Health teaching in clinical nursing practice

The Nurses' Board of Western Australia identifies health teaching as one of five essential role competencies in its regulation of professional nursing practice. This implies that patient/client education is recognized as a fundamental component of health care, however there is mounting concern within the profession that nurses are not taking full advantage of teaching opportunities that present in clinical practice. This paper reviews literature about health teaching and suggests that patients should be better informed about their health status and future health maintenance.     

Nursing approaches to the mental health of the elderly: a position paper

Although geropsychiatric nursing or mental health nursing with the elderly (MHNE) can be conceived of as a new subspecialty in psychiatric mental health nursing, in essence it is as old as nursing itself, for caring for people of all ages has always been within the purview of nursing. Today, however, in the more developed countries, older adults have increased both in numbers and in sophistication. These two changes have altered mental health care for the elderly. For example, mental health professionals now recognize that the elderly have an image problem which leads to underutilization of existing services. Psychiatric mental health nursing as a whole is questioning the nature of its practice and its place both within academic settings, and within the health care service delivery system. This paper explores the future possibilities and choices for the new subspecialty, mental health nursing with the elderly.     

Community as client: appropriate baccalaureate- and graduate-level preparation

This article focuses on the theoretical concept of community as client and its application in community health nursing education and practice. Although the concept of community as client has been widely accepted, it was observed that care to individuals and families within community settings constitutes the bulk of current community health nursing practice. The argument is made that undergraduate nursing students should be prepared as generalists to provide care within community settings. Undergraduate nursing students should be introduced to the concept of community as client, with an emphasis on understanding the relationship between individual or family needs and community needs. It is also argued that graduate nursing students should be prepared at the specialist level, focusing primarily on providing care to the community as client. An example of undergraduate and graduate levels of preparation in one university nursing program is described.     

Surgical considerations in the elderly

The number of older adults in America is rising every year. This increase in the elderly population will have a direct impact on health care delivery and perianesthesia nursing. Consequently, nurses need to increase their knowledge regarding the geriatric patient undergoing surgery. Areas of particular importance for nurses are preoperative assessment, medications taken by the elderly, preoperative instructions, intraoperative nursing care, postoperative nursing care, and discharge planning. Also of particular concern for the elderly surgical patient are nutrition, skin integrity, pain management, and promotion of sleep and comfort. The geriatric client requires extra time when being prepared for both elective and emergency surgery. A little planning goes a long way, and nurses need to enhance their communications skills to promote positive outcomes for the geriatric surgical patient. Caring for the elderly surgical patient can be a significant challenge, but if nurses work together as part of the perianesthesia/perioperative team, the experience can be extremely rewarding.     

Adaptation of a Best Practice Guideline to Strengthen Client‐Centered Care in Public Health

Best practice guidelines (BPGs) were developed by the Registered Nurses Association of Ontario (RNAO) to support evidence‐based nursing practice. One Ontario public health unit chose to implement the BPG on client‐centered care (CCC). A critical review of this BPG revealed issues that would hinder successful implementation within a public health setting. These included a focus on the client as an individual, the predominance of acute care exemplars and training resources that were not representative of public health nursing practice, and the need to reconcile the enforcement roles of public health with the BPG principles. The purpose of this article is to describe the process of adapting the CCC BPG to more accurately reflect the broad scope of public health nursing practice. A model for CCC in public health nursing context is presented and processes for implementing, evaluating, and sustaining CCC are described.     

The impact of client selection on clinical teaching

Inclusion of gerontological nursing in curricula is emerging as an issue of concern to faculty of schools of nursing. Using research findings which view the setting and client selection as major determinants of learning outcomes, faculty are experimenting with teaching strategies which support a positive more realistic view of the elderly and their inherent potential and motivation for health. This paper examines the learning outcomes about ageing of a senior clinical experience at the baccalaureate level directed toward learning to nurse the elderly in a responsive and health promoting manner. Students were provided with an opportunity to become comfortable working with the elderly and their families in order to: 1 increase their level of knowledge about the process of ageing; and 2 incorporate this knowledge within a nursing framework by identifying critical aspects of development used in the health assessment of the elderly. The method of study was primarily experiential in nature with each student making a series of home visits over a 3-month period to one selected client family. Two groups of clients participated in the programme: clients in group A were maintaining themselves in their own homes, were not anticipating institutionalization and were in good health; clients in group B were in hospital for treatment of a major health problem but would be recuperating in their own homes. By using Palmore's Facts on Ageing Quiz, it was determined that client selection did in fact make a difference vis-à-vis learning outcomes about ageing and the aged.     

A community nursing center for the health promotion of senior citizens based on the Neuman systems model

This article describes a community nursing center that provided clinical learning experiences for students from two schools of nursing. Work at the center was based on the Neuman systems model, which views the client as a system in interaction with environmental stressors. Nursing interventions focused on health promotion services for an underserved elderly population. The benefits of using the Neuman systems model for patient care, education, and research are outlined.     

A portrait of district nursing: its contribution to primary health care

This paper explores the role and contribution of district nursing within primary health care. Examples of how this service is organised within different health care systems are used to discuss the context-dependent nature and challenges of the work. By drawing on UK policy change, health priorities and recent research into district nursing, the paper concludes that, in attempting to deal with the challenges of health care in the 21st century, the significance and potential of district nursing services are frequently overlooked. It is recommended that a research strategy for district nursing should build on the profession's comprehensive understanding of the needs of families and communities and should aim to provide evidence for practice that will further improve patient and client outcomes.     

A portrait of district nursing: its contribution to primary health care

This paper explores the role and contribution of district nursing within primary health care. Examples of how this service is organised within different health care systems are used to discuss the context-dependent nature and challenges of the work. By drawing on UK policy change, health priorities and recent research into district nursing, the paper concludes that, in attempting to deal with the challenges of health care in the 21st century, the significance and potential of district nursing services are frequently overlooked. It is recommended that a research strategy for district nursing should build on the profession's comprehensive understanding of the needs of families and communities and should aim to provide evidence for practice that will further improve patient and client outcomes.     

Developing an evening clinical experience for baccalaureate community health nursing students

With the ever-changing directions in health care delivery, baccalaureate nursing instructors are being challenged with the task of seeking out innovative approaches to community health nursing clinical experiences. With the focus on "community as client," an evening clinical program was designed and piloted for nontraditional nursing students who, because of daytime employment, were in need of evening courses to further their nursing education. The pilot project incorporated family nursing care, community-centered practice, and observational experiences. The evening community health nursing clinical experience was found to be mutually beneficial to clients and students and served to fill a gap in health teaching within the community.     

Client relevant care and quality of life: the trial of a Client Generated Index (CGI) tool for community nursing

Community nursing organisations worldwide seek optimal ways to ensure adequate measurement of health outcomes for the client following nursing care, and to facilitate a consumer focus. This article presents a trial of the Client Generated Index (CGI) tool that subjectively assesses and measures the quality of life outcomes pertaining to a client's health status, whilst also facilitating individualised care. Sixty district nursing clients participated in the trial, which ascertained that the CGI tool effectively directs the client to list, grade and prioritise personally relevant quality of life issues. Consequently, this tool is being incorporated into client admission and discharge assessment within the organisation.     

Differentiated practice: The evolution of professional nursing

Differentiated practice identifies and uses three distinct nursing roles to create a comprehensive nursing care delivery system that meets client needs across the health care continuum. Clearly defined associate degree in nursing, bachelor's of science in nursing, and master's science in nursing competencies present career opportunities for professional nurses at the bedside providing, integrating, or managing client care as well as options in management, education, and regulation. An evolutionary paradigm shift required of all nurses is the awareness that each nurse is not the whole of nursing, but rather each nurse contributes to the whole of nursing. A nursing community comprised of differentiated roles that are mutually valued and well integrated will position nursing as a powerful force in meeting the diversity and complexity of health care needs in contemporary society.     

Primary Health Care of Elderly Women

Traditional health care of the expanding elderly population has focused on illness diagnosis and management. However, because more individuals, women especially, are living longer and living better, the emphasis should be shifted and modified to include primary health care for elderly people. Primary health care includes active health promotion and health maintenance, prevention of illness or disability, and attention to the quality as much as to the quantity of life. Unfortunately, the health concerns of elderly women, especially the oldest-old groups who live more or less independently, have been addressed inadequately in medical and nursing literature. Routine approaches to health care for women aged 70 and older must consider women's apparent hardiness, potential social isolation, and unique worries about safety and independence. Nurse practitioners in adult health, family practice, and gerontology must expand their repertoire of health promotion and health maintenance strategies to meet the needs of this special population. This article outlines the role of the nurse practitioner in the care of the well elderly woman.     

Client satisfaction with student care in a nurse-managed center.

Nursing faculty across the country are developing nurse-managed centers to provide students with community health experiences. Although students deliver much of the care provided within nursing centers, the literature offers little data on the quality of student-rendered care. This study evaluated client satisfaction with care received from student nurses. Results have direct implications for faculty supervising students in community health nursing agencies.     

Nursing protocol for telephonic supervision of clients.

Access to care, client vulnerabilities, technology, and health costs affect not only the delivery of health care but also the roles, responsibilities, and opportunities for nurses. Patients are often managed in the home or discharged from hospitals before they or their families are ready. To address some of these needs, nurses are utilizing telehealth opportunities. For many nurses, telehealth translates to telephonic nursing. This article provides an algorithm that nurses can utilize in order to safely monitor patients in their homes. This can be a cost-effective program, particularly for those who are homebound or for persons, such as the elderly or those with chronic illness, who have long-term needs that vary between relative health and acute illness. This algorithm serves as a guide in our nursing practice for the telephonic supervision of patients in the home environment.     

Client satisfaction with nursing services. Evaluation in an occupational health setting.

Client satisfaction surveys have served as a valued appraisal tool of quality nursing care in various health care settings, but there is a paucity of published research using these tools in the occupational health setting. Employing a modified version of the SERVQUAL questionnaire, this study identified employees' current levels of satisfaction and perceived importance of nursing care provided by an occupational health program. Two hundred randomly selected employees were asked to participate by completing the survey, with 86 (43%) responding. Results indicated a positive correlation between client satisfaction and perceived importance of nursing care. Moderately high levels of client satisfaction existed in the sample. The use of client satisfaction surveys based on the strength of client preferences could identify areas of health care that need improvement.     

An exploration of mental health nursing students' experiences and attitudes towards using cigarettes to change client's behaviour

Using cigarettes to change client behaviour is a common, yet little studied, practice in mental health care. A questionnaire survey was used to explore mental health nursing student's experiences and attitudes to this practice. The sample was four cohorts of mental health nursing students (n= 151). Of them, 84% had experienced the practice of using cigarettes to change client behaviour in acute wards (73%), rehabilitation wards (28%) and elderly care (14%). Cigarettes were used to change client behaviour in areas such as attending to personal hygiene (57%) or engaging in the ward routine (39%). However, items such as leave (60%) or drinks (tea and coffee) (38%) were also reportedly used. Of the respondents, 54% inferred that the practice did not work well with 46% stating it was not written up in care plans; 52% felt it was an ad hoc practice, 60% inferred that at times it was used as a punishment while 55% intimated that they felt bad withholding cigarettes. There are ethical and moral dilemmas around using lifestyle risk factors as rewards or using client's nicotine addiction as a means of controlling behaviour. The question of whether this intervention should ever be used, given its associated health risk, requires more critical debate in clinical practice.     

Correlates of caregiving satisfaction: prerequisites to elder home care

In this comparative study, a path analytic model was used to identify variables predictive of satisfaction in providing care to elderly family members, and to determine differences in the predictor variables between past and present caregivers as potential precipitators of institutionalization. Nineteen current caregivers and 29 past caregivers were recruited from health agencies in a rural area. Demographic predictors of caregiving satisfaction included age and sex of the client and age of the caregiver; psychological problems of the client influenced caregiver satisfaction. Measures of situational stress (medical, psychological, environmental) revealed that the past caregivers had higher psychological and environmental stress and less life satisfaction than current caregivers. Additional analysis revealed that the most common pattern of nursing home admission was hospitalization of the client for physical illness, with subsequent physician-recommended nursing home placement. Areas of identified need for preventing premature relinquishing of the caregiving role are discussed.     

Substitution of formal and informal care for the community-based elderly

The Minnesota Pre-Admission Screening/Alternative Care Grants Program screens those at risk of nursing home placement and funds services that will allow the elderly to be cared for at home. Information was collected for a 1-year period on client placement, health and functional status, informal support, use of health and formal services, and care-giver characteristics for 214 clients screened during the last quarter of 1984. A two-equation model was hypothesized to examine the formal service decisions of case managers and the amount of informal care provided for elderly clients at risk of institutionalization. A system of two simultaneous equations was estimated using a two-stage least-squares approach. The findings suggest that case managers allocate formal services based primarily on client need. The amount of informal care provided to clients did not affect significantly the decisions of case managers and is not determined significantly by the amount of formal services received by the elderly in the community. The lack of substitution between formal services and informal care reinforces the findings of previous research.