Outcomes of nursing care: the case of primary nursing

Using primary nursing as a ‘case study’, this paper reviews research literature which attempts to measure the effectiveness of a mode of nursing using outcome measures. Previous research, it is argued, is hampered by a lack of conceptualization of structure and process and inadequate research design, with consequent uncertain findings. A shift in emphasis is suggested from an evaluation of global concepts, such as primary nursing, to an identification of the features of structures and processes of nursing care which interrelate with patient and nurse outcomes. For this purpose, multivariate research design and investment in methodological research are recommended.     

Group reminiscence among people with end-stage chronic lung diseases

BACKGROUND: Reminiscence is a process of recalling long-forgotten memorable experiences and events through verbal interaction between the person eliciting memories and one or more persons. Reminiscence is considered an effective treatment for various groups of people, particularly the elderly. AIM: This paper describes an intervention study on group reminiscence intervention for people with end-stage chronic lung diseases. The following hypotheses were proposed: (1) Depression in people with end-stage chronic lung diseases will decrease after participating in a reminiscence group. (2) Self-esteem in people with end-stage chronic lung diseases will increase after participating in a reminiscence group. (3) People with end-stage chronic lung diseases will report increased well-being after participating in a reminiscence group. METHODS: The research design was quasi-experimental, using Beck Depression Inventory and Rosenberg's Self-Esteem Survey pre- and posttreatment, in addition to conducting semistructured interviews after the treatment was finished and qualitatively evaluating outcomes of selected nursing diagnosis. A total of 12 patients participated, 10 women (mean age 70 years) and two men (mean age 86 years). The treatment was provided by two nurses to a group of patients dwelling at a long-term unit for people with end-stage lung diseases located in Iceland. A total of 13 group meetings were held, with 5-8 participants each time. Each group meeting had a preselected focus. It started with a short period of relaxation followed by a selected reading from a biography or from Icelandic literature and then the group discussion started, focusing on the topic of the day. RESULTS: The first two hypotheses were not supported. The following themes support the third hypothesis: (a) enjoyment, (b) feeling well and (c) closeness and affirmation of self and others. CONCLUSIONS: The purpose of the study was partly achieved. Although hypotheses one and two were not supported, the third was supported by the qualitative results, which clearly demonstrated that participation in the intervention increased well-being.     

Emergency nurses' experience with violence: does it affect nursing care of battered women?

OBJECTIVE: To determine what effect nurses' experience of interpersonal violence had on proposed nursing care of battered women ED patients. METHODS: One hundred ninety-five emergency nurses completed surveys on their personal experiences with violence involving patients or intimate partners and on their proposed nursing care of battered women given 2 vignettes. RESULTS: Seventy percent of participants experienced violence perpetrated by a patient; 40% of the nurses reported violence perpetrated by their intimate partners; and 19% had used force on their partners. Prior assault of a nurse by a patient or partner did not affect the proposed nursing care that would be provided by that nurse to battered women ed patients. Female nurses who committed violence against their intimate partners proposed less nursing care than did those who did not commit violence against their intimate partners for the vignette describing a woman who had received minor injuries. CONCLUSIONS: This study documents the vulnerability of nurses to assault by patients and intimate partners. This vulnerability does not affect their proposed nursing care of battered women. An exception is nurses who themselves commit violence against intimate partners. Findings point to the need to increase safety for nurses in the workplace and provide employee assistance to help nurses confront violence at home.     

Introducing primary nursing: nurses' opinions

• ? This article reports on one aspect of a research project carried out to monitor and evaluate the introduction of primary nursing on four demonstration wards in one health authority.
• ? Nursing staff working on the wards were interviewed to identify how the changes were affecting them and their work.
• ? Stress questionnaires were also completed by a sample of nurses on the wards.
• ? Responsibility and communication — key concepts emerging from the data — are discussed and related to the literature on primary nursing.

     

Investigating and implementing change within the primary health care nursing team

Primary care is developing rapidly with significant impacts on the nursing team. Such changes have brought inter-professional team-working into sharper focus, particularly community care and collaborative working. This paper: examines the nursing roles within a general practice; describes the perspectives of service users; identifies areas of change; clarifies core and specialist skills; defines new roles among the primary health care nursing team; proposes a new model of working; and identifies appropriate education. The project was set in a general practice in south-west England and used an action research methodology. The objectives were to create a change in practice and to develop and refine existing theory to underpin nursing roles. Throughout the research regular team meetings allowed reflection and discussion about research findings and progress. Data were collected from multiple sources, including team workshops, patient focus group interviews, and individual interviews with GPs, practice managers and area managers. Reflective diaries and a patient survey were also used. The analysis of the quantitative and qualitative data collected from patients formed a basis for practice development and facilitated the team's reflection on the areas of change. Overall high satisfaction with services and care was expressed in the patient interviews and the questionnaire. The themes from the data highlighted areas important for patients and helped in shaping the new roles and responsibilities for team members. Regarding the team perspective, the data indicated many areas that could be considered for development. The community nursing team decided to concentrate on three key areas: child health, leg ulcer management, and cardiovascular health. The research concludes that action research presents some problems and challenges but is a useful approach to developing team-working in primary health care.     

慢性病患者自我倡权研究进展

慢性病成为威胁居民健康的重大问题。自我倡权水平高的慢性病患者能够通过收集各种医疗信息,不断获取外部支持,从而主动选择更加适合自己的照护和治疗方式,以满足自身需求和愿望,更好地管理自身疾病。国外对慢性病患者自我倡权研究已经取得部分进展,而国内对此尚处于起步阶段。因此,该文对慢性病患者自我倡权的测评工具、影响因素、干预措施进行综述,以期为慢性病患者自我倡权的发展提供依据。     

District nurses' needs: palliative care for people with learning disabilities

The aim of this article is to identify national palliative care issues, and current palliative care services provided by district nurses for people with a learning disability in North Staffordshire, UK. The professional and educational needs of district nurses in the role of palliative care providers for people with a learning disability were identified by two small focus groups involving district nurses. This resulted in the formulation of a questionnaire, which was circulated to 165 district nurses. While the initial part of the research is qualitative, the final survey involved a quantitative analysis using a questionnaire and a three-point Likert scale. This compared a number of independent variables such as age range, length of experience and number of contacts with clients who have a learning disability and palliative care needs. The results provide an overview of existing service uptake and a profile of the professional and educational needs of district nurses when caring for people with a learning disability who also have palliative care needs.     

Managing technology in the intensive care unit: the nurses' experience

This study investigates the experiences of a group of critical care nurses regarding the use of technology in the intensive care unit. The study is grounded in the phenomenological hermeneutics of Martin Heidegger and argues that this methodology is compatible with the humanistic values of nursing. Data were generated from in-depth interviews and overt participant observation. The process of data analysis was guided by Heidegger's notions of phenomenological reflection and hermeneutic circle, (Van Manen's, Researching lived experience: human science for an action sensitive pedagogy. The State University of New York press, Ontario, Canada, 1990) process of thematic analysis and (Draper's, Nursing perspectives on quality of life. Routledge, London, 1997) analytical principles. The ability to manage the technology emerged as a main component of being a critical care nurse. It is revealed also that the nurses' ability to manage the technology is gained mainly through experience. The effect of machinery management on patient care is seen as part of everyday routine in the critical care setting. Moreover, technical activities are seen as more important and stimulating than other nursing activities.     

对社区慢性病患者延续护理服务真实需求的调查

目的：了解社区慢性病患者对三元联动延续护理服务的真实需求。方法自行设计调查表,采用便利抽样法选取5家社区的200例慢性病患者进行调查。结果共发放问卷200份,回收有效问卷178份,有效率为89％。对延续护理服务项目非常了解的慢性病患者仅占21．4％（38/178）;希望出院后继续接受医护照护的慢性病患者占80．9％（144/178）;38．2％（68/178）的慢性病患者“不确定”延续护理服务对疾病疗效的影响;77．5％（138/178）的慢性病患者担心延续护理服务的自费比例问题。社区慢性病患者对延续护理服务的需求包括安全用药知识、血压控制及自我监测、饮食指导、疾病相关知识、血脂及血糖控制与监测、康复锻炼方法等。希望由社区护士提供院外护理服务的慢性病患者仅占8．4％（15/178）。结论社区慢性病患者对延续护理服务内容的需求量比较大,但是尚存在一些瓶颈,因此要充分利用社区护士人力资源,有效开展医院-社区-家庭三元联动延续护理服务。     

Information technology training in primary care: the nurses' voice

Information technology (IT) is now essential to the development and delivery of health services. Healthcare professionals, including nurses, need appropriate educational training to enable them to use IT adequately because care is shared within multiprofessional teams in both hospitals and the community. In particular, primary care nurses have had less access than other health professionals to IT training and fewer opportunities to benefit from IT. Furthermore, there is little evidence in the literature on the current situation of IT training needs and requirements for primary care nurses. The PRACTIS (PRimary care nurses Access to Communications Technology and Informatics Skills) UK-based project has addressed these issues through an empirical investigation to establish a picture of the current primary care situation. This was done using a questionnaire, followed by practicing nurse focus groups. Directions for further work in the IT training of primary care nurses are discussed, together with recommendations to investigate the effect that the organization of the work within primary care groups may have on nurses' use and access to communications technology and informatics skills.     

Working in long-term care settings for older people with dementia: nurses' aides

Aim. This paper reports a study exploring the reasons for continuing to work among nurse aides who cared for older people with dementia in long‐term care settings in Taiwan. Background. High nurse aide turnover has been a major problem for many managers of long‐tem care facilities in Taiwan. Most studies on nurse aide turnover have focused on the factors on why they left, but little is known about their reasons for continuing to work in long‐term care settings in Taiwan. Methods. A qualitative research design was used. Sixteen nurse aides were interviewed individually using a semi‐structured interview guide and content analysis was used to identify the major themes in the data. Results. Five major themes emerged from interview data: monetary needs, relationships with residents, working environment, training opportunities and gratification (listed in order of frequency of occurrence). Conclusion. Nurse aides face challenges in caring for the increased number of older people with cognitive impairment and it is important to assess their perspectives towards their work in the changing environment. The findings suggest that it is essential for nursing managers to assess nurse aides’ needs to increase job retention and to improve the quality of resident care in long‐term care settings. Relevance to clinical practice. Careful appraisal of prospective nurse aides’ attitudes, regular training programmes in dementia care, adequate staffing and equipment, performance‐based pay rises and subsidized training are practical retention strategies for these nurse aides.