presented to women undergoing hysterectomy

• ? A study of a random sample of hospitals in England that provide information leaflets for women undergoing hysterectomy indicates a large variation in quality.
• ? In general, the findings reveal that written information for patients is given a relatively low priority.
• ? Production and dissemination of information for hysterectomy patients is somewhat ad hoc.
• ? It is not clear that any evaluation of the leaflets has been conducted to prove the efficacy of the available literature.
• ? While the majority of leaflets include information deemed essential by past hysterectomy patients, the presentation of the recovery process often implies no control for the patient, and conceives normality with a narrow perspective about what healthy behaviour means for women. The provision of a specific timetable for resumption of housework duties in 65% of the leaflets is a case in point.
• ? On the basis of the results of the survey, recommendations are made concerning the improvement of the standard of patient information leaflets.

     

Evaluation of a new night nursing service for elderly people suffering from dementia

• ? A new night hospital nursing service was developed for older people with dementia.
• ? A case study approach to evaluation was adopted using a structure-process-outcome quality assurance cycle.
• ? The effects and attendance of patients are reported and discussed.
• ? Discussion relating to care provision for the future is presented.
• ? The effects on carers of patients' attendance are briefly discussed.

     

Shiftwork and quality of care

Summary

• ? This article reviews the literature on shiftwork in nursing and relates this to quality of care issues.
• ? The implications of a fully rotational shift system are discussed.
• ? The biological effects of working shifts are reviewed, but there appear to be other factors, such as social circumstances and autonomy, which moderate these effects.
• ? It is suggested that tasks, formal and informal structures, and staff needs vary widely between nursing shifts, and that this should be taken into account when quality initiatives are introduced.
• ? It is concluded that claims that increasing the number of nurses who work fully rotating shifts results in an improved quality of care for patients are premature, as quality issues in nursing have not been addressed on a 24-hour basis.

     

An attempt to give nursing home residents a voice in the quality improvement process: the challenge of frailty

• ? Advanced frailty and confusion of many nursing home residents present a particular conundrum to researchers committed to resident participation. While the research is set in Australia, the challenge of frailty is common to researchers working with compromised older persons.
• ? This study was conducted in an Australian 32 bed nursing home. As researchers we took on the roles of facilitators and negotiators within a quality improvement process using the approach of fourth generation evaluation.
• ? The overall aim of the project was to provide all stakeholders, including residents and their significant others, with a voice in the negotiations and decisions that impact on their lives.
• ? The focus of this paper is our attempt to gain the perspective of residents and significant others.

     

An evaluation of nurse-led team care within a rehabilitation ward for elderly people

• ? This small exploratory study evaluated the effects of introducing a system of nurse-led team care on a ward providing intensive nursing and rehabilitation to elderly people.
• ? A quasi-experimental design compared three variables between the study ward and two similar wards within the unit. These were:

• — quality of care,
• — job satisfaction,
• — length of patient stay. Quantitative data were complemented by semi-structured interviews with team members and by observation of team meetings.

• ? Quality of care scores showed an improvement on the study ward, but no difference on the main comparison ward. There were no differences between nurse job satisfaction between the study and comparison wards or in length of patient stay throughout the period of evaluation.
• ? Observation of team meetings suggested that communication was more structured and focused on the study ward and that patient goals were more clearly specified. Interviews suggested three main factors in successful implementation of the change to nurse-led team care:

• — commitment of the team,
• — open communication about difficulties,
• — the support of managers and medical staff. The main effects noted were:

• — partnership with patients,
• — equality between team members,
• — improved decision making and quality of care.

• ? Further studies of nurse-led team care are required, and the stress and anxiety for staff consequent on developing the nurse's role in this way should be considered.

     

Feasibility and effects of a combined adjuvant high-intensity interval/strength training in breast cancer patients: a single-center pilot study

Purpose: To evaluate feasibility of an exercise intervention consisting of high-intensity interval endurance and strength training in breast cancer patients.

Methods: Twenty-six women with nonmetastatic breast cancer were consecutively assigned to the exercise intervention- (n= 15, mean age 51.9?±?9.8?years) and the control group (n?=?11, mean age 56.9?±?7.0?years). Cardiopulmonary exercise testing that included lactate sampling, one-repetition maximum tests and a HADS-D questionnaire were used to monitor patients both before and after a supervised six weeks period of either combined high-intensity interval endurance and strength training (intervention group, twice a week) or leisure training (control group).

Results: Contrarily to the control group, endurance (mean change of VO₂, _peak 12.0?±?13.0%) and strength performance (mean change of cumulative load 25.9?±?11.2%) and quality of life increased in the intervention group. No training-related adverse events were observed.

Conclusions: Our guided exercise intervention could be used effectively for initiation and improvement of performance capacity and quality of life in breast cancer patients in a relatively short time. This might be especially attractive during medical treatment. Long-term effects have to be evaluated in randomized controlled studies also with a longer follow-up.

• Implications for Rehabilitation

• High-intensity interval training allows improvement of aerobic capacity within a comparable short time.

• Standard leisure training in breast cancer patients is rather suitable for the maintenance of performance capacity and quality of life.

• Guided high-intensity interval training combined with strength training can be used effectively for the improvement of endurance and strength capacity and also quality of life.

• After exclusion of contraindications, guided adjuvant high-intensity interval training combined with strength training can be safely used in breast cancer patients

     

Effects of Ai Chi on balance,quality of life,functional mobility,and motor impairment in patients with Parkinson’s disease*

Purpose: In this study, we aimed to investigate effects of Ai Chi on balance, functional mobility, health-related quality of life, and motor impairment in patients with Parkinson’s disease.

Method: This study was conducted as an open-label randomized controlled trial (ISRCTN26292510) with repeated measures. Forty patients with Parkinson’s disease stages 2 to 3 according to the Hoehn and Yahr Scale were randomly allocated to either an Ai Chi exercise group or a land-based exercise control group for 5 weeks. Balance was measured using the Biodex-3,1 and the Berg Balance Scale. Functional mobility was evaluated using the Timed Up and Go Test. Additionally, health-related quality of life and motor activity were assessed with the Parkinson’s Disease Questionnaire-39 and the Unified Parkinson’s Disease Rating Scale-III.

Results: Although patients in both groups showed significant improvement in all outcome variables, improvement of dynamic balance was significantly greater in the Ai Chi group (p?p?p?=?0.002), Parkinson’s Disease Questionnaire-39 (p?p?Conclusion: Our results suggest that an Ai Chi exercise program improves balance, mobility, motor ability, and quality of life. In addition, Ai Chi exercise was more effective as an intervention than land-based exercise in patients with mild to moderate Parkinson’s disease.

• Implications for rehabilitation

• Ai Chi exercises (aquatic exercises) may help improve balance, functional mobility, health-related quality of life, and motor ability in patients with mild to moderate Parkinson’s disease more efficiently than similar land-based exercises.

• Ai Chi exercises should be considered as a rehabilitation option for treatment of patients with mild or moderate Parkinson’s disease.

     

Cognitive therapy as a tool for caring for the elderly confused person

• ? With the increase in the numbers of elderly people, methods to improve the quality of life for this population has never been more relevant. As the primary carers for this group of people, nurses are likely to be faced with this task.
• ? Cognitive therapies such as reality orientation, validation, reminiscence and life review, can help to maintain or improve aspects of cognitive or behavioural functioning for the elderly confused.
• ? If this in turn can increase life satisfaction for those elderly suffering from dementia then cognitive therapies must be addressed as means to improve individual quality of life.
• ? Existing research otters contradictory evidence as to the practical application and usefulness of such therapies. More substantial research must be undertaken in the area, addressing nursing perspectives with regards to the implementation of cognitive therapies.
• ? The author maintains that the cognitive therapies discussed in this paper have great potential for use within care of the elderly and despite controversial research results, can help to maintain or improve the quality of life for the elderly confused.

     

Long-lasting improvements in health-related quality of life among women with chronic pain,following multidisciplinary rehabilitation

Purpose: To determine whether observed health-related quality-of-life improvements after four-week traditional multidisciplinary pain management program and additional neuroscience education and mindfulness-based cognitive therapy for chronic pain are sustained at six-month follow-up.

Method: This observational longitudinal follow-up study, with complete follow-up of 75 women, 61.5% of initial traditional approach group (treated 2001–2005) and 56 (62.2%) receiving the new approach (treated 2006–2009). Pain intensity and quality of life were measured at baseline and six months after interventions. Analysis of variance (ANOVA) and paired samples t-tests were used for statistical analysis.

Results: Both groups showed sustained improvements in pain intensity (traditional approach?=??10.6 [p?<?0.001]; new approach?=??14.5 [p?p?p?p?=?0.066]), whereas all other domains among both groups were sustained. Significant decline was observed from discharge to six month among both groups with the exception of the sleep domain among the traditional approach group, pain intensity among the new approach and financial status among both groups. No baseline differences were revealed between responders and nonresponders.

Conclusions: Multidisciplinary interventions for women with chronic pain conditions improved quality of life and pain intensity with lasting improvements observed half a year after treatment completion.

• Implications for rehabilitation

• Intensive multidisciplinary biopsychosocial rehabilitation is essential for chronic pain conditions.

• This follow-up study shows sustained improvement in health-related quality of life and pain intensity six months after such rehabilitation was completed.

• Emphasizing mindfulness-based cognitive therapy and neuroscience patient education may contribute to less decline in pain intensity from discharge to six-month follow-up compared with a more traditional approach.

     

Improving stroke care through action research

• ? Stroke accounts for ～20% of beds occupied on general medical wards yet nurses felt inadequately prepared to participate fully in the interdisciplinary approach to stroke rehabilitation.
• ? An action research project was established to improve stroke care and rehabilitation in a general medical ward.
• ? Results indicate a correlation between knowledge and attitudes: the greater the nurse's understanding the more positive the nurse is towards nursing involvement in rehabilitation.
• ? It was concluded that nurses have a vital part to play in the rehabilitation of stroke patients and that their contribution can be enhanced through greater understanding.
• ? Further research is needed to determine the effects of greater nursing involvement in terms of quality of patient recovery and length of patient stay.

     

Changes of nursing organization in a surgical department: effects on work satisfaction and quality of care

• ? The aim of the study was to evaluate the effects of an organizational change programme in a surgical department in Sweden (the introduction of modular nursing) on the nursing staffs perception of job satisfaction and quality of care, and to identify factors which promote or hinder this organizational change.
• ? Planning and implementation of the change programme took about 1 year and comprised structural changes and staff training.
• ? Assessments of job satisfaction and quality of care were made immediately before, and 1 year after, implementation of the change programme. Data were collected from the staff of two wards.
• ? Virtually no statistically significant changes were found when looking at the department as a whole. However, considerable differences were noted between the two wards, particularly in the following areas: relationships with colleagues, identification and commitment, and perceived quality of care.
• ? The quality of the interpersonal relationships, and the leadership of the wards' head nurses, appeared to be crucial determinants of the outcome.

     

Student midwives' learning experience on the wards

• ? This paper is based on an investigation into the learning experiences of student midwives in the clinical setting in one maternity unit in the Republic of Ireland.
• ? A questionnaire approach was adopted for the data collection and 42 student midwives participated in the study.
• ? A number of factors were identified which appear to influence students' experiences of ‘learning on the job’. The quality of their clinical teaching and their observations of the way in which trained staff practise midwifery may influence their decision to continue practising midwifery following registration.
• ? These findings clearly point to the importance for midwives to reassert their true role as ‘independent practitioners’ of normal maternity care.

     

In pursuit of quality of nursing care

Summary

• ? This paper explores the elusive and complex concept of quality of nursing care. In attempting to define it, the question is raised whether it is possible to preserve the concept of the whole in the drive to isolate and measure component parts.
• ? Components of quality in health care are identified including technical skills, interpersonal relationships and contextual properties of the organizational setting.
• ? Values fundamental to a high-quality service are highlighted—equity, respect for persons and caring—that enable nurses to negotiate therapeutic relationships with their patients.
• ? A study in the Nursing Research Unit at Kings College London that incorporates multiple triangulation in an attempt to understand the domain of quality of nursing care is described.
• ? Priority is given to patients and nurses as primary definers of quality of nursing care. The process developed in our research to identify indicators of quality as perceived by them is outlined and examples of their views are included. The study is not yet complete; further analysis will enable us to identify conceptual frameworks of quality of nursing care held by patients and nurses.

     

Reading research critically. II. An introduction to appraisal: assessing the evidence

• ? This is the second of two articles providing an introduction to the critical appraisal of research reports.
• ? In this paper guidelines for evaluating the quality of evidence and the validity of conclusions are suggested, and a check-list of evaluation points is presented.

     

Admission to care: facilitating role transition amongst family carers

• ? Admission to care after a period of family care-giving has been the focus of much recent research.
• ? Rather than being seen as an end in itself, admission is part of a process.
• ? This article concentrates on ‘reaching the end’ of family care-giving and the ‘new beginning’ of entering residential care.
• ? A cross-national study conducted in the USA and the UK is discussed, and similarities and differences in the two cultures are highlighted.
• ? Decisions to enter a nursing home were often taken hurriedly and with lack of information in both countries.
• ? Issues of quality of care and emotional responses by former carers were also important in both settings.

     

Where do I stand? Legal implications of telephone triage

• ? The introduction of telephone triage in many accident and emergency (A&E) departments is seen as a way to give clients information immediately on demand, to assess and prioritize the need for treatment and to direct the client to the most appropriate service available.
• ? This article aims to examine the medico-legal aspects of telephone triage and the nurse's responsibility to the caller and themselves.
• ? It will involve looking at triage as a nursing function and how the nurse may minimize the threat of liability by beginning to understand the legal implications of giving advice by telephone.
• ? The article will also discuss the use of detailed documentation and communication skills and will aim to show how important these are in the protection of nurses in a court of law.

     

What neurological patients regard as quality of life

• ? The aim of this study was to investigate how patients with progressive neurological disorders describe what they perceive as quality of life.
• ? The patients (n = 169) were interviewed while staying at a neurological rehabilitation centre by way of an open question, what ‘quality of life’ represented to them.
• ? Patients' statements were classified and a comparison was made with Kajandi's three levels of factors constituting quality of life. The categories that came forth were ‘living in a sense of affinity’, ‘being independent’, ‘living on one's own terms’ and ‘feeling that life is meaningful’. The statements constituting the basis of the categories were impressive and illustrated wisdom.
• ? The results underline the uniqueness of each patient's situation, and how important it is that nursing and treatment are adjusted to the needs of the individual.

     

Health-related quality of life improvements among women with chronic pain: comparison of two multidisciplinary interventions

Purpose: To measure the effect of 4 weeks traditional multidisciplinary pain management program (TMP) versus neuroscience education and mindfulness-based cognitive therapy (NEM) on quality of life (HRQL) among women with chronic pain. Method: This observational longitudinal cohort study conducted in an Icelandic rehabilitation centre included 122 women who received TMP, 90 receiving NEM, and 57 waiting list controls. Pain intensity (visual analogue scale) and HRQL (Icelandic Quality of Life scale) were measured before and after interventions. ANOVA and linear regression were used for comparisons. Results: Compared with controls we observed statistically significant changes in pain intensity (p?p?p?=?0.008). Head to head comparison between study groups revealed that pain intensity improved more among TMP participants (21.8 versus 17.2?mm; p?=?0.013 adjusted). Women with low HRQL at baseline improved more than those with higher HRQL (mean TMP?=?13.4; NEM?=?12.9 if HRQL?≤?35 versus mean TMP?=?6.6 and NEM?=?7.8 if HQRL?>?35). Conclusions: Our non-randomized study suggests that both NEM and TMP programs improve pain and HRQL among women with chronic pain. Sleep quality showed more improvements in NEM while pain intensity in TMP. Longer-term follow-ups are needed to address whether improvements sustain.

• Implications for Rehabilitation

• Chronic pain is a debilitating condition affecting quality of life and restricting societal participation.

• Intensive multidisciplinary bio-psycho-social rehabilitation is essential for this patient group.

• This study shows improvement in health-related quality of life and pain intensity following such rehabilitation.

• Emphasizing mindfulness based cognitive therapy and neuroscience patient education improves sleep to more extend than more traditional approach.

     

An action research investigation into the feasibility of experienced registered sick children's nurses (RSCNs) becoming children's emergency nurse practitioners (ENPs)

• ? Emergency nurse practitioners (ENPs) formally developed in accident and emergency (A & E) departments as a direct response to waiting times for the walking wounded, the need to reduce junior doctors hours and changes in nursing practice.
• ? ENPs existed informally for many years in minor injuries units and specialist ophthalmic departments.
• ? This study aimed to examine whether or not the role of ENP could be applied to the specialist service of a paediatric casualty department.
• ? The results showed that 3% of patients could be seen and treated to conclusion by a children's ENP, and some patients could have their care accelerated by a children's ENP.
• ? The introduction of children's ENPs would have an impact on waiting times, junior doctors work-load and the quality of patient care.

     

Efficacy of pulsed high-intensity laser therapy on pain,functional capacity,and gait in children with haemophilic arthropathy

Aim: The aim of this study was to evaluate the effects of pulsed high-intensity laser therapy (HILT) on pain, functional capacity, and gait in children with haemophilia.

Methods: Thirty children with haemophilia type A with ages ranging from 9 to 13 years were selected for this study. They were assigned randomly, into two equal treatment groups. The laser group received the traditional physical therapy programme plus active laser (total energy of 1500 J through three phases/3 sessions/week), whereas the placebo group received the same physical therapy programme plus placebo laser over three consecutive months. Baseline and post-treatment assessments used the visual analogue scale (VAS) to evaluate pain, a 6-min walk test (6MWT) to evaluate functional capacity, and the GAITRite^® system to evaluate gait parameters.

Results: Children in the laser group showed significant improvement in pain, functional capacity, and gait parameters compared to those in the placebo group (p?Conclusions: HILT is an effective modality in reducing pain, increasing functional capacity, and improving gait performance in children with haemophilic arthropathy.

• Implications for Rehabilitation

• Haemophilic arthropathy due to recurrent joint bleeding leads to physical, psychological, and socioeconomic problems in children with haemophilia and reduces their quality of life.

• Early physiotherapeutic interventions help to prevent and treat the sequelae of recurrent haemarthrosis.

• High-intensity laser therapy has been introduced as non-invasive and an effective physiotherapy modality for rapid pain control, with consequent improvement in children’s quality of life.

• High-intensity laser therapy should be used as an adjunct to exercise programme in the rehabilitation of children with haemophilic arthropathy.