Nurses' attitudes of a web patient portal prior to its implementation in home health care nursing

ObjectivesEffective communication is essential in home health care nursing in order to meet the needs of both the patients and the caregivers. Given the key role of nursing staff inpatient training through the patient portal; nursing staffs' attitudes toward the use of this technology thus need to be further evaluated. The present study evaluated Iranian nurses' attitudes before the web-based patient portal implementation in home health care nursing.MethodsThis study was conducted on 600 nursing staff working in health care organizations affiliated to Semnan University of Medical Sciences in Iran. A questionnaire was used to evaluate the nurses’ attitudes.ResultsThe study subjects' attitudes scores were 3.06±0.71 on "patient education", 3.02±0.78 on "health care plan" and 2.95±0.82 on the cost of nursing services, based on the 5-point Likert scale (1-5: completely disagree to completely agree). There was a statistically significant relationship between nurses' attitudes and computer skill (B=0.07, SE=0.03, P=0.021) and nurses' acceptance of IT (B=0.085, SE=0.039, P=0.030), and sex (B=0.176, SE=0.058, P=0.003).ConclusionThe nurses agreed that the use of this self-management tool can ease patient education, easily implement a health care plan for patients and reduce the cost of nursing services. The nurses also agreed that changes are required at the minor and major levels of in-home health care institutions to support the implementation and meaningful use of this portal for home health care nursing.Public interest (lay) summaryHome health care is one of the alternative solutions to continue hospital care that is performed by nursing staff. The nursing staff in-home care should effectually cooperate to render secure and high-quality patient care. The web-based patient portals have confirmed effectiveness to improve patient gratification, engagement, and health outcomes, improve the quality and efficacy of the healthcare settings, decrease emergency unit appointments and ease patient-centered care. Nurses agree the implementation of the patient portal in home health care nursing depends on organizational and individual preparation in healthcare organizations and this technology should be also adopted by the nursing staff to meaningful use of the patient portal to attain significant improvements in home health care nursing.     

A narrative approach to understanding the nursing work environment in Canada

Narrative interviews were conducted with hospital nurses participating in a research study designed to provide support and assistance to hospitals as they addressed work life issues for nurses in an attempt to create quality work environments. The eight interviews were conducted in a sample of Canadian hospitals and generated themes relating to an imbalance between the effort that nurses put into their work and rewards attained from it. Seigrist's ((1996) Journal of Occupational Health Psychology, 1, 27-41, (2002) In: P.L. Perrewe & D.G. Ganster (Eds.), Historical perspectives on stress and health. Research in Occupational Stress and Well Being (vol. 2). Boston, MA: Jai Press) effort-reward imbalance model was used to frame this study. The nurses' narratives suggest that multiple factors constitute the nurses' work environment and their experiences and perceptions of it. Issues which surfaced repeatedly in the interviews related to changing needs of hospitalized patients in today's health care system and the associated workload, the widespread shortage of nurses, and the imbalance this creates for nursing work. A crucial finding is the extent to which the nurse is impacted by the adequacy of care they are able to provide. These narratives outline the tremendous burden of guilt and the overcommitment that nurses bear when factors in the work environment prevent them from providing complete, quality care. Nurses are experiencing frustration and stress that is impacting their worklife, family and home life, personal health, and possibly patient outcomes.     

A Study to Assess Home Health Nurses from a Carative Perspective

The aging population is steadily rising, resulting in an increased need for in-home healthcare. This study examined the impact of several carative factors demonstrated by home health nurses. Multiple regression was used to examine the impact of the carative factors, measured by the Caring Nurse Patient Interaction Scale (CNPI-70). A total of 77 home health nurses from five home health agencies in Northeastern Pennsylvania participated in the study. The findings indicate that the principles of care theory are widely applied in home health settings. The author recommends that care theory be a focus of educational health programs and future research.     

Research to practice in occupational health nursing

Occupational health nursing research has gained a significant place in national and international nursing programs and has advanced occupational health nurses' understanding of the most effective ways to prevent occupational illness and injury, provide access to quality care for workers, and manage occupational injuries and return to work. This article describes the history of nursing research in general and highlights the current national shortages that must be addressed to ensure that nurses continue to impact the field. Occupational health nursing priorities are described and examples are given of nurse scientists who have established the foundation of occupational health nursing research and who illustrate varied expertise and the interdisciplinary context in which the work is conducted.     

The nurse as an action tool in care for the aged

This study approaches nursing care as related to the aged. The studied situation involved health care needs of hospitalized persons, using the following central question: which is the meaning of nurses' actions when attending hospitalized aged patients without expectation of recovery and when technology is no longer that important? We aimed to reflect about hospitalized elders' needs in nursing reality. Comprehensive Sociology was used as a theoretical-methodological framework. The study was carried out at an Intensive Care Service of a Municipal Hospital in the city of Rio de Janeiro-Brazil. The subjects were nurses who attend hospitalized aged persons without any expectation of recovery, who were approached through a phenomenological interview. Through a comprehensive analysis, we identified care by being together, providing at the same time physical comfort and well-being to cope with the situation as typical of nursing actions. This study indicates some contributions for nursing care, assistance, teaching and research, aimed at strengthening nurses' attitude as an action tool in care for aged patients.     

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.     

宝安区西乡街道桃源居社区居家老人护理需求研究

目的调查分析桃源居社区居家老人对社区护理服务需求的现状,为开展居家护理服务和制定内容规划提供依据。方法编制居家老人护理需求评估表,通过专业人员对240名老年人的健康功能状况和居家护理服务需求进行入户评估。结果67.08%的居家老人有居家护理服务,年龄、文化程度、自理能力是影响老年人护理需求的影响因素。结论开展居家护理能够有效提高老年人的自我保健意识和能力,对保障老年人的健康生活具有重要意义。     

The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

OBJECTIVE. This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN. Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD. Secondary data analysis of the National Long-Term Care Data Set. PRINCIPAL FINDINGS. The use of formal in-home care, which was increased by the Channeling intervention, was positively associated with nursing home utilization at 12 months. However, the negative direct effect of Channeling on nursing home use was of sufficient magnitude to offset this positive indirect effect, so that a small but significant negative total effect of Channeling on subsequent nursing home utilization was found. CONCLUSIONS. This study shows why Channeling did not have a large total impact on nursing home utilization. The analysis did not provide evidence of direct substitution of in-home care for nursing home care because the direct reductions in nursing home utilization due to other aspects of Channeling (including, but not limited to case management) were substantially offset by the indirect increases in nursing home utilization associated with additional home care use.     

Are submissive nurses ethical?: reflecting on power anorexia

We believe that the notion of power anorexia, which we define as a lack of desire to exercise power, is central to reflections about nursing ethical concerns. Questioning the assumption that nurses are powerless, we argue that nurses can and do exercise power and that their actions and inactions have consequences not only for themselves, but also for those for whom they care. We propose that a feminist ethics perspective be used both to understand and to overcome nurses' power anorexia. Feminist thinkers remind us not only of oppression's psychological impact, but that stereotypical views about women are socially constructed and, therefore, can be changed. Nurses using this framework should explore the implications of a centralized notion of caring to the way we conceive of power relations in health care. Perhaps deconstructing caring by focusing on how nurses exercise power could help us to re-conceptualize nursing and promote new agendas for health and health care.     

The role of nurses in psychiatric services

Specific features of the nursing process in practical activities of nurses of psychiatric service of the Russian Federation should receive special attention in the system of vocational training. Increase of the volume and improvement of quality of training, reorganization of nurses' work in an inpatient and outpatient setting are the main approaches to improving the quality of medical care and, among other things, mental health of the population.     

A study of patients receiving no billed nursing care

Although home health care traditionally is conceptualized as nursing care, in today's environment care at home may be delivered by a myriad of professional and nonprofessional practitioners. In fact, many patients who receive home care do not receive billed nursing visits. We studied a group of patients (n = 200) who received no billed nursing care, but rather received billed care from therapists, social workers and home health aides. This cohort of patients differed from patients who received billed nursing care in several ways: they were more frequently referred to home care from the community, their prognoses on admission to home care were significantly better, and their outcomes from home care services were considerably more favorable. Clearly patients not receiving billed nursing care have service and resource needs different from those of the population receiving billed nursing care. Therefore, new perspectives must be used when considering how to assess, deliver and perhaps pay for the requirements of these patients.     

'We are bitter but we are satisfied': nurses as street-level bureaucrats in South Africa

This study investigates how a group of nurses based in busy urban primary care health clinics experienced the implementation of the free care (the removal of fees) and other South African national health policies introduced after 1996. The study aimed to capture the perceptions and perspectives of front-line providers (street-level bureaucrats) concerning the process of policy implementation. Using qualitative and quantitative research methods, the study paid particular attention to the personal and professional consequences of the free care policy; the factors which influence nurses' responses to policy changes such as free care; and what they perceive to be barriers to effective policy implementation. The research reveals firstly that nurses' views and values inform their implementation of health policy; secondly that nurses feel excluded from the process of policy change; and finally that social, financial and human resources are insufficiently incorporated into the policy implementation process. The study recommends that the practice of policy change be viewed through the lens of the 'street-level bureaucrat' and highlights three sets of related managerial actions.     

Nurses' widespread job dissatisfaction, burnout, and frustration with health benefits signal problems for patient care

Job dissatisfaction among nurses contributes to costly labor disputes, turnover, and risk to patients. Examining survey data from 95,499 nurses, we found much higher job dissatisfaction and burnout among nurses who were directly caring for patients in hospitals and nursing homes than among nurses working in other jobs or settings, such as the pharmaceutical industry. Strikingly, nurses are particularly dissatisfied with their health benefits, which highlights the need for a benefits review to make nurses' benefits more comparable to those of other white-collar employees. Patient satisfaction levels are lower in hospitals with more nurses who are dissatisfied or burned out-a finding that signals problems with quality of care. Improving nurses' working conditions may improve both nurses' and patients' satisfaction as well as the quality of care.     

The essence of 'community' within community nursing: a district nursing perspective

Over the past decade or so, there has been a marked shift in the location and nature of nursing care from the hospital setting to primary and community care. The past decade has also witnessed the development of a number of policy initiatives which indicate that the drive towards the community as a key location of nursing care is set to continue. Although notions of community have been explored extensively within the literature from a number of perspectives, there is an absence of a clear definition, and more particularly for the purposes of the present study, one from a nursing perspective. This lack of conceptual clarity is further compounded when notions of community and the place of nursing within the community are considered contemporaneously. The present pilot study, which was based on semi-structured interviews with district nurses, seeks to address this deficit and explore how district nurses define the nature of their role, both in terms of providing nursing care within the community and also in terms of defining community within the context of their work. The study illuminates the principal position of the home in defining the essence of community within community nursing and notions surrounding the nature of relationships which exist within this setting. This is highlighted through the identification of emerging themes: the maintenance of personal-professional boundaries, notions of holistic care and professional definitions of community. These observations raise important questions regarding the extent to which the location of care and the taken-for-granted assumptions surrounding community-based nursing care have been translated into practice to date. This also raises key issues regarding the tensions which exist for nurses trying to balance notions of community and community-based care within the parameters of organisational and professional boundaries.     

Influences of the culture of science on nursing knowledge development: Using conceptual frameworks as nursing philosophy in critical care nursing

Nursing knowledge development and application are influenced by numerous factors within the context of science and practice. The prevailing culture of science along with an evolving context of increasingly technological environments and rationalization within health care impacts both the generation of nursing knowledge and the practice of nursing. The effects of the culture of science and the context of nursing practice may negatively impact the structure and application of nursing knowledge, how nurses practice, and how nurses understand the patients and families for whom they care. Specifically, the nature of critical care and its highly technical environment make critical care nursing especially vulnerable to these potentially negative influences. The influences of the culture of science and the increasingly technical practice context may result in an overreliance on the natural sciences to guide critical care nursing actions and an associated marginalization of the caring relationship in critical care nursing practice. Within this environment, nursing philosophy may not be foundational to nursing actions; rather, the dominant culture of science and the rationalization of health care may be informing nursing practice. As such, the ideology and goals of nursing may not be central to the practice of critical care nursing. The purpose of this paper is to explore the influence of the culture of science on the development of nursing knowledge and theory. Further, we aim to describe the value of using conceptual frameworks, such as Roy's Adaptation Model, as a nursing philosophy to influence the development of person‐centred nursing knowledge and theory to inform critical care nursing practice as it related to the care of patients and families. In doing so, nursing philosophy is situated as foundational for nursing actions.     

Physicians' capability in home health practice: home health nurses' perceptions.

OBJECTIVES: To examine home health nurses' attitudes towards physician capabilities in home health care, and whether nurses' attitudes are associated with their experience, practice setting, degree of physician interaction, or use of home health guidelines. DESIGN: A multiple regression analysis of a 90 item survey on agency characteristics, degree of interaction with physicians, and ratings of physicians capabilities across multiple dimensions of home health practice. SETTING/PARTICIPANTS: 86 registered visiting nurses from seven Chicago-area home health agencies, who averaged 25 home visits and over one hour of direct contact with physicians weekly. MEASUREMENTS: Nurses' ratings of physician capability in home health practice were scaled from 18 survey items with high internal consistency reliability and correlated with nurses' practice characteristics. RESULTS: While most nurses (72%) felt that physicians responded adequately in emergencies and respected them as colleagues (70%), over 70% of respondents did not agree that physicians were adequately trained in home health. A majority of respondents rated physicians negatively on patient education, cross-coverage and availability, discharge planning, support and medical supply services, and insurance issues. Respondents' years of home health experience correlated negatively (p = .004) and degree of contact with physicians correlated positively (p = .05) with ratings of physician capabilities. CONCLUSION: Nurses' attitudes about physicians' performance can provide important insights for improving the effectiveness of specialized disease and outcomes management programs which rely on care in the home setting.     

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.     

对护士人性化护理认知情况的调查分析

目的了解护士对人性化服务的认知情况,针对目前现状,提供有效的人性化服务,为真正实施、落实人性化护理提供理论依据.方法采用问卷随机对浙江省9家三级医院的119名护士和352名病人进行了调查.对护士进行人性化护理的认知调查,同时对护士和病人进行希望住院期间的饮食、信息、治疗时间的调查和比较.结果护理人员对人性化护理有错误认知所占比例较大,病人对饮食、休息、治疗时间的需求与护士的意愿有显著性差异.结论护理人员对人性化护理有错误认知,不能从病人角度真正满足病人需求,工作时间的安排以方便自己为前提.因此,需要进一步对护理人员进行人性化护理知识的宣传、培训,加大人性化护理管理的力度.