Self-administration of medication in hospital: patients' perspectives

BACKGROUND: Little information is available about patients' perspectives on self- or nurse-related administration of medication. AIM: The aim of the study was to determine patients' perspectives about self-medication in the acute care setting. METHODS: A qualitative approach, using in-depth semi-structured interviews, was taken. Ten patients with a chronic medical illness who had experienced multiple hospital admissions for treatment were interviewed about their experiences of medication administration in the acute care setting. Participants were recruited from two cardiovascular wards in a private, not-for-profit hospital in Melbourne, Australia. Data collection occurred between August and September 2002. FINDINGS: Four major themes were identified from the interviews: benefits of self-administration, barriers to self-administration, assessing appropriateness of self-administration and timing of medication administration. Seven participants had previously experienced self-administration of medications and six were in favour of this practice in the clinical setting. Nine managed their own medications at home, and one self-administered with some assistance from his family. Participants were very concerned about how nurses' heavily regulated routines affected delivery of medications in hospital and disrupted individualized plans of care maintained in the home setting. CONCLUSIONS: In planning and implementing self-administration programmes, it is important to consider patients' views. Medication regimes should be simple and flexible enough to adapt to patients' lifestyles and usual routines. Nurses should also take advantage of opportunities to support and facilitate patient autonomy, to enable more effective management of health care needs when patients return home.     

Modelling nursing activities: electronic patient records and their discontents

A fully integrated and operating EPR in a clinical setting is hard to find: most applications can be found in outpatient or general practice settings or in isolated hospital wards. In clinical work practice problems with the electronic patient record (EPR) are frequent. These problems are at least partially due to the models of health care work embedded in EPRs. In this paper we will argue that these problems are at least partially due to the models of health care work embedded in current EPRs. We suggest that these models often contain projections of nurses' and doctors' work as it should be performed on the ward, rather than depicting how work is actually performed. We draw upon sociological insights to elucidate the fluid and pragmatic nature of healthcare work and give recommendations for the development of an empirically based EPR, which can support the work of nurses and other health care providers. We argue that these issues are of great importance to the nursing profession, since the EPR will help define the worksettings of the future. Since it is a tool that will impact the development of the nursing profession, nurses have and should have a stake in its development.     

Attitudes of nursing staff towards electronic patient records: A questionnaire survey

Background

A growing number of health care organizations are implementing a system of electronic patient records (EPR). This implies a change in work routines for nursing staff, but it could also be regarded as an opportunity to improve the quality of care.

Objective

The objective of this paper is to obtain more insight into the usefulness of EPR as perceived by nursing staff and to clarify the determinants of nursing staff's acceptance of EPR. Determinants were tested using an extended version of the Technology Acceptance Model.

Design

Nursing staff members (NAs and RNs) completed a survey questionnaire about the use of EPR in health care, and their experiences, perceptions and attitudes regarding EPR.

Settings

All nursing staff members were working in Dutch hospitals, psychiatric organizations, care organizations for mentally retarded people, home care organizations, nursing homes or homes for the elderly.

Participants

The study population is a nationally representative Dutch research sample, further referred to as the Nursing Staff Panel. The Panel consists of a permanent group of Nursing Assistants (NAs) and Registered Nurses (RNs), who are prepared to fill in a postal questionnaire twice a year on average. In January 2009, 685 participants completed the questionnaire.

Results

Nursing staff members associate EPR with improved care, especially qualitatively better and safer care. They also expect an increase in costs of care, while anticipating only a relatively small rise in the number of patients that can be cared for. In general, the effects of EPR on the work circumstances of nursing staff are expected to be negative. Job-related characteristics were found to be determinants of attitudes towards using EPR. A relatively positive attitude towards EPR was found in three categories of nursing staff in particular, i.e. staff working at least 30 h per week, staff already using EPR and staff working in hospitals. Nursing staff in management positions also tend to have a more positive attitude. When the Technology Acceptance Model was tested, attitudes towards EPR were primarily associated with job-related characteristics and perceived usefulness with respect to quality of care.

Conclusions

The implementation strategies for EPR need to take account of the job characteristics of the intended future users. If implementation is to be successful, it is important that the users understand the beneficial effects of EPR on the quality of care.     

临床护理记录电子模板的开发与应用

目的研究护理记录电子模板在临床应用的可行性,为提高护理文书质量提供保证。方法按照《病历书写基本规范(试行)》的要求,在计算机上开发护理记录模板,套入"军字1号"病程记录续版进行临床护理记录书写。结果提高了工作效率,且操作简单快捷,护理文书质量明显提高。结论护理记录电子模板在临床应用具有可行性,能促进我国护理信息化发展的进程。     

Nurses' views on the use, quality and user satisfaction with electronic medical records: questionnaire development

AIM: This paper is a report of the development of an instrument to measure nurses' views on the use, quality and user satisfaction with electronic medical records systems. BACKGROUND: Use of electronic medical records systems in hospitals is steadily increasing, yet no validated instruments have assessed the effectiveness of these systems from the viewpoint of nurses. METHOD: Items were designed following a literature review based on three main constructs: use, quality and user satisfaction with electronic medical records. Reliability and validity were examined based on responses from 1,666 nurses from 42 hospitals in Japan in February 2006. Exploratory factor analysis was conducted to determine the degree to which each item within a construct was associated. The reliability of each resultant factor was computed using Cronbach's alpha coefficient. Content validity was addressed by basing the items on previous surveys and review of the instrument by a panel of nurses experienced in nursing informatics. Construct validity was examined through factor analysis and correlational analyses. FINDINGS: Extent of 'use' of electronic medical records resulted into three factors with good factor loadings, but only two had acceptable reliability. 'Quality' of electronic medical records had two factors with good factor loadings and reliability. 'User satisfaction' with electronic medical records had three factors, but only one had acceptable reliability. 'Use' and 'quality' constructs were positively correlated with 'user satisfaction'. CONCLUSION: The final instrument incorporates 34 items from the original 44-item pool. Initial validity results were positive and therefore the instrument can be used in evaluating electronic medical records in hospitals.     

Continuity of care and monitoring pain after discharge: patient perspective

Title.  Continuity of care and monitoring pain after discharge: patient perspective.
Aim.  This paper is a report of a study conducted to evaluate, from the patients' perspective, a Liaison and Continuity of Care Programme coordinating care provision between a hospital and primary care centres.
Background.  Promoting continuity of care between hospitals and primary care improves quality of care, patient satisfaction and decreases further hospitalizations. However, inadequate pain management is common after discharge.
Method.  A sample of patients from the Liaison and Continuity of Care Programme were included in a longitudinal study in 2007. We conducted standardized telephone interviews at 24 hours, 7 days, 1 and 3 months after discharge. Outcome measures included readmission, time between hospital discharge and readmission, information level at discharge, patient satisfaction, queries about care and information related to perceived state of health and pain.
Results.  Eighty-three adult patients (average age 69·3, 50·6% males) who needed continued care at discharge were followed. Ten participants died during follow-up, and seven required readmission. A total of 49·4% of patients stated that they had understood the information given at discharge very well or perfectly. At 24 hours after discharge, 30% already had doubts about their state of health and the management of their condition. In relation to perceived health, only 25·3% stated that this was good or very good. Prevalence of pain 24-hours after discharge was 58·3% in surgical patients and 17·1% in other patients.
Conclusion.  The preparation and education of patients and family members should be improved before discharge, and appropriate written information must be given, especially if a patient has pain or requires complex care.     

新加坡医院病人图书馆见闻

随着医学模式的转变 ,书籍对病人治疗的影响日益为广大医务人员和患者接受 ,文章介绍了新加坡医院病人图书馆的设置、管理 ,认为病人图书馆是图书疗法的临床应用形式 ,为病人提供了大量医学信息 ,扩大了医院的服务范围 ,对我国医院病人图书馆的建立和发展有重要的参考价值     

骨质疏松症患者出院准备度与社会支持的相关性分析

目的探讨骨质疏松症患者出院准备度与社会支持现状,并分析二者之间的相关性。方法应用出院准备度量表和社会支持评定量表对114例骨质疏松症患者于出院前4 h进行调查。结果骨质疏松症患者出院准备度评分为(7.40±1.35)分,社会支持总分为(37.46±9.58)分。骨质疏松患者出院准备度和社会支持呈正相关(P0.01)。结论骨质疏松患者出院准备度和社会支持现状处于中等水平,医务人员应注重社会支持,进而提高骨质疏松患者的出院准备度现状,降低患者的再入院率。