A communication intervention for nursing staff in chronic care

Title.  A communication intervention for nursing staff in chronic care.
Aim.  The paper is a report of a study conducted to evaluate the effect of a brief, focused educational intervention on the quality of verbal interactions between nursing staff and patients in a chronic care facility.
Background.  Positive nurse–patient communication in chronic care is crucial to the quality of life and well-being of patients. Despite this, patients are dissatisfied with these interactions and nursing staff indicate the need for additional training.
Method.  A repeated-measures design was used to collect data between April 2003 and February 2004, by audiotaping verbal interactions between nursing staff and patients during morning care. Baseline data were analysed and an educational intervention was developed based on the results of the pretest. Five months after the educational intervention, interactions between the same nursing staff and patients were audiotaped. Twenty-seven randomly chosen patients and selected nursing staff participated in the study. Data were analysed using a qualitative comparative method, and a quantification technique was developed to compare the quality of the interactions before and after the intervention.
Findings.  Preintervention interactions were task-oriented, superficial and dominated by nursing staff. Results statistically significantly improved after the intervention was implemented. Nursing staff were less authoritative, used more solution-focused communication and interactions had a statistically significantly higher positive ratio.
Conclusion.  Brief interventions can change nursing staff's communication practice and they realized the importance of effective communication as a fundamental component to deliver patient-focused care.     

The Excess Costs of Hospitalization for Acute Stroke in People With Communication Impairment: A Stroke123 Data Linkage Substudy

ObjectiveTo describe the costs of hospital care for acute stroke for patients with aphasia or dysarthria.DesignObservational study from the Stroke123 project.SettingData from patients admitted with stroke (2009-2013) from 22 hospitals in Queensland participating in the Australian Stroke Clinical Registry (AuSCR) were linked to administrative datasets.ParticipantsCommunication impairments were identified using International Classification of Diseases, 10th Revision, Australian Modification codes. Overall, 1043 of 4195 (25%) patients were identified with aphasia (49% were women; median age 78 years; 83% with ischemic stroke), and 1005 (24%) with dysarthria (42% were women; median age 76 years; 85% with ischemic stroke).InterventionsNot applicable.Main Outcome MeasuresLinked patient-level, hospital clinical costing related to the stroke, were adjusted to 2013/2014 Australian dollars (AU$, US$ conversion x 0.691) using recommended national price indices and multivariable regression analysis with clustering by hospital performed.ResultsCompared with patients without aphasia, the median hospital costs/patient were greater for those with aphasia for medical (aphasia AU$2273 vs AU$1727, P<.001), nursing (aphasia AU$3829 vs AU$2748, P<.001) and allied health services (aphasia AU$1138 vs AU$720, P<.001). Similarly, costs were greater for patients with dysarthria compared with those without dysarthria. Adjusted median total costs were AU$2882 greater for patients with aphasia compared with patients without aphasia (95% confidence interval, AU$1880-3884), and AU$843 greater for patients with dysarthria compared with those without dysarthria (95% confidence interval, AU$–301 to 1987).ConclusionsPeople with communication impairment after stroke incur greater hospital costs, in particular for medical, allied health, and nursing resources.     

Providing psychosocial and physical rehabilitation advice for patients with burns

Title.  Providing psychosocial and physical rehabilitation advice for patients with burns.
Aim.  This paper is a report of a study evaluating the perceived skills of nursing and allied healthcare professionals in providing psychosocial and physical rehabilitation advice, including the effect of years of burn injury experience.
Background.  Recovery from burn injuries is a complex mix of physical and psychosocial rehabilitation, yet research in the UK has demonstrated that healthcare professionals feel more competent at giving advice to patients on issues of physical rehabilitation than psychosocial rehabilitation.
Methods.  This was a replication study with a cross-sectional design. A questionnaire survey was conducted with a convenience sample of healthcare professionals in a large urban hospital with specialist burn and plastic services in New Zealand. The data were collected in 2005.
Results.  Consistent with the UK results, New Zealand healthcare professionals rated their skills in advising patients about physical items of burn rehabilitation higher than their skills for psychosocial items. Years of experience working with burns was related to greater perceived skill in advising patients on physical rehabilitation. In contrast, no relationship between years of experience and perceived skill in the provision of psychosocial rehabilitation advice was found.
Conclusion.  Strategies to enhance effective staff/patient communication should form an integral part of staff education. The psychosocial needs of patients must be incorporated as an essential part of such strategies.     

Elderly peoples' experience of nursing care after a stroke: from a gender perspective

Title.  Elderly peoples' experience of nursing care after a stroke: from a gender perspective.
Aim.  This paper is a report of a study conducted to explore, from a gender perspective, older people's experiences of nursing care after a stroke.
Background.  Little attention has been given to gender differences in nursing care. The majority of people who have a stroke are older. Improving knowledge of the gender perspectives of older men and women regarding nursing care after stroke is crucial.
Method.  This was a qualitative study based on interviews with five women and five men between 66 and 75 years of age, who had received nursing care at a ward for stroke rehabilitation. The data were collected in 2006. Qualitative content analysis of the interviews was carried out.
Findings.  A main theme and five categories, all common to both men and women, were identified. The main theme, to promote recovery of the body, encompassed the categories. There were, however, gender differences in how the nursing care received was experienced. The ways patients experienced nursing care seemed to be linked with their lives as women and men before they had the stroke. Their perceptions are linked with their lives as women and men before they had their stroke. Both men and women will reclaim former abilities but what they perceive to be the goals of nursing care and rehabilitation may differ.
Conclusion.  Nurses need to increase their awareness and knowledge concerning the similarities and gender differences in the experiences and needs of older people, both men and women.     

运动性失语患者的康复护理

目的：探讨康复护理对运动性失语患者的语言康复和非语言交流能力的作用。方法：35例运动性失语患者随机分为康复组18例和对照组17例，康复组进行为期3个月的言语康复训练和护理，对照组仪给予日常治疗护理。采用标准汉语失语检查法评定患者语言功能恢复情况。结果：复述、表达及运用语言功能方面与治疗前比较康复组明显恢复（P〈0．01或P〈0．05），且优于对照组（P〈0．05）。结论：康复护理对运动性失语患者的语言康复和非语言交流能力有良好的促进作用。     

Nursing: Does It Still Eat Its Young,or Have We Progressed Beyond This?

BACKGROUND.  Nursing has endured a long-standing tradition of not supporting new staff, whether they are new graduates or seasoned professionals.
AIMS.  To reflect on the need for staff to support each other and develop camaraderie within the profession.
MATERIALS AND METHODS.  With the development of pairing new nurses with experienced nurses, the turnover rate tends to decrease.
RESULTS.  The turnover rate of nurses leaving the profession has shown a decrease.
DISCUSSION.  For the nursing profession to maintain the high standards that is has and continue to have the proper amount of staffing, we need to work as a team, not as individuals.
CONCLUSION.  Nursing now commands respect that is long overdue. We must all work together to provide the best possible environment in which to care for our customers both internal and external.     

A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care

hasson h. & arnetz j.e. (2009)   A comparative study of nursing staff, care recipients' and their relatives' perceptions of quality of older people care. International Journal of Older People Nursing   5 , 5–15
doi: 10.1111/j.1748-3743.2009.00186.x
Background.  Comparisons of different stakeholders' ratings of the quality of older people care can help to drive quality improvement.
Aim.  The aim was to compare staff, older care recipients' and their relatives' quality of care ratings.
Design.  Cross-sectional questionnaire surveys in 2003 and 2004, using a repeated measures design on an organizational level.
Methods.  Nursing staff, care recipients and relatives in two older people care organizations were included. The ratings of an overall quality grade, information, activities, general care and staff skills were compared between the respondent groups.
Results.  Care recipients in both organizations rated the overall quality grade significantly higher than nursing staff and relatives. Staff ratings of the information given to care recipients were significantly more positive than care recipients' and relatives' ratings. All three groups gave lowest ratings to the quality of activities offered to care recipients, with lowest ratings from nursing staff.
Conclusions.  Concurrent measurements of staff, care recipients and relatives' care quality perceptions can provide a broad evaluation of an organization's strength and limitations.
Relevance to clinical practice.  Staff, care recipients' and relatives' perceptions can be useful for older people care organizations and decision makers in developing care processes and outcomes of care.     

Staff-family relationships in nursing home care: a typology of challenging behaviours

Aim.  This paper draws on data from a study which investigated how Australian nursing home staff constructed staff–family relationships.
Background.  Working with the family in aged care to provide the best care possible is consistent with modern nursing philosophy which espouses holistic care. The quality and enjoyment of the experience however, is frequently fraught with problems and challenges for both the staff and the family involved.
Design.  A qualitative constructivist design as described by Guba and Lincoln [ Fourth Generation Evaluation . Sage Publications, London.] was used.
Method.  Thirty paid caregivers drawn from eight nursing homes were interviewed about their experiences of working with residents' families. A constant comparative method of data analysis was used to arrive at the findings.
Results.  This paper reports on seven themes under the category of 'unacceptable behaviours'. These themes describe a range of attitudes and behaviours exhibited by families which staff members found undesirable.
Conclusions.  Staff members found a number of family behaviours challenging. Nursing home staff perceives the family as subordinate to their needs and want to retain control of the work environment.
Relevance to clinical practice.  Nursing home staff need to move away from custodial models of care focused on 'getting the work done' and develop more family friendly work practices that are inclusive of the needs of the family and view them as equal partners in care.     

Coaching patients to self-care: a primary responsibility of nursing

Aim.  To explore the process nurses use to guide and support patients to actively re-establish self-care.
Background.  The movement of hospitalized patients from less to more independence is primarily a nursing responsibility. Studies of nursing practice in inpatient rehabilitation settings have begun to shed some light on this, but as yet there is limited understanding of the actual skills nurses use to support patients to re-establish self-care.
Method.  This study used grounded theory. Microanalysis and constant comparative analysis of data collected during interviews with, and observation of, registered and enrolled nurses during everyday nursing practice in five inpatient rehabilitation units facilitated open, axial and selective coding. Relevant literature was woven into the final theory.
Findings.  To facilitate patient transition from the role of acute care patient to rehabilitation patient actively reclaiming self-care, nurses engaged in a three-phase process known as coaching patients to self-care. The three phases were: easing patients into rehabilitation, maximizing patient effort and providing graduated assistance.
Conclusion.  Coaching patients to self-care is a primary activity and technology of rehabilitation nursing.
Relevance to clinical practice.  Patients in a variety of settings would benefit from nurses incorporating coaching skills into their nurse–patient interactions.     

Psychosocial support as a counselling in improving health-related quality of life in patients with recent multiple sclerosis in Finland

Aim.  The aim of the study was to describe and explain psychosocial support provided by nursing personnel as experienced by people with multiple sclerosis.
Background.  The goal of providing psychosocial support is to understand and improve patients' health, self-care, initiative, commitment to care, resources, deal with emotions, social interaction and circumstances.
Design and methods.  Informants were individuals ( n  = 204) diagnosed using multiple sclerosis between the years 2003–2005 in Finland. Data were collected in 2005 by a posted questionnaire. The data were analysed with cross-tabulations, correlation coefficients, mean tests, a factor analysis and multiple regression analysis.
Results.  People with multiple sclerosis need psychosocial support from nursing personnel to promote health and self-care, strengthen emotional and mental resources and maintain social relationships. The support was to include information on multiple sclerosis and related treatment options, as well as discussion, listening to the patient and supporting them in the new situation in life caused by the illness.
Conclusion.  The psychosocial support received by the patients was sufficient and corresponded to their needs. Nursing personnel have the skills to improve the health-related quality of life of people with multiple sclerosis.
Relevance to clinical practice.  The results of this research may be applied in practical nursing, such as in planning of program of neuropsychosocial rehabilitation, in developing of home care and institutional care and in planning of content of nursing education.     

Task-oriented training in rehabilitation after stroke: systematic review

Title.  Task-oriented training in rehabilitation after stroke: systematic review.
Aim.  This paper is a report of a review conducted to provide an overview of the evidence in the literature on task-oriented training of stroke survivors and its relevance in daily nursing practice.
Background.  Stroke is the second leading cause of death and one of the leading causes of adult disability in the Western world. The use of neurodevelopmental treatment in the daily nursing care of stroke survivors does not improve clinical outcomes. Nurses are therefore exploring other forms of rehabilitation intervention, including task-oriented rehabilitation. Despite the growing number of studies showing evidence on task-oriented interventions, recommendations for daily nursing practice are lacking.
Data Sources.  A range of databases was searched to identify papers addressing task-oriented training in stroke rehabilitation, including Medline, CINAHL, Embase and the Cochrane Library of systematic reviews. Papers published in English between January 1996 and September 2007 were included. There were 42 papers in the final dataset, including nine systematic reviews.
Review methods.  The selected randomized controlled trials and systematic reviews were assessed for quality. Important characteristics and outcomes were extracted and summarized.
Results.  Studies of task-related training showed benefits for functional outcome compared with traditional therapies. Active use of task-oriented training with stroke survivors will lead to improvements in functional outcomes and overall health-related quality of life.
Conclusion.  Generally, task-oriented rehabilitation proved to be more effective. Many interventions are feasible for nurses and can be performed in a ward or at home. Nurses can and should play an important role in creating opportunities to practise meaningful functional tasks outside of regular therapy sessions.     

Engagement and learning: an exploratory study of situated practice in multi-disciplinary stroke rehabilitation

Purpose.?Active participation is considered to be a key factor in stroke rehabilitation. Patient engagement in learning is an important part of this process. This study sets out to explore how active participation and engagement are ‘produced’ in the course of day-to-day multi-disciplinary stroke rehabilitation.

Method.?Ethnographic observation, analytic concepts drawn from discourse analysis (DA) and the perspective and methods of conversation analysis (CA) were applied to videotaped data from three sessions of rehabilitation therapy each for two patients with communication impairments (dysarthria, aphasia).

Findings.?Engagement was facilitated (and hindered) through the interactional work of patients and healthcare professionals. An institutional ethos of ‘right practice’ was evidenced in the working practices of therapists and aligned with or resisted by patients; therapeutic activity type (impairment, activity or functional focus) impacted on the ways in which patient engagement was developed and sustained.

Conclusions.?This exploration of multi-disciplinary rehabilitation practice adds a new dimension to our understanding of the barriers and facilitators to patient engagement in the learning process and provides scope for further research. Harmonising the rehabilitation process across disciplines through more focused attention to ways in which patient participation is enhanced may help improve the consistency and quality of patient engagement.     

An exploratory study of nurse aides' communication behaviours: giving 'positive regard' as a strategy

medvene l.J. & lann-wolcott h. (2009)   An exploratory study of nurse aides' communication behaviours: giving 'positive regard' as a strategy. International Journal of Older People Nursing   5 , 41–50
doi: 10.1111/j.1748-3743.2009.00183.x
Aim.  The aim of this study was to identify the communication behaviours and strategies used by socially skilled geriatric nurse aides working with residents in long term care facilities.
Background.  Communication skills are recognized as tools for establishing relationships and accomplishing care related tasks. A small but growing research literature exists within gerontology around geriatric nurse aide/resident communication. The present study was intended to contribute to this literature.
Design.  This study used an exploratory qualitative design involving personal interviews with geriatric nurse aides.
Methods.  Interviewers carried out 90-minute interviews with 16 nurse aides who worked at an assisted living facility or a nursing home. Of interest was the extent to which established systems for coding interactions could be used to code nurse aide/resident interactions, or whether new categories would emerge.
Results.  The novel finding that all of the aides used a communication strategy that could be characterized as 'giving positive regard', defined as acknowledging the resident, treating the resident with respect.
Relevance to clinical practice.  The category of 'giving positive regard' included specific behaviours which can be included as content in communication skill training programs.     

Case Study: Home Nursing Care for a 62-Year-Old Woman with Multiple Health Problems

PURPOSE.  This case study illustrates the characteristics of, and challenges for, a woman in the United States with multiple health problems.
DATA SOURCES.  Data were obtained through the authors' experience and knowledge of community health nursing and from published literature.
DATA SYNTHESIS.  NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification were utilized to identify appropriate nursing diagnoses, interventions, and outcomes for the client.
CONCLUSION.  This case study illustrates and provides appropriate nursing diagnoses, interventions, and outcomes relevant to a woman with many health concerns. It provides guidance for nurses in community health settings when caring for patients with multiple health problems.
IMPLICATIONS FOR NURSING PRACTICE.  Utilizing the standardized nursing languages of NANDA International, Nursing Interventions Classification, and Nursing Outcomes Classification can provide the necessary framework for enhancing and improving the management of care for patients with many health concerns in the community setting.     

Acute care teaching in the undergraduate nursing curriculum

Aim:  To incorporate basic aspects of acute care into the undergraduate nursing programme by providing an opportunity for the development of knowledge and skills in the early recognition and assessment of deteriorating patients on general hospital wards.
Background:  Acute care initiatives implemented in the hospital setting to improve the identification and management of 'at risk' patients have focused on the provision of education for trained or qualified staff. However, to ensure student nurses are 'fit to practice' at the point of registration, it has been recommended that acute care theory and skills are incorporated into the undergraduate nursing curriculum.
Practice development initiative:  An 'Integrated Nursing Care' module was incorporated into year 3 of the undergraduate nursing programme to introduce students to acute care theory and practice. Module content focuses on the early detection and management of acute deterioration in patients with respiratory, cardiac, neurological or renal insufficiencies. We used a competency-based framework to ensure the application of theory to practice through the use of group seminars. High-fidelity patient-simulated clinical scenarios were a key feature. The United Kingdom Resuscitation Council Intermediate Life Support course is also an important component of the module.
Conclusions:  Incorporating the Integrated Nursing Care module into the undergraduate nursing curriculum provides pre-registration students the opportunity to develop their knowledge and skills in acute care.
Relevance to clinical practice:  The provision of undergraduate education in care of the acutely ill patient in hospital is essential to improve nurses' competence and confidence in assessing and managing deteriorating patients in general wards at the point of registration.     

康复训练与个性化护理干预对脑卒中失语患者康复的影响

【目的】观察个性化护理干预对脑卒中失语患者康复的影响。【方法】选择36例脑卒中失语患者,全部经头CT或MRI确诊是脑卒中失语,根据波士顿失语诊断测验（BDEA）评估表对患者语言功能进行评分并判断其失语类型,根据不同类型失语给予相应的康复训练与个性化的护理干预。于发病后1周进行第1次评估,以后每月随访1次,共4次,然后3个月再随访1次。经过（180±7）d康复训练后再次根据BDEA评估表对36例患者语言功能进行评分。【结果]36例患者全部完成康复训练后BDEA检测评分较康复训练前明显提高（P〈0．05）。【结论】康复训练与个性化的护理干预能有效改善脑卒中失语患者的语言功能,促进其康复。