Hong Kong patients' experiences of intensive care after surgery: nurses' and patients' views.

This study was designed to explore the lived experience of patients after elective surgery when they were being cared for in a surgical intensive care unit (ICU) in the immediate post-operative period. A phenomenological approach using unstructured interviews was employed and 10 ICU nurses and 10 patients were recruited for the study. Thematic data analysis was used. Most of the nurses believed that patients had memories of their ICU stay. Two clear categories emerged from the nurses' responses: 'perceptions of the feelings experienced by the patients' and 'perceptions of what patients experienced as support'. The nurses expressed that patients had feelings related to anxiety, pain and tiredness and they were frightened by the environment and the unknown. The nurses provided support to the patients by pre-operative visits, continuous and repeated explanation, encouraging family visits and ensuring adequate pain relief and sleep. All the patients could remember at least some of what happened during their stay in ICU. The 2 main categories which emerged from patients' responses were 'feelings experienced' and 'needs during the stay'. The patients recalled the feeling of anxiety about the reason for admission and a feeling of being safe in ICU. Six patients suffered from moderate to severe pain during movement and procedures and 2 patients complained of sleeping problems. They appreciated the preoperative visit and preferred the open unit design and flexible visiting hours. The four sub-categories: pain, sleep, pre-operative visits and family visits are discussed in detail and are reviewed in the light of other studies to compare the results. Ideas for nursing interventions to help overcome these problems are outlined and recommendations for future research are presented.     

Assessment of patient expectations for care

This research identified patients' expectations for their hospitalization and immediate, posthospitalization outcomes of care. Patients' expectations for care are integral to tailoring care to meet needs. Little investigation of patients' overall expectations for hospitalization exists and standardized instruments to measure them are unavailable. Qualitative analyses of 20 interviews yielded 105 data bits, subsequently rated by a second sample of 18 patients. Eight themes and 70 items resulted. Several expectations are distinct from items typical in patient satisfaction instruments. Assessment of patient expectations offers insights to what they value and expect during hospitalization and provides an important foundation for assessing patients' experiences, based on their expectations. Such assessment ultimately contributes to the goal of assessing patient-centered care.     

Vulnerability and security in seriously ill patients in intensive care.

The purpose of this research was to gain an understanding of the experience of being a seriously ill patient in an intensive care unit (ICU). Fourteen former patients, aged 17-71 years old, who had been in ICU 3-53 days, participated in focus group interviews 3-6 months after discharge. The focus groups met 3 times each for 1.5 hours, resulting in 13-14 hours of audiotaped discussions. The transcribed data were qualitatively analysed to identify themes representing participants' experiences. Vulnerability emerged as a central concept that captured the identified themes. The data reveal that patient vulnerability while in ICU was related to extreme physical and emotional dependency. Lack of information and depersonalizing care were associated with fear, anxiety and increased vulnerability. Lack of sleep and rest also contributed to patient fear and anxiety. Vulnerability decreased when patients were kept informed of what was occurring while in ICU, received care that was personalized to their individual needs, and when their families were present. The results of this study suggest that ICU patients' vulnerability may be decreased by the security that they experience when they are adequately informed about what is happening, and when nursing and medical care is personalized to their individual needs.     

Effects of a needs-based education programme for family carers with a relative in an intensive care unit: a quasi-experimental study

Critical illness and subsequent hospitalisation of a relative to an intensive care unit (ICU) can result in many physiological and psychosocial problems for patients and their family members. Caring for the anxiety and frustration of these families is an integral part of critical care nursing. The purpose of this study was to examine the effect of a needs-based education programme provided within the first 3 days of patients' hospitalisation, on the anxiety levels and satisfaction of psychosocial needs of their families. This was a quasi-experimental study with pre- and post-test design. A convenience sample was recruited over a period of three months, consisting of one primary family carer of each critically ill patient who had been admitted to an ICU in Hong Kong. Conducted by an ICU nurse specially assigned for the purpose, family carers in the experimental group (n=34) received an individual education programme based on the results of a literature review and an individual family needs assessment carried out at the time of patient admission, using the Critical Care Family Needs Inventory. The subjects in the control group (n=32) received the usual orientation and explanation given by the ICU nurses. Anxiety and need satisfaction were measured in the two groups at pre- and post-test and their mean scores were compared. Of the ten most important statements identified by the family carers in the two groups, the statements regarding the needs for information and assurance were found to predominate. After the needs-based intervention, the experimental group reported significantly lower levels of anxiety and higher levels of satisfaction of family needs than the control group at the post-test. The findings support the effectiveness of providing families of newly admitted critically ill patients, with a needs-based educational intervention to allay anxiety and satisfy immediate psychosocial needs. The formulation of a family education programme should be based on the results of a needs assessment, in order to meet family carers' individual needs.     

Patients' accounts of the differences in nurses' and general practitioners' roles in primary care

AIM: This paper reports a study of patients' accounts of the differences in nurses' and general medical practitioners' roles in primary care. BACKGROUND: Nurses are now diagnosing and treating illnesses including conducting first contact care consultations. However, the findings of international studies reporting patients' views of developments in nursing roles are not consistent. Whilst some studies report higher satisfaction following nurse consultations, others suggest that patients do not want nurses to replace general medical practitioners. Healthcare professionals' views of the boundaries of their roles have been studied, but patients' views have not been reported. METHOD: Semi-structured interviews were conducted with 28 adults attending general practices for urgent 'same day' appointments during 2004. Participants were interviewed prior to their consultation with either the nurse or general medical practitioner and 19 participants were interviewed after the consultation. Data collection and analysis were concurrent, and based on the constant comparative method. FINDINGS: Participants' views reflected traditional hierarchies in primary care. They preferred to consult with general medical practitioners if they perceived their symptoms to be serious and with nurses for minor symptoms and reassurance. They thought that nurses had more time for them and were more compassionate. Interpersonal/relational continuity of care was important and for most participants this was with a general medical practitioner who knew them. Participants trusted known practitioners; they also placed trust in professional groups and familiar structures such as the practice. CONCLUSION: New nursing services should incorporate patients' views on continuity of care provider when developing models of care delivery. Patient information leaflets in general practices should be used to explain the roles of general practitioners and nurse practitioners/practice nurses. As these roles develop further, more research is needed into all aspects of their implementation and patients' views should particularly be evaluated.     

重症监护病房设置康乃馨服务岗对护患关系的影响

[目的]设立康乃馨服务岗,改善重症监护病房护患关系,提高护理质量。[方法]于2012年11月开始设立康乃馨服务岗,成立康乃馨小组,对重症监护室病人根据访谈提纲进行回访,针对影响护患关系的主要因素进行护理,比较设岗前后4个月的病人满意度及护患纠纷发生情况。[结果]设立康乃馨服务岗后病人满意度为98.33%,护患纠纷发生率0.83%,明显优于设立前（P〈0.05）。[结论]重症监护病房设立康乃馨服务岗,可有效改善护患关系。     

An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unit

The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi-method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi-method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others' roles and expectations.     

叙事护理对ICU患者家属焦虑情绪及满意度的影响

目的 探讨叙事护理对ICU患者家属焦虑情绪及满意度的影响。方法 采用便利抽样法,选取2018年7-9月神经内科重症监护病房(ICU)30例患者的家属为对照组。选取2018年10-12月神经内科ICU30例患者的家属为干预组。对照组给予常规探视流程干预,干预组在对照组的基础上增加叙事护理。比较2组的焦虑评分及对护理工作的满意度。结果 干预后,干预组焦虑评分低于对照组(t=2.153,P=0.040);对护理工作的满意情况好于对照组(Z=-2.137,P=0.033)。结论 叙事护理可以有效缓解 ICU 患者家属焦虑情绪,提高其对护理工作的满意度。     

Quality focus of the first line nurse manager and relationship to unit outcomes

The purpose of this article was to examine the relationship between the quality focus of the first line nurse manager and patient satisfaction, job satisfaction of the nursing personnel, unit effectiveness, staff perceptions of quality, and nursing personnel turnover. Of the unit outcomes that were tested, quality focus was found to be a significant predictor variable only for staff nurse job satisfaction (R2 = 0.218). Managers need to be aware of their vision for quality of patient care and how this translates into expectations for nursing care quality and overall quality of the organization.     

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.     

优化人员管理对提高重症监护室护理质量的作用

目的 探讨优化人员管理对提高重症监护室(ICU)护理质量的作用.方法 2007年6月起对我院ICU护理人员实施分层分级管理,2008年和2010年分别对ICU护理人员和患者进行问卷调查,比较优化管理后护理质量的达标情况和患者满意度.结果 实施优化管理后,护理质量达标率及患者满意度均较以前显著提高,差异有统计学意义(P＜...     

"Realising the potential of critical care nurses": an exploratory study of the factors that affect and comprise the nursing contribution to the recovery of critically ill patients.

BACKGROUND: This study seeks to make evident the complexity of issues associated with the delivery of care by nurses to the critically ill. Emphasis had been placed on the results and implications of these for nursing practice. For a more in-depth account, the full report can be accessed on www.lscn.co.uk. METHOD: Following multi-centre research ethics committee approval, 10 critical care units participated in the 3-month study. Data collection comprised 231 nurse interviews and 51 relative interviews during 33 observation participation periods. RESULTS: Analysis demonstrated that the context of the critical care unit, in terms of geographical layout, unit activity, case mix and skill mix of nurses, had a major effect on the ability of nurses to contribute to the recovery of the critically ill. The effectiveness of the nursing resource appeared to be a function of knowledge (theoretical and patient related), experience and exposure. Nurses who were unused to a particular environment were not seen to be as effective as those who were. A model was constructed that identified the central tenets upon which nursing care can be optimised or compromised. When nursing care was optimised the difference nurses made potentially decreased risk to patients, enabled timely patient progression and increased the potential for patient recovery. CONCLUSIONS: The results confirm that nurses have a significant contribution to make in the recovery of patients who have experienced critical illness. Recommendations are far reaching and include the need to develop a valid and reliable tool which addresses patients' need for nursing in terms of nurses' knowledge and experience, patient dependency and decreasing clinical risk across the continuum of care. Current nursing workload tools and patient:nurse ratios were seen to lack validity because they do not appraise the context in which care is delivered, define all nurses as equal and concentrate on activity rather than the effect nurses can have on the outcome of the critically ill.     

Models of nursing care: a comparative study of patient satisfaction on two orthopaedic wards in Brisbane.

Patient satisfaction measures assist nurses in the evaluation of effectiveness of nursing practice and assist the process of improvement regarding established practice. A comparative study was carried out on 36 patients from a ward using team nursing (Model 1) and 38 patients from a ward using patient allocation (Model 2) in two orthopaedic wards of a 900 bed teaching hospital in Brisbane, Australia. The purpose of the research was to measure if differences in the levels of patient satisfaction were evident. The Patient Satisfaction Survey (Greenhill and Henderson 1997) used in this study encompassed aspects such as patients' feelings and perceptions; nurses' skills, behaviour and attitudes; nurses' communication and education skills; and continuity of care experienced. The results indicated that there were no differences between models of nursing care and levels of patient satisfaction. However, there were significant relationships between patient satisfaction and patients' characteristics such as age, education and health status.