How professional nurses in a general hospital setting perceive mentally ill patients

In recognition of the enormous challenges in South Africa confronting the nursing of the mentally ill, this project was conducted in a public hospital in Gauteng. The purpose of the research was to describe professional nurses' perceptions of nursing mentally ill people in a general hospital setting and was carried out amongst a sample size of 124 professional nursing staff. Data was collected using a survey questionnaire. The study looked at two different types of perceptions that were guided by categories of conceptual framework proposed by Mavundla in 2000, namely perception of self and perception of patients. This particular study found that the majority of professional nurses had a predominantly positive perception of self in caring for or nursing the mentally ill in a general hospital setting, although a significant number of them had a negative and stereotyped perception of the patients. Lack of knowledge, skill and experience in psychiatry among the nursing staff was identified as affecting the nursing care process of the mentally ill.     

The need to know: experiences of critically ill patients.

BACKGROUND: Critically ill patients vary in their memories of their experience in the intensive care unit. Some have little recall and need to learn about their critical illness. Others have more vivid memories of their experiences, some of which were extremely unpleasant. Patients' not knowing what was happening may have exacerbated the unpleasant experiences. OBJECTIVES: To elicit the experience of knowing for critically ill patients and to explore the differences in perceptions between patients who were intubated and those who were not intubated during the illness. METHODS: Grounded theory was used to explore the meaning of knowing and not knowing and the process by which knowing occurs. Unstructured interviews were done with 14 patients. RESULTS: Knowing had 2 phases: the need to know (1) during and (2) after the critical illness. The first phase had 3 facets: needing information, needing to be oriented, and having confusing perceptions. The second phase had 2 facets: needing information about what had happened and piecing together events. Many experiences with knowing during and after a critical illness were similar for both intubated and nonintubated patients. The main difference was the intensity of the experience in some categories. CONCLUSIONS: Critically ill patients have a strong need to know throughout and after their time in the intensive care unit. Nurses must address this need for constant reorientation to the past and present in these patients. In addition, adequate nursing staff must be available for these patients.     

Transporting critically ill patients: new opportunities for nurses

This article examines the inter-hospital and intra-hospital transport of critically ill patients in relation to recent guidelines and recommendations for the safe transfer of patients. The impact of new legislation on existing practice and the implications for developing new nursing roles are also discussed.     

Nurses' experiences of caring for patients with a dual diagnosis of depression and alcohol abuse in a general psychiatric setting

The aim of this study is to describe mental psychiatric health nurses' experiences of caring for persons with the dual disorders of major depression and alcohol abuse. The study was conducted in 2003 on three psychiatric wards located in two general hospitals in Sweden. The study group comprised 11 registered nurses with experience of caring for patients with dual disorders. The data were analyzed by means of qualitative content analysis. The findings revealed three categories: Enabling a good level of cooperation with patients; Facilitating continued care and treatment; and Understanding barriers to cooperation with patients. Building a trusting relationship in order to enable cooperation with patients was the basis for continued care and treatment. The nurses needed more training and multidisciplinary knowledge in order to meet the particular clinical needs of this patient group. Nurses have an important obligation to utilize the best available evidence, including research findings and other scientific sources.     

The hidden contribution of the health care assistant: a survey-based exploration of support to their role in caring for the acutely ill patient in the general ward setting

butler-williams c. , james j. , cox h. & hunt j . (2010) Journal of Nursing Management 18, 789–795
The hidden contribution of the health care assistant: a survey-based exploration of support to their role in caring for the acutely ill patient in the general ward setting Aim To examine the feelings, support and feedback available to health care assistants (HCA) when caring for acutely ill ward patients. Background The role of the HCA continues to evolve with increased responsibility for patient care. Contextual issues that affect their contribution to acute care management of the ward patient have been given limited attention. Methods A survey of HCAs (n = 131) was conducted within two district general hospitals. Results There were a number of emotions and stressors associated with the care of acutely ill patients. While normal hierarchical systems were in place in order to obtain help HCAs additionally bypassed these normal channels. Support mechanisms included registered nurses, ward doctors, peers and family. Feedback regarding performance was limited. Conclusion HCAs play a significant role in the care of the acutely ill patient. Feedback mechanisms need to be developed and associated emotions recognized. Implications for nursing management HCAs support needs to be more evident and clinical feedback mechanisms need to be reviewed in order to improve care delivery.     

A model to help nurses caring for patients who are terminally ill

In an age when people are no longer automatically dying from serious illnesses such as cancer or heart disease, patients, families and health-care staff may find coping with a terminal illness difficult. A multidisciplinary team in one hospital used Moos' transitional model, which describes adaptive and coping techniques, in their care of a dying man and his family.     

Decisions and attitudes of nurses caring for severely ill elderly patients: a culture-comparing study

Results of a comparative investigation in Swedish and German nurses are presented. Based on a case-vignette with three levels of available information about patient wishes the subjects were asked about their decisions. Generally, the Swedish nurses showed a tendency towards less aggressive treatment-options and to perform less frequent cardio-pulmonary resuscitation (CPR) against the patient written will compared with the Germans. The compliance with patient wishes among nurses from both countries was related with the valuation of the patient directive as a useful tool in their decision-making process. Furthermore, the "level of dementia" emerged as a significant predictor of the treatment decision in both groups. The results point to the necessity of continuous education and training of nurses aiming at the issues of ethical attitudes and coping with ethically problematic situations in the treatment of the elderly in order to improve patient autonomy.     

The experiences of district nurses caring for people receiving palliative chemotherapy

The treatment options being offered to people with advanced cancer are increasing with growing use of palliative chemotherapy. As people are experiencing shorter hospital stays and receiving treatment on an outpatient basis, this has implications for primary health-care provision. This study aimed to explore the experiences of district nurses caring for patients receiving palliative chemotherapy: how they viewed their role, factors that influenced their role and their attitudes to palliative chemotherapy. Data were collected using qualitative interviews that incorporated critical incident technique (n=10). Themes that emerged from the content analysis included the role of the district nurse, knowing the patient and family, the interface between hospital and primary care, and uncertain ground. District nurses saw their role as having relevance at all stages of the patient's cancer journey and the provision of holistic care based on good interpersonal relationships was valued. However, difficulties were perceived at the interface between hospital and primary care. District nurses had ambivalent attitudes to palliative chemotherapy but had positive attitudes towards optimizing quality of life and care in the palliative stages of illness.     

Transport of critically ill children in a resource-limited setting

OBJECTIVE: To audit paediatric intensive care unit (PICU) transfer activity and transfer-related adverse events in a resource-limited setting. DESIGN AND SETTING: Twenty-two bed regional PICU of a university children's hospital in Cape Town, South Africa. Prospective 1-year audit of all children transferred directly from other hospitals. Data were collected for patient demographics, diagnostic category, referring hospital, transferring personnel, mode of transport, and technical, clinical, and critical adverse events. Data are median (interquartile range) or percentages. The transfers of 202 children, median age 2.8 months (1.1-14), median weight 3.5 kg (2.5-8.1) were analysed. RESULTS: Most transfers were performed by paramedic personnel (82%) and via road ambulance (76%). One or more technical adverse events occurred in 36%, clinical adverse events in 27%, and critical adverse events in 9% of children. Retrievals by intensive care staff (10%), all from rural hospitals, had a lower incidence of technical adverse events (0%). Children transferred from non-academic hospitals within the metropolitan area had the highest incidence of technical (44%), clinical (39%), and critical (17%) adverse events. Crude mortality was 17% ( n=34). Technical adverse events were not associated with mortality. Non-survivors were more likely to develop shock (32%) or hypoxia (26%) during transfer than survivors (10% and 11%, respectively). CONCLUSIONS: There is a high incidence of transfer-related adverse events, most commonly in transfers from non-academic metropolitan hospitals. Further studies are needed to assess the impact of regional paediatric life support training or a specialised retrieval team on clinical adverse events and mortality.     

From a psychiatric ward to a home‐like setting: the meaning of caring as narrated by nurses

? This study presents interviews with nurses 1 and 2 years after they moved to a home‐like setting, compared with results from interviews with nurses before their move. A phenomenological hermeneutic perspective inspired by Ricoeur guided the study. The interviews focused on the meaning of their work, including their view of the client as a person and the care they provide. ? The meaning of caring was interpreted in terms of the following themes: ‘being free and entrusted with the task of caring makes a difference’; ‘sharing the activities of everyday life is a natural way of being together’; ‘providing a warm, open and supportive caring atmosphere’, ‘sharing the client’s everyday world with compassion and love, glimpsing possibilities’; and ‘dealing with limiting circumstances in care, the lack of “homeliness”’. ? Findings suggest a transformation in the view of care that reveals itself in increased closeness in the client–carer relationship and a change in values. The narratives revealed a caring atmosphere, valuing the client as well as the carer. ? The same questions guided all interviews, allowing developments to be followed. The carer and the interviewer thus became increasingly familiar with the situation on each interview occasion and the possibility that this has influenced the study must be taken into consideration. However, the similarity between nurses’ narratives validated their trustworthiness.     

Pleural effusion in critically ill patients and intensive care setting

Pleural effusion usually causes a diagnostic dilemma with a long list of differential diagnoses. Many studies found a high prevalence of pleural effusions in critically ill and mechanically ventilated patients, with a wide range of variable prevalence rates of up to 50%-60% in some studies. This review emphasizes the importance of pleural effusion diagnosis and management in patients admitted to the intensive care unit(ICU). The original disease that caused pleural effusion can be the exact caus...