Nutrition knowledge of clinic nurses in Lebowa, South Africa: implications for nutrition services delivery

Background: Nutrition-related health problems are prevalent in South Africa, particularly in the black communities in the Homelands and black rural areas. Lebowa, one of the Homelands in the Northern Transvaal province, has inadequate nutrition services, without qualified nutrition professionals. The responsibility of nutrition care in Lebowa rests with clinic or community health nurses, who have limited nutrition training.
Aim: To determine the current nutrition knowledge of clinic nurses in Lebowa.
Method: Clinic nurses ( n =99) in Lebowa answered a 40-item nutrition knowledge test (NKT) and five demographic questions.
Results: The general performance of the clinic nurses on the NKT was poor, 14±3.8 (35%) answers correct, with scores ranging from 4 to 25 (10% to 63%) answers correct.
Conclusion: Considering the responsibility the nurses are entrusted with regarding nutrition care, the current nutrition knowledge of clinic nurses is a cause for concern. The results of this study provide a basis for nutrition education efforts directed at community health nurses.     

妇幼保健机构注册护士核心胜任能力现状分析

目的 了解妇幼保健机构注册护士核心胜任能力现状,为护理管理提供相关数据. 方法 2013年3-4月,对湖南省妇幼保健院17个护理单元的在岗注册护士进行整群抽样,由护士长指导注册护士以无记名方式填写调查量表,内容包括基本人口学资料问卷与注册护士核心能力量表.采用Epidata统计软件进行双人数据录入,并使用SPSS16.0统计软件进行分析. 结果 发放问卷382份,回收有效问卷367份,有效回收率为96％;注册护士核心能力量表中,7个维度中得分最高的项目为领导能力（28.24±4.36）分,得分最低的项目为专业发展（16.32±3.50）分;护士核心能力得分后10位条目中,批判性思维、科研和临床护理是薄弱环节;随着年龄的增加、工作年限的延长、职称的升高,护士核心能力均呈上升趋势,差异有统计学意义（P＜0.05）;不同学历护士核心能力差异无统计学意义（F=1.048,P＞0.05）. 结论 本院护士核心能力处于较高水平,但护理人员还应该更多的了解有关医疗卫生系统的新动态和专业发展信息,要加强创新思维、教学方法、咨询技巧、护理科研、护理人文知识等在职培训,进一步提高护士核心能力.     

陕西省基层医疗卫生机构护理人员现状调查

目的了解陕西省基层医疗机构护理人员现状和护理人员执业能力。方法抽取陕西省1市10县医药卫生体制综合改革试点市县,通过座谈、问卷调查及实地走访等形式,在县乡医疗卫生机构开展调研。结果陕西省基层护理专业人员结构概况:农村地区平均每千人拥有注册护士1.62人;基层护理人员中女性占96%,男性占4%;学历以大专为主,其次为中专和本科;职称结构中以初级职称为主,占88%;从事护理专业5年及5年以下者占40.8%,6年-10年占23.8%。基层护理人员执业能力整体状况良好,健康教育及预防保健能力、科研能力、社区护理能力评价较低。结论基层卫生机构护理人力资源匮乏,护理队伍结构不合理;基层护理人员执业能力较强,能够胜任一般护理工作,基本能够满足用人单位的需求,但仍需进一步加强沟通能力、急危重症患者的监护处置能力,提高科研意识,强化社区护理意识和能力。     

Pediatric Health Care Professionals' Perceptions and Practices of Family-Centered Care

Health care professionals' ratings of their perceptions and practices of the components of family-centered care were examined to determine possible barriers to practice at a western Canadian children's hospital. A significant and large difference was found between health care professionals' perceptions and practices of family-centered care using the Family-Centered Care Questionnaire-Revised (FCCQ-R; Bruce, 1993)(p<.001). Older participants had higher scores on the Practices scale. Participants with post--secondary education as their highest level of education-predominately registered nurses--and physicians also scored lower on the Perceptions scale of the FCCQ-R. In contrast, nurses has higher overall scores on the Perceptions scale of the FCCQ-R. Professionals in staff positions as opposed to educational or administrative positions also scored lower on the Perceptions scale. Bachelor's-and master's-prepared health care professionals had significantly higher perceptions scores on the FCCQ-R. Perceptions were found to account for the majority of the variance in the regression equation of practices of family-centered care, as measured by the FCCQ-R. The findings suggest that education, knowledge, experience, and employment position influence health care professionals' abilities to practice family-centered care. The 'dilemma of helping' (Dunst, Trivette, Davis, & Cornwall, 1988) is proposed as an explanation for these findings.     

Nutritional knowledge and attitudes of registered nurses.

Nutritional knowledge and attitudes of hospital nurses in Nebraska and their perceptions of the role of the dietitian in patient care were studied. In general, they had favorable attitudes toward nutrition. Although their knowledge was adequate, they lacked confidence in that knowledge. The nurses perceived dietitians in an educational rather than a service role. Older nurses had more favorable attitudes but were less knowledgeable than younger ones. More knowledgeable nurses had more positive attitudes toward their own role in nutrition education and toward the team approach to health care.     

对护士医嘱执行记录知识、态度、行为的调查分析

目的了解护士对书写医嘱执行记录规范要求所持态度、行为及相关知识掌握情况,为护理管理者实施有效管理提供依据。方法采用自行设计的问卷,随机对本院不同学历、职称、工作年限的100名护士进行问卷调查。结果①知识得分最高,态度得分次之,行为得分最低,形成知与行相互分离的特点;②不同学历、职称护士在知识、态度得分上有显著性差异;而行为得分无显著性差异;③不同工作年限的护士在知识得分上有显著性差异,而在态度、行为得分上无显著性差异。④护士医嘱执行记录行为不符合规范要求发生率高。结论护士在医嘱执行记录问题上知而不信,信而不行,不利于履行举证责任的法定义务。提示护理管理者应及时采取措施,使护士医嘱执行记录真正成为法律的依据和提高护理质量的有效资源。     

护士对骨科病人疼痛知识掌握的现状调查分析及对策

目的了解骨科护士对骨科病人疼痛知识掌握程度。方法采用“骨科病人疼痛知识调查量表”对137名在岗骨科护士进行了问卷调查。结果疼痛知识问卷平均分仅有41．16分；受教育程度、年龄、职称以及是否参加过疼痛知识的培训班的护士得分没有统计学差异，但不同的年龄段、护龄段和不同的工作医院的护士得分有显著差异。结论大多数骨科护士缺乏足够的骨科病人疼痛护理知识．建议加强骨科护士对骨科病人疼痛管理知识的培训及在校护生的疼痛知识基础课程的教育，鼓励护士积极参与疼痛管理实践，共同促进疼痛管理实践标准化？     

护士对骨科病人疼痛知识掌握的现状调查分析及对策

目的了解骨科护士对骨科病人疼痛知识掌握程度。方法采用"骨科病人疼痛知识调查量表"对137名在岗骨科护士进行了问卷调查。结果疼痛知识问卷平均分仅有41.16分;受教育程度、年龄、职称以及是否参加过疼痛知识的培训班的护士得分没有统计学差异,但不同的年龄段、护龄段和不同的工作医院的护士得分有显著差异。结论大多数骨科护士缺乏足够的骨科病人疼痛护理知识,建议加强骨科护士对骨科病人疼痛管理知识的培训及在校护生的疼痛知识基础课程的教育,鼓励护士积极参与疼痛管理实践,共同促进疼痛管理实践标准化。     

Nurses' perceptions of inter- and intra-professional relationships: an analysis of support from nursing and physician colleagues in rural hospitals.

Nurses employed in ten rural hospitals in Canada completed questionnaires designed to examine their perceptions of the strength of the professional relationship which existed among nurses and between nurses and physicians. Four questions addressed the availability of nursing education programs and the attendance of nurses and physicians at such programs. Seven questions examined the nurses' perception of physician interest in nursing education and the encouragement received from their nursing colleagues to participate in learning activities and medical management decision making. Chi square analysis was undertaken to determine whether the colleagial relationships differed by hospital or medical staff characteristics. Forty percent of the nurses felt that the majority of of physicians were supportive of continuing nursing education. Sixty-three percent indicated their nursing colleagues encouraged them to attend educational programs. The results indicate that physician participation in nursing continuing education was greatest in communities with the fewest health resources (an acute hospital with fewer than 50 beds). In contrast, encouragement to participate in continuing nursing education was highest in settings where the hospital provided both acute and extended care services, had more patient admissions and a greater availability of educational programming.     

An evaluation of a community dietetics intervention on the management of malnutrition for healthcare professionals

Background: Healthcare professionals working in the community setting have limited knowledge of the evidence‐based management of malnutrition. The present study aimed to evaluate a community dietetics intervention, which included an education programme for healthcare professionals in conjunction with the introduction of a community dietetics service for patients ‘at risk’ of malnutrition. Changes in nutritional knowledge and the reported management of malnourished patients were investigated and the acceptability of the intervention was explored. Methods: An education programme, incorporating ‘Malnutrition Universal Screening Tool (MUST)’ training, was implemented in eight of 10 eligible primary care practices (14 general practitioners and nine practice nurses attended), in seven private nursing homes (20 staff nurses attended) and two health centres (53 community nurses attended) in conjunction with a community dietetics service for patients at risk of malnutrition. Nutritional knowledge was assessed before, immediately after, and 6 months after the intervention using self‐administered, multiple‐choice questionnaires. Reported changes in practice and the acceptability of the education programme were considered using self‐administered questionnaires 6 months after the intervention. Results: A significant increase in nutritional knowledge 6 months after the intervention was observed (P < 0.001). The management of malnutrition was reported to be improved, with 69% (38/55) of healthcare professionals reporting to weigh patients ‘more frequently’, whereas 80% (43/54) reported giving dietary advice to prevent or treat malnutrition. Eighty‐percent (44/55) of healthcare professionals stated that ‘MUST’ was an acceptable nutrition screening tool. Conclusion: An education programme supported by a community dietetics service for patients ‘at risk’ of malnutrition increased the nutritional knowledge and improved the reported management of malnourished patients in the community by healthcare professionals.     

The Development of a State-level Health Manpower Database Using an Employer-based Survey: A Pilot Project

State health care reform may provide a better approach to meeting the health care needs of rural communities than does federal reform because the planning is closer to the needs of local communities. However, state health reform requires a health manpower database (along with other data) that includes all health occupations and such databases are often nonexistent. This study reports on one element of such a database--a survey of a wide range of rural health care employers covering the full range of health occupations in Alabama. Information on current and future employment of the most significant health occupations is reported here. It was found that the greatest numbers of new health personnel employees needed in the future were, in descending order, nursing assistants, registered nurses, licensed practical nurses, radiological technicians, specialist physicians, nurse practitioners, physical therapists, primary care physicians, and respiratory care therapists. While an employer survey has limitations and should be supplemented by data on community needs and health status indicators, it does provide useful information for planning educational programs to prepare health personnel.     

Do empowerment strategies facilitate knowledge and behavioral change? The impact of family health advocacy on health outcomes

This study evaluates the impact of a Family Health Advocacy (FHA) intervention on 46 African American women ages 13 to 35 living in a rural southern community. FHA utilizes empowerment strategies to provide education and social support to reduce risk factors for poor pregnancy outcomes. Use of a paired t test demonstrated a statistically significant difference between pretest and posttest scores in the acquisition of knowledge of safer sex practices, alcohol consumption, early prenatal care, maternal infection, and nutrition. Behavioral change was not realized in the areas of nutrition or behaviors that cause risk of maternal infection. Social workers can influence behavioral change for at-risk populations by addressing microlevel barriers such as education and resources and macrolevel barriers such as advocacy for expanded health and social services.     

Diagnosis and treatment of pulmonary tuberculosis at basic health care facilities in rural Vietnam: a survey of knowledge and reported practices among health staff

One fundamental element needed for tuberculosis control programmes to succeed is that health staff should adequately manage persons with both suspected and confirmed tuberculosis. This study assesses the level of knowledge and reported practices regarding tuberculosis among health staff at basic health care facilities in a rural district in Vietnam. A questionnaire consisting of 17 multiple-choice questions, 6 open questions, and five case-studies was completed by 253 health staff. Nearly half of the respondents (47%) answered at least 17 out of 23 questions correctly. The mean knowledge score was 15.59 +/- 3.78 (range 5-23). The mean practice score was 2.03 +/- 1.28 (range 0-5). Health staff knowledge of theoretical aspects was better than knowledge related to patient management. Even staff members who had attended TB training courses had inadequate TB knowledge, particularly in the area of TB control. District hospital staff reported surprisingly lower knowledge scores than community health care staff. Practice competency related to the management of tuberculosis patients during treatment course was low. The importance of targeted education using multiple educational methods needs to be emphasized within the National Tuberculosis Programme.     

A regionalized perinatal continuing education programme: successful adaptation to a foreign health care system and language

Much of the decline in perinatal mortality over the past two decades in the United States has been attributed to regionalization of perinatal care. Outreach education from regional medical centres to community hospitals is an essential component of regionalization. The Perinatal Continuing Education Program (PCEP) has been successfully used for outreach education in more than 30 states since 1979. This project tested the efficacy of implementing the PCEP strategy in Poland. PCEP was adapted to Polish conditions, translated, and implemented in four phases. The scheme allowed gradual transfer of ownership to Polish leaders and use of the existing regional structure to disseminate information from regional centres to community hospitals. Evaluation included measures of programme use (participation and completion rates) and acceptance (participant evaluation forms), cognitive knowledge (pre- vs. post-tests), and patient care (chart reviews). Of 2093 doctors, nurses and midwives who began, 1615 (77%) completed the programme, with higher completion by regional centre than community hospital staff. All participant groups responded favourably to the materials and expressed moderate confidence in their mastery of the information and skills. Test scores improved significantly for all phases and for all disciplines, with baseline and final scores consistent with degrees of previous professional education. Large baseline and inter-hospital variations in chart review data restricted analysis of care practices. A comprehensive perinatal education programme can be successfully transferred to a foreign health care system. We believe the following to be particularly important: multidisciplinary instructors and students; a self-instructional format; content aimed at practice rather than theory; and an organized implementation strategy co-ordinated by local personnel.     

Sustained benefits of a community dietetics intervention designed to improve oral nutritional supplement prescribing practices

Background: Healthcare professionals working in the community do not always prescribe oral nutritional supplements (ONS) according to best practice guidelines for the management of malnutrition. The present study aimed to determine the impact of a community dietetics intervention on ONS prescribing practices and expenditure 1 year later. Methods: The intervention involved general practitioners (GPs), practice nurses, nurses in local nursing homes and community nurses. It comprised an education programme together with the provision of a new community dietetics service. Changes in health care professionals’ nutrition care practices were determined by examining community dietetics records. ONS prescribing volume and expenditure on ONS were assessed using data from the Primary Care Reimbursement Service of the Irish Health Service Executive. Results: Seven out of 10 principal GPs participated in the nutrition education programme. One year later, screening for malnutrition risk was better, dietary advice was provided more often, referral to the community dietetics service improved and ONS were prescribed for a greater proportion of patients at ‘high risk’ of malnutrition than before (88% versus 37%; P < 0.001). There was a trend towards fewer patients being prescribed ONS (18% reduction; P = 0.074) and there was no significant change in expenditure on ONS by participating GPs (3% reduction; P = 0.499), despite a 28% increase nationally by GPs on ONS. Conclusions: The community dietetics intervention improved ONS prescribing practices by GPs and nurses, in accordance with best practice guidelines, without increasing expenditure on ONS during the year after intervention.     

The 1990s and Beyond: Determining the Need for Community Health and Primary Care Nurses for Rural Populations*

ABSTRACT: Increased numbers of primary care and advanced practice nurses with unique generalist skills will be required to meet the accelerating physiologic and sociocultural health care needs of rural populations. Several factors have been identified that will influence the demands and position of community-based nurses in rural practice settings during the next decade. A back-to-basics type of health care offered out of a growing elderly population; technological breakthroughs that make it possible for more chronically ill patients to live at home; serious substance abuse and other adolescent problems; AIDS; and high infant morbidity and mortality statistics are only some of the concerns that will demand nursing intervention. These changes speak to the need for improved nursing coordination, stronger collegial relationships, and better communication between physicians and nurses. Health care is moving in new directions to offer more efficient and technologically sophisticated care. These changes enhance the need for clinically expert educators who teach and jointly practice in programs with a rural focus. Telecommunications, and heightened computer literacy, will play a major role both in nursing education and clinical practice. The goals of kindergarten through 12th grade health promotion and disease prevention strategies in school health will be the norm and will require better prepared, and positions for, school nurses. More midwives and public health nurses will be needed to care for the growing population of sexually active adolescents who are in need of family planning and prenatal care. Underinsured and indigent populations will continue to fall within the purview of midlevel practitioners, as will providing anesthesia services in small rural hospitals. The transition of some rural hospitals into expanded primary care units (e.g., EACHs and RPCHs), and new models of case management will greatly influence nursing demands. This paper will further identify critical areas of advanced practice nursing within community settings, including new relationships with other health care providers, and will introduce strategies upon which rural health policy recommendations for the 1990s can be addressed.     

上海市金山区临床护士灾害护理能力现况调查及影响因素研究

目的调查上海市金山区临床护士的灾害护理能力及灾害应急知识掌握现状,探讨临床护士灾害护理能力的影响因素。方法通过便利抽样法,选取金山区5所二级及以上医院及11家社区卫生服务中心的1270名临床护士作为研究对象,采用一般资料调查表、临床护士灾害护理能力评估工具及灾害应急知识量表进行问卷调查,采用多元线性回归模型分析灾害护理能力的影响因素。结果收到有效问卷1263份,回收率为99.44%。1263名临床护士的灾害护理能力总分为(204.64±43.88)分,其中备灾能力均分最高,减灾/预防能力均分最低;临床护士灾害应急知识总分(134.97±30.60)分,其中事故指挥系统均分最高,特殊护理及隔离、去污均分最低。多元线性回归分析结果显示:相比三级医院,社区医院的护士灾害护理能力得分较低(β=-5.966,P=0.017);相比其他科室,急诊/ICU护士的灾害护理能力得分较高(β=5.765,P=0.029);护士灾害应急知识总分越高者,其灾害护理能力得分越高(β=1.000,P<0.001)。结论上海市金山区临床护士灾害护理能力、灾害应急知识储备整体处于中等偏上水平,在减灾/预防能力及恢复/重建能力上仍有待进一步提升。护理管理者可通过提升护士灾害应急知识水平、加强对急诊和ICU以外科室的护士以及三级医院以下护士的培训,提升临床护士的灾害护理能力。     

Attractiveness of people‐centred and integrated Dutch Home Care: A nationwide survey among nurses

The World Health Organization is calling for a fundamental change in healthcare services delivery, towards people‐centred and integrated health services. This includes providing integrated care around people′s needs that is effectively co‐ordinated across providers and co‐produced by professionals, the patient, the family and the community. At the same time, healthcare policies aim to scale back hospital and residential care in favour of home care. This is one reason for the home‐care nursing staff shortages in Europe. Therefore, this study aimed to examine whether people‐centred, integrated home care appeals to nurses with different levels of education in home care and hospitals. A questionnaire survey was held among registered nurses in Dutch home‐care organisations and hospitals in 2015. The questionnaire addressed the perceived attractiveness of different aspects of people‐centred, integrated home care. In total 328 nurses filled in the questionnaire (54% response rate). The findings showed that most home‐care nurses (70% to 97%) and 36% to 76% of the hospital nurses regard the different aspects of people‐centred, integrated home care as attractive. Specific aspects that home‐care nurses find attractive are promoting the patient′s self‐reliance and having a network in the community. Hospital nurses are mainly attracted to health‐related prevention and taking control in complex situations. No clear differences between the educational levels were found. It is concluded that most home‐care nurses and a minority of hospital nurses feel attracted to people‐centred, integrated home care, irrespective of their educational level. The findings are relevant to policy makers and home‐care organisations who aim to expand the home‐care nursing workforce.