Factors influencing home care nursing problems and nursing care

This study was conducted to determine the contributions of sociodemographic factors, medical conditions, and nursing dependency to nursing problems identified and nursing care provided to patients during a home care nursing visit. Patient interviews, direct observation of nursing care, record abstraction, and nurses' reports were used to obtain data from 438 patients receiving nursing visits from a certified home health agency. Nursing dependency was the strongest predictor of the nursing problems of and nursing care provided to home care patients. Measures of nursing dependency should be incorporated in models to determine the extent of nursing problems and nursing care provided in the home and in models of home care nursing reimbursement. © 1993 John Wiley & Sons, Inc.     

Analysis of spirituality content in nursing textbooks

Although most nurses believe spiritual care is an integral component of quality, holistic nursing care, they rarely address spiritual issues and typically feel unprepared to do so. One reason for nurses' lack of preparedness to provide spiritual interventions is that their basic education only minimally discusses spirituality and related issues. This is compounded by the problem that only sporadic reference to spiritual care is found in most nursing textbooks. This study was conducted to analyze the content related to spirituality in nursing textbooks in order to determine where spiritual care is addressed and evaluate its adequacy. A total of 50 textbooks from a wide variety of nursing specialty areas were selected from the most recent Brandon Hill list. These books were examined to assess the percentage of pages discussing spiritual issues and analyze inclusion of core content essential for nursing practice. Although there was considerable variation among the books from all specialty areas, overall, hospice/terminal care, fundamentals of nursing, health assessment/health promotion, and transcultural nursing textbooks provided the most information about spirituality and spiritual care. Textbooks focusing on professional issues, medical-surgical nursing, maternal-child health nursing, critical care nursing, and community health nursing contained the least spiritual content. Suggestions are made regarding how to integrate spiritual issues and spiritual care in all nursing textbooks that pertain directly to patient care.     

Economic crisis and nursing in Spain

zabalegui a. & cabrera e. (2010) Journal of Nursing Management 18 , 505–508
Economic crisis and nursing in Spain Aim The purpose of the present study is to describe the economic context in Spain and its impact on the health care sector and in nursing schools. Background The global economic crisis is affecting nursing in Spain. This study analyses and compares indicators related to health care and nursing schools among European countries. Some new strategies to cope with the challenges arising from the health care crisis are suggested. Key issues Health care costs are increasing as a result of the ageing of the Spanish population, immigration, chronicity of health problems and new medical technology. Nursing education has changed in 2010 from a 3-year diploma programme to a 4-year University degree in Nursing. This change requires new resources involving staff, facilities and equipment, all of which are lacking because of the economic crisis in Spain. Conclusions The worldwide economic crisis has affected Spain more than it has other European Union (EU) countries. This global crisis has an impact on the health care sector as well on nursing schools. Implications for nursing management It is essential for nursing management to develop creative approaches to maintain cost effective patient care. New programmes and technology must be carefully evaluated in terms of cost effectiveness before being implemented. All health care professionals should be well informed and have a solid understanding of this situation.     

Family nursing education and family nursing practice in Nigeria

A survey of six Nigerian nursing program curricula was conducted to determine the extent to which family nursing theory was used as a reference for conceptualizing nursing care in Nigeria. In addition, 25 nurse clinicians were purposely selected from three levels of primary, secondary, and tertiary health care units in Ile-Ife, Nigeria, and were interviewed to determine the extent to which nurses in practice reported using family assessment tools in their practice. The survey of the postgraduate curricula showed that master's and doctorally prepared nurses specializing in community health nursing have a theoretical base in family nursing theory. The limited focus on family nursing theory in basic, postbasic, and first-degree nursing curricula was deemed inadequate to develop the knowledge and skills necessary for all practicing nurses to embrace family-focused care in Nigeria. In nursing practice, families were seen to be involved in nursing care only to the extent of meeting financial and physical care needs of their family members. Findings from this study point to the need for a reorientation of the nursing curricula in Nigeria to include more family nursing theory. Specialized education of family nurse practitioners who would function at all levels of care also is a desirable goal to provide holistic health care to Nigerian families.     

Health-promoting nursing practice: the demise of the nursing process?

Health promotion is gaining widespread recognition throughout the world as the most efficacious practice in achieving health for all In Canada, the philosophy of health promotion is driving both federal and provincial health initiatives Such a philosophy is derived from a human science paradigm and is in direct opposition to the natural science paradigm from which the biomedical approach to health care emerged There now exists a tension between these contrasting paradigms as health care shifts to embrace a health-promotion perspective The nursing process is based in the natural science paradigm and on a biomedical approach to health care In order for nurses to embrace health promotion fully, they must move away from the philosophy of the natural sciences and adopt a human science perspective Such a shift requires a radical transformation in nursing practice as nurses move away from the'top-down'approach of the nursing process and adopt a'bottom-up'approach to health-promoting nursing practice The purpose of this paper is to compare and contrast the nursing process with the principles of health promotion, and to challenge our use of the nursing process in current nursing practice In particular, a framework for health-promoting nursing practice will be provided     

The pricing of nursing care

Despite the poor performance of the general economy, the health care industry in Australia has experienced constant growth for several decades. Overall, Australia's expenditure on health is relatively high and, with an increasingly aged population, this expenditure is not likely to decrease. With the current concerns over cost-containment in the health sector it is important to assess the value of nursing care in economic terms. This paper explores the issue of valuing of nursing care within the framework of the Australian Health Care System. Questions are posed of nurses as to whether they are prepared to confront the realities of the health care arena and whether they are ready to value nursing practice in terms of economic value. As well as answering these questions, the paper argues that nursing costs are not sufficiently reimbursed under the current Australian health benefits, and that this poor estimation of the worth of health care may stem from the historical and social influences of nursing and the care provided by nurses. The paper concludes that the Australian health care system is clearly no longer static and that the public cannot afford to support the costs associated with a growing health care industry. Moreover, nursing can no longer afford not to be viewed as an entity in it's own right. A greater awareness of nursing's output will result if organisational or institutional changes are encouraged for the benefit of the Australian society, as a whole, as well as for the nursing profession.     

School nursing services: the early years.

This is the first in a series of three articles devoted to school nursing practice past, present, and future. This article highlights development of school health programs in the late 1800s to 1950. Since its inception, school nursing service has paralleled events and developments in society. Nursing services were introduced to treat minor illnesses or injuries of children at school, to provide health education to children in school, and to provide follow-up care and teaching in the home setting in order keep the children healthy enough to attend school. As health care moved away from the home into physician-directed hospitals, nursing services in schools shifted from a focus on the public health nurse to the notion of a nurse-teacher with emphasis on health education. By exploring the practice of the early visionaries in school nursing, one realizes that today's nurses have similar challenges and opportunities in providing quality health care to the school community.     

The future of community nursing in the United Kingdom: district nursing, health visiting and school nursing

This paper examines the future of community nursing, within the wider framework of a rapidly changing National Health Service. The research was commissioned by the Community Performance Review Network, as part of a series of comparative studies between community healthcare NHS trusts. Three questionnaires were sent to 24 trusts, covering three of the community nursing services: district nursing, health visiting and school nursing. Of the 24 trusts involved in the network, 22 responded to some or all of the questionnaires. A wide range of management structures and working practices were found between trusts, but several common themes and issues of concern emerged. For district nurses, these included the shift from secondary to primary care and the changing demands of the client population served, with increasing numbers of elderly and chronically disabled patients. This led to anxiety over the communication between different providers of care, such as community, acute and social services, and the skills mix and training requirements for nurses. Health visitors and school nurses were concerned about being marginalized in the move towards integrated primary health care teams. As the emphasis changes from treating illness to health promotion, concern was expressed about how performance could be measured on the less quantifiable outcomes of preventative care, and hence how jobs could be justified to purchasers of health care. A central theme was the potential role of the nurse practitioner in provision of primary care, and this formed a focus for other anxieties concerning both the current situation and future of community nursing services.     

Good nursing practice as perceived by clients: a starting point for the development of professional nursing

This paper presents clients' experiences of health care and nursing services in the Finnish primary health care and hospital system. These are described to find evaluation criteria for good nursing care and to point out challenges for development of the nursing profession.     

The changing division of labour between nurses and nursing assistants in New Brunswick

BACKGROUND: In 1989, the professional nursing organization that represents nurses in New Brunswick adopted baccalaureate entry to practice in nursing. This decision coincided with a major restructuring of provincial health care. Consequently, there has been a reorganization of health care worker roles which affects nurses and nursing assistants. AIM: This paper explores the changing division of labour between nurses and nursing assistants in the province of New Brunswick, Canada. METHODS: The study used archival material, from the period 1978-1990, of three nursing organizations that played a significant role in initiating baccalaureate entry to practice. Interviews with 19 key people involved in the decision to upgrade nurse education were conducted. Data from the archival material and interviews were analysed jointly. FINDINGS: There are ongoing tensions between nurses and nursing assistants. Although nurses would like a support worker, they remain ambiguous about the role of nursing assistants in health care and which tasks should be delegated to this group. Nursing leaders are concerned about the ease with which some patient-related tasks are moved to nursing assistants. In the past, these concerns have led nursing leaders to attempt to limit nursing assistant responsibilities through both legislative means and ways of organizing nursing labour (primary nursing). As a result of health care reforms and baccalaureate entry to practice for nurses, nursing assistant responsibilities are currently expanding. CONCLUSION: Upgrading nurse education, which came into effect in 1996 with the closure of diploma schools in New Brunswick, is likely to entrench the role of nursing assistants in health care because of the economic value of their work during a period of restructuring and rationalization of health care.     

A concept analysis of holistic nursing care in paediatric nursing

Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative and contextual research design was used. An evolutionary concept analysis was undertaken to clarify the concept "holistic nursing care" in paediatric nursing in three Johannesburg hospitals. Rodgers' (1989, 2000) evolutionary method was utilised to analyse the concept. The study objectives were formulated in two phases to: --Conduct an analysis of the concept "holistic nursing care" --Obtain an emic viewpoint of holistic nursing care from paediatric nurses working in the academic hospitals. --Identify the characteristics and dimensions of "holistic nursing care" and develop a framework of holistic nursing care for paediatric nurses working in the academic hospitals. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-Spirit dimension. The decriptors of whole-person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual as a spiritual being with a mind-body-spirit dimension. Spirituality is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapeutic interventions that are directed to the mind-body-spirit dimension. Therapeutic interventions are designed to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has not been sufficiently investigated in child health care.     

An innovative professional nursing practice model.

Nursing, as with health care delivery, is changing to meet the greater challenges brought about by managed care and the accompanying external forces in the marketplace. Nurses, with their vast resources of knowledge and experience, are crucial in achieving optimal quality care. Given the opportunity to redefine and strengthen the impact of nursing practice at Piedmont Medical Center in Atlanta, Georgia, a group of advanced practice nurses began developing a unique practice model. The resulting Professional Nursing Practice Model--a theoretical framework created for nurses by nurses--presents a common vision of human beings, health, and nursing in accordance with the values and beliefs of nursing. This model demonstrates the importance of a person-centered, value-driven nursing practice across the continuum of health from birth to death.     

Oral health care--a low priority in nursing. In-depth interviews with nursing staff

In this study we examined how nursing home staff experienced assisting patients with oral health care. The results of a previous questionnaire indicated that oral health care is a low priority in nursing. The 22 in-depth interviews administered in this study showed that the quality of the oral health care received by the patients depended on several factors. It was found that often there were no specific routines for assisting oral health care in the nursing homes and that other activities were given higher priority. Assisting oral health care was described as passing a barrier, where the main problem was to gain access to the oral cavity. It was concluded that nursing staff working with geriatric patients need to be better educated in oral health care and should be seen by themselves and others as part of a team, where oral health care is clearly defined and included among other daily nursing activities.     

Reconstructing mental health nursing in home care

BACKGROUND: Psychiatric care for people in Sweden with long-term mental health problems has shifted from institutional to community and home settings. AIM: The aim of this study was to explore and describe mental health nurses' experiences of how structural changes in mental health nursing influence interaction when providing home care to patients with long-term mental health problems. METHOD: We conducted interviews with 11 mental health nurses who provided home care to people with long-term mental health problems. The constant comparative method of grounded theory was used for data collection and analysis. FINDINGS: The process of attempting to reconstruct mental health nursing by entering into the everyday reality of people with long-term mental health problems was identified as the core category. Central to this process was a change in perspective from nurse-controlled to client-centred care. This led to changes in moral values, assessment of client needs, and ways of meeting clients and establishing relationships. However, attempts to reconstruct mental health nursing according to a client-centred perspective became problematic when clients were at risk of harming themselves. In these situations, respondents felt the need to make decisions for clients, and this was experienced as burdensome and lonely. CONCLUSIONS: Our study indicates that the process of reconstructing mental health nursing in line with a client-centred perspective is incomplete. Opportunities to interact with people with mental health problems in the home environment may lead to a broader perspective on the daily lives of these people, but also to a realization that home care cannot be modelled on institutional care.     

Experiencing primary nursing: three perspectives

While primary nursing holds great promise for both nurses and clients in health care, the reality is that it is not often achieved in practice. The experiences of those involved in primary nursing offer insight into the benefits of this method of care delivery. This paper reports on primary nursing from the perspectives of three practitioners: an administrator, a clinical practitioner and a clinical teacher. If the potential of primary nursing is to be realized, those committed to this modality of care have a responsibility to describe and advance it.     

Health care and nursing in Romania

Health care and the nursing profession have been affected dramatically by political and socio-economic conditions in Romania The Romanian Ministry of Health has recognized the health problems and barriers to care delivery which exist in the country, with several goals identified to improve the status of Romanian health care This paper explores the critical issues which have impacted on health care and nursing in Romania     

Cultural competency and nursing care: an Australian perspective

AIMS: To propose a process that will facilitate cultural competence in Australian nursing practice. BACKGROUND: Cultural diversity is a prominent feature of the Australian health system and is impacting significantly on nursing care quality. A fictitious, but typical clinical exemplar is profiled that identifies cultural insensitivity in care practices leading to poor quality outcomes for the health consumer and her family. Strategies are proposed that will reverse this practice and promote culturally competent nursing care and that locates overseas qualified nurses in this process. CONCLUSION: This paper contributes to nursing care quality internationally by articulating strategies to achieve cultural competence in practice. Nurses must pay attention to interpersonal relationships and develop respect for the health consumer's value systems and ways of being, in order to protect their rights and avoid the tendency to stereotype individuals from particular cultures. The expertise of qualified nurses from different cultures can greatly assist this process.     

Nursing informatics: a universal nursing language

Knowledge is necessary to use information to make decisions in nursing situations. Nursing data must be grouped in a logical way so the interrelationship between the classification systems and specific concrete phenomena in individual nursing situations is useful. The processing and management of information for decision making is the focus in nursing and health care. The development and use of language that represents the domain of nursing is an essential dimension in an integrated and coordinated health care delivery system. The design and acceptance of a universal nursing language system is critical to collect appropriate data to document nursing's role, functions, and effectiveness in health care by the year 2000. This is an urgent message for nurses to be involved in the technology and nursing care documentation to demonstrate quality care that is cost effective. In the next century, nurses must speak a common nursing language that has the same meaning for all nurses.