Developing and establishing an expanded and more comprehensive HIV/AIDS nursing practice

Developing and establishing an advanced nursing practice is an essential step toward future-oriented nursing care. An action research process was initiated to establish advanced nursing practice at the HIV clinic of the outpatient department at the University Hospital Basel with the goal to offer advanced nursing care to patients. Participatory action research allows generating knowledge about a social system while at the same time tempts to promote social change. The most important goal is to constantly analyse, improve, and evaluate nursing care for patients and family caregivers. Advanced nursing practice in HIV/AIDS is based on solid knowledge regarding the illness and current therapies. Central concepts are caring, clinical experiences, evidence based practice, and patient preferences. Through a systematic step-by-step process, the nurses at the HIV clinic are being better educated and more experienced in these concepts. An essential aspect of advanced nursing practice is the specialization of each nurse in a self selected topic within HIV/AIDS care. These nurses now offer new services such as medication management and adherence support, health maintenance and prevention, and symptom management. This ongoing process of learning while establishing advanced nursing practice in HIV/AIDS, enables the nurses to face future changes in health care in a proactive way.     

Testing a classification instrument for the ambulatory care setting

The purpose of this study was to evaluate the construct validity, generalizability, and interrater reliability of an instrument designed to measure the complexity of nursing care in the ambulatory care setting. The conceptual framework for the development of the classification instrument was adapted from a theory of organizations and is based upon knowledge technology. Previous research using the Delphi methodology delineated 44 activity categories for the classification instrument. These categories were organized under six literature-based responsibility areas. The instrument was tested in seven areas of one hospital-based ambulatory care setting. A total of 641 valid patient ratings were used for the analysis. Results indicate the instrument has beginning construct validity and high interrater reliability with training. It is not generalizable across services unless the effect of clinic type on nursing care complexity is considered.     

Evidence-based nursing practice: both state of the art in general and specific to pressure sores.

The importance of research-based practice in nursing has been frequently stressed, and a number of nursing studies have been conducted whose results enable nursing to improve knowledge and practice. This study reports a literature review in which the current status of knowledge and research utilization with regard to pressure sores is described. This review first gives an overview of studies on knowledge utilization in general and shows that the spontaneous diffusion of knowledge is inappropriate. Furthermore, an overview of planned research utilization activities focusing on pressure sore prevention and treatment in nursing is presented. The results of these studies show that planned research utilization activities performed in individual organizations lead to positive outcomes in almost all cases. Therefore, it could be concluded that implementing planned research utilization activities in individual health care institutions seems to be an effective strategy to decrease pressure sore incidence and prevalence rates.     

Developing specialty knowledge: the case of Australian critical care nursing.

The generation of new knowledge is important to the evolution of the nursing profession and its specialties and is a fundamental requirement for the development of the discipline. This study documents the growth of empirical knowledge in Australian critical care nursing by examining the research published in one critical care specialty journal and a second generalized nursing research journal between 1994 and 1998. The proportion of research published in the specialty journal increased from 25 to 69%, with almost one-half focusing on patient therapies and treatments. The proportion of research in the general journal was consistently high, approximately 80 to 90%, with one to two critical care research articles per year. Nurses were first authors on the vast majority of these research articles. Approximately half of the critical care research focused on patient care. The results support the claim that Australian critical care nurses are conducting research to promote best practice in patient care and are thus contributing to the development of the discipline of nursing.     

Evaluating the Use of the Basic Knowledge Assessment Tool (BKAT) in Critical Care Nursing with Baccalaureate Nursing Students

In this study the Basic Knowledge Assessment Tool (BKAT) was administered to 38 senior baccalaureate nursing students prior to and following a course in critical care nursing to evaluate the reliability of the tool in measuring knowledge in critical care.
Results from the study indicate that the BKAT is a valid and reliable measure of knowledge in critical care nursing in the sample studied and possibly in similar samples, and part of that knowledge is basic nursing knowledge, and the B U T measures learning. A comparison group of 73 nurses with from 1 to greater than 6 years of experience in critical care nursing had statistically significant higher scores on the BKAT than did the students. This finding is consistent with that of previous research. However, findings from the study also indicate that senior nursing students have some critical care knowledge to bring to the employment situation following graduation .
The BKAT is regarded as an instrument that can assist nursing educators in schools of nursing to evaluate courses in critical care nursing and educators in the clinical setting to evaluate orientation programs. Indications also exist that the BKAT can be used as a tentative bench mark in narrowing the expectancy gap between what is learned by students and what nurse managers expect new graduates to know.     

Evaluation of a model of nursing care for older patients using participatory action research in an acute medical ward

Aims and objectives. The main aim of this study was to improve the quality of nursing care for older acutely ill hospitalized medical patients through developing, implementing and evaluating a new model of care using a participatory action research process. Background. One of the challenges of nursing today is to meet the health‐care needs of the growing older population. It is important to consider what quality of nursing care means to older patients if nurses are to address gaps between their own perceptions and those of older patients themselves and to consider conceptual models of care appropriate for older patients care in order to improve the quality of care provided. Design. This study is a mixed method triangulated study, involving the use of both quantitative and qualitative methods through participatory action research methodology to establish an evidence‐base for an evolving model of care. Methods. The model was tested on 60 acutely ill patients aged at least 65 years. The medical ward nurses selected a key reference group including the researcher to facilitate the participatory action research process to develop, implement and evaluate a new model of care based on Orem's self‐care model incorporating the Nurses Improving Care to Health System Elders Faculty (Am J Nurs 1994; 94:21) medication protocol to improve the nursing care provided for acutely ill older patients. Results. The participatory action research process resulted in improved heath‐care outcomes for the patients, such as significant improvements in activities of daily living capabilities between admission to discharge, significant improvements in knowledge levels regarding their medication regimes, as well as increased satisfaction with nursing care activities as perceived by older patients and nursing staff. The implementation of educational sessions during the model of care improved the older patient's functional activities and knowledge levels of their medication regime prior to discharge. In addition, by repeatedly explaining procedures, nurses became more involved with their individual patient's care, developing a patient‐centred care relationship based on Orem's self‐care model. Conclusions. This study demonstrates the efficacy of a new model of nursing care in improving the quality of nursing care for older patients in the acute medical ward setting. Relevance to clinical practice. This study is significant because of its evidence‐base and demonstrates how the participatory action research process empowered nurses to make sustainable changes to their practice. The nurses in the study wanted to affect change. The planned change was not dictated by management, but was driven by the clinical nursing staff at the ‘grass roots’ level. Therefore, being involved in the decision‐making process provided an incentive to actively implement change.     

An evaluation of a teaching intervention to improve the practice of endotracheal suctioning in intensive care units

Endotracheal suctioning is a frequently performed procedure that has many associated risks and complications. It is imperative that nurses are aware of these risks and are able to practise according to current research recommendations. This study was designed to examine to what extent intensive care nurses' knowledge and practice of endotracheal suctioning is based on research evidence, to investigate the relationships between knowledge and practice, and to evaluate the effectiveness of a research-based teaching programme. This quasi-experimental study was a randomized, controlled, single-blinded comparison of two research-based teaching programmes, with 16 intensive care nurses, using non-participant observation and a self-report questionnaire. Initial baseline data revealed a low level of knowledge for many participants, which was also reflected in practice, as suctioning was performed against many of the research recommendations. Following teaching, significant improvements were seen in both knowledge and practice. Four weeks later these differences were generally sustained, and provide evidence of the effectiveness of the educational intervention. The study raised concern about all aspects of endotracheal suctioning and highlighted the need for changes in nursing practice, with clinical guidelines and focused practice-based education.     

Good nursing care to ICU patients on the edge of life

Critically ill patients are admitted to intensive care units (ICUs) to receive advanced technological and medical treatment. Some patients seem not to benefit from the treatment, and sometimes questions are raised as to whether treatment should be withheld or withdrawn. This study was conducted using ICU nurses' experiences with the aim of acquiring a deepened understanding of what good nursing care is for these patients. The study was performed at an adult ICU in Norway, where 14 ICU female nurses were included as participants. The research design was based on interpretative phenomenology and data was collected by group interviews inspired by focus-group methodology. The participants were divided into two groups and each group was interviewed four times. Colaizzi's model was used in the process of analysis. The results show that good nursing care depended on several basic conditions: continuity, knowledge, competence and cooperation, and included clear goals to give appropriate life-saving -- or end-of-life treatment and care. Cornerstones in good nursing care were nurses' verbal communication and nurses' use of their hands. The study emphasises several consequences for future ICU nursing practice and education to enhance good nursing care to patients on the edge of life.     

The decision making process in a district nursing assessment

Assessment is a key element of district nursing practice and a cornerstone of community care. Yet very little research has been undertaken in this area. Given the current emphasis on evidence-based practice in health care, there is a need to ensure that district nurses, nursing students and educators can draw from an empirically derived and sound knowledge base. This article explores the relationship between knowledge and decision-making in district nursing assessment. It is based on a case study of one district nurse participant from a qualitative study of district nursing assessment. The case study material illustrates key findings from this study in order to examine the relationship between theoretical perspectives and everyday decision-making, based on the stages of decision-making identified by Carroll and Johnson (1990).     

A paradigm for the production of practice-based knowledge

Aim  The aim of this paper was to explore trends, arguments and issues surrounding knowledge production and nursing practice, and to propose a paradigm of practice-based knowledge along with strategies to promote theory-based knowledge development in practice.
Background  Practice-based knowledge has been marginalized in the current practice and research paradigms. Several reasons for this are presented, some of which may be addressed to facilitate a more inclusive approach to knowledge that can potentially advance patient care and the discipline.
Evaluation  Classic and contemporary scholarly sources in nursing, philosophy, education, social sciences and other areas were critically reviewed and applied to support the argument and propose a paradigm of practice-based knowledge production.
Key issues  A key point identified in the paper is that theory, meaning conceptualizations at all levels of abstraction, is an important tool of knowledge development in nursing practice as it is in traditional research.
Conclusions  Various strategies exist that can be employed to promote development and use of practice-based knowledge in the clinical setting. The strategies are innovative yet practical, and require the support and encouragement of nursing management for their successful implementation.
Implications for Nursing Management  Nursing managers can influence if not facilitate all of the strategies to promote practice-based knowledge development identified in the paper. These efforts could give voice to the caregiver's knowledge and, in turn, enhance patient care and the satisfaction and retention of nurses.     

Learning through teaching: empowering students and culturally diverse patients at a community-based nursing care center

This article addresses the effect of a nursing care center on student learning. Associate degree nursing students spend clinical days at a nursing care center that was created in collaboration with an inner-city clinic serving individuals who are uninsured and underinsured. The nursing students learn cultural sensitivity, teaching strategies, and interdisciplinary skills. The service-learning experience benefits the nursing students, the nursing department of the college, the patients who visit the nursing care center, the clinic, and the community. This article describes the development of the nursing care center, examples of teaching-learning opportunities, and evidence of student learning. This successful collaboration between a community college and an inner-city clinic can be Associareplicated by other nursing programs.     

Nursing students' knowledge and beliefs about care of older adults in a shifting context of nursing education

baumbusch j., dahlke s. & phinney a. (2012)?Nursing students' knowledge and beliefs about care of older adults in a shifting context of nursing education. Journal of Advanced Nursing68(11), 2550-2558. ABSTRACT: Aim. To a report a study of improvements in students' knowledge and beliefs about nursing care of older adults following completion of an introductory course with integrated adult/older adult content. Background. Nursing schools are under pressure to provide accelerated programmes to meet growing workforce demands and provide students with the knowledge they require to care for an ageing population. Thus, stand-alone courses in gerontological nursing are being eliminated and integrated with general adult content. The effect of this approach remains poorly understood. Design. A one-group pretest-post-test design was used. Methods. Data were collected between September-December 2010. Students completed the Palmore Facts on Aging Quiz, the Perceptions of Caring for Older People Scale, and open-ended questions about their experiences before and after completing a course with integrated adult/older content. Results. Students' knowledge and beliefs about nursing care of older adults demonstrated an important improvement following completion of the course. Qualitative findings reflected three themes: relating to older people; neglect by the system; having time to learn. Conclusions. Findings from this study suggest that even when integrated with general adult content, students' knowledge and beliefs about older adult care can be positively influenced. Furthermore research is needed to examine long-term integration of students' learning about older adult care. Nursing faculty with expertise in nursing care of older adults must develop resources and supports for their colleagues to build capacity among nurse educators and integrate older adult content throughout nursing programmes to enhance nursing practice with an ageing population.     

A staff development programme to support the incorporation of the McGill model of nursing into an out-patient clinic department

In order to adopt a nursing model as a framework for professional practice in an out-patient department of a paediatric tertiary care hospital, a staff development programme was instituted The nursing model chosen was the McGill model of nursing, which emphasizes the complementary role of nursing and focuses on people's health, strengths and potentials Staff development initially consisted of a journal club and clinic nurses were exposed to such concepts as family, coping, and health As the nurses acquired theoretical knowledge, the staff development programme was concerned with applying this knowledge to clinical situations As well as the nursing in-service training, clinical supervision with small groups of nurses was instituted A study showed that staff development helped nurses to build a larger repetoire of family nursing skills The nursing role in the department evolved Nurses developed a more professional practice and provided health services which were complementary to those offered by other health professionals     

肿瘤患者安宁疗护护理质量评价标准的构建及应用研究

目的：建立安宁疗护护理质量评价标准,探讨其合理性及可操作性,为客观评价安宁疗护护理质量提供依据与检测工具。 方法：采用理论研究与临床调研相结合的方法初步拟订安宁疗护护理质量标准,应用德尔菲专家咨询法对 20 名专家进行两轮问卷咨询,定量分析各指标的权重。将该评价指标应用于临床,比较使用该指标前后护理质量的改善情况。 结果：护理质量标准包括Ⅰ级指标4条、Ⅱ级指标27条。将肿瘤患者安宁疗护质量评价指标应用于临床,比较应用后与应用前患者临终护理质量、患者及家属对护理的满意度,都有显著提高（P＜0.05）,具有统计学差异。 结论：安宁疗护护理质量标准指标体系各级指标的条目专家意见集中,研究结果可信度高,对安宁疗护护理质量的评价提供了客观、可量化的依据,值得在临床推广应用。     

肿瘤患者安宁疗护护理质量评价标准的构建及应用研究

目的 建立安宁疗护护理质量评价标准,探讨其合理性及可操作性,为客观评价安宁疗护护理质量提供依据与检测工具.方法 采用理论研究与临床调研相结合的方法初步拟订安宁疗护护理质量标准,应用德尔菲专家咨询法对20名专家进行两轮问卷咨询,定量分析各指标的权重后确定.将该评价指标应用于临床,比较使用该指标前后安宁疗护护理质量的改善情...     

A supportive nursing care clinic: conceptions of patients with head and neck cancer.

Patients with head and neck cancer have complex long-lasting physical and psychosocial needs due to illness and treatment, and studies have shown deficiencies concerning support in these respects. The purpose of this study was to describe how head and neck cancer patients with eating problems conceived the significance of a supportive nursing care clinic before, during and after completion of radiotherapy. Thematic interviews were carried out in an open dialogue with 12 patients treated with radiotherapy for head and neck cancer. The phenomenologischer method was used in the analyses. The findings showed that the nurse clinic could meet head and neck cancer patients' needs of safety and security, which was especially important before and after completion of treatment when no other regular contacts in the health care system existed. The significance of the nurse clinic varied depending on where in the trajectory the patients were, what needs and problems they experienced, and how severe these were experienced by the individual patient. The supportive nursing care clinic could meet these patients' needs of knowledge, care and support both concerning practical measures related to the disease and its treatment, and emotional needs. This way of organising the care can contribute to these patients' health and wellbeing.     

Nursing prioritization of the patient need for care: A tacit knowledge embedded in the clinical decision-making literature

Every day in clinical settings, nurses practise in complex and dynamic situations. Nurses work to achieve emergent order in these situations through nursing prioritization of the patient need for care. As direct research on nursing prioritization had not been reported, a study, using critical realism as method, was designed to discern the profession's embedded understanding from within the clinical decision-making literature. The research synthesizes a tacit knowledge on nursing prioritization of the patient need for care from key international literature (from 1966 to 2003). Nursing prioritization was discerned in both education and practice literatures; interrelationships between these and theoretical approaches were also identified. Nursing prioritization of the patient need for care was revealed both as a non-sequential decision-making process throughout unfolding patient situations and as an advanced skill of nursing practice. Increasing confidence with this skill is the hallmark of developing expertise.     

Mistrust of academic knowledge among nurses in Slovenia

DOMAJNKO B. & PAHOR M. Mistrust of academic knowledge among nurses in Slovenia. International Nursing Review 57 , 305–311 Aim: The paper discusses the negative attitudes of some nursing assistants in Slovenia towards higher nursing education and academic (theoretical and research based) knowledge. Background: The topic is discussed in the context of traditional hierarchical and patriarchal relations in the health‐care sector, professionalization of nursing and the evidence‐based debate in nursing. Methods: A secondary analysis of data gathered in 2005 was carried out. The topic of the original research was the interprofessional collaboration between medical and nursing care professionals in Slovenia. The secondary study looked closely into the relations within nursing care. Specifically it focused on the nursing assistants' perspective. Five hundred ninety‐two answer to two open‐end questions (307 from nurses and 285 from nursing assistants) and five semi‐structured interviews (with three nurses and two nursing assistants) were re‐analyzed (with the new focus), applying inductive qualitative content analysis and the pragmatic approach to interpretation. Findings: In nursing assistants' view, the difference between themselves and graduate nurses was described in terms of the distinction ‘work – non‐work’. Higher education was associated primarily with striving for higher social status. Academic knowledge was not perceived to include the right competencies for either practising or improving the quality of nursing care. Conclusions: The mistrust of the academic nurse on the part of some nursing assistants is interpreted as a barrier to full professionalization of nursing care and also interprofessional collaboration in the health‐care sector.