The impact of economic recession on health‐care and the contribution by nurses to promote individuals' dignity

The health sector is facing many challenges, and there is a need to maintain the delivery of high‐quality health‐care. Issues related to equity and access to health‐care have emerged in a context of an economic recession in which the sustainability of the health system depends on everyone, including the actions and decisions of professionals. Therefore, nurses and their skills may be the answer to ethical, professional and community health management, but this recession could lead to major problems in the education of nurses in daily health‐care practice. Due to the limited availability of resources, nurses are increasingly taking leadership positions, continuing to develop their critical abilities and thinking skills, and considering sciences such as deontology and ethics. The main goals of this study were to reflect on the economic recession and its impact on health‐care and to demonstrate the contribution of nursing to the sustainability of health‐care and in the promotion of individuals' dignity. The authors conclude that health‐care depends on economic redistribution and, in this context, needs to be equitable and fair. Nurses have the responsibility to develop their profession according to the underlying sciences and can therefore strategically help the healthcare system.     

Experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary incontinence

Scand J Caring Sci; 2011; 25; 303–310
Experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary incontinence Aim: To explore experiences and attitudes of nurse specialists in primary care regarding their role in care for patients with urinary incontinence (UI), thereby identifying facilitators and barriers for wider implementation. Background: Currently, primary care for patients with UI lacks sufficient adherence to existing guidelines on UI and is far from optimal. Studies in various countries show that involving nurse specialists may offer a solution to the inadequate care for UI. As qualitative studies on experiences of nurses with this type of intervention are lacking, we performed this study with a qualitative approach and data collection method within the course of a randomized controlled trial (RCT). Method: A focus group study was conducted in 2007 with six nurse specialists who were trained in caring for patients with UI in our pragmatic RCT. The focus group interview was audio‐taped and transcribed verbatim. The data were analysed using qualitative content analysis to identify themes. To understand obstacles and incentives for change, we relied on an existing ‘implementation model’. Findings: Nurse specialists feel competent to provide advice and information, to offer possible solutions and to give attention and guidance to the process of care of people with UI. They feel appreciated by patients and feel they offer an added value to the usual care of general practitioners (GPs). Nurses sometimes notice that GPs lack interest in UI. Personal contact with the GPs, availability of enough time, adequate equipment and financial resources are important preconditions for effective nurse specialist care. Nurse specialists value continuous education and feedback in daily care for patients with UI. Conclusion: Trained nurse specialists appeared to feel competent and satisfied to support GPs in care for patients with UI. They feel highly appreciated by both patients and GPs.     

A survey on oral care practices for ventilator‐assisted patients in intensive care units in 3A hospitals of mainland China

Oral hygiene is a critical element of patient care, particularly among patients who need ventilator‐assisted equipment. The objective of this study was to explore the current status of oral care practices, attitudes, education and knowledge among intensive care unit (ICU) nurses caring for ventilator‐assisted patients in 3A hospitals in mainland China. To achieve this aim, an 18‐item self‐assessment questionnaire was mailed to head ICU nurses in 189 Grade 3A hospitals. Additional data were collected through in‐person interviews at 38 ICUs throughout Sichuan, Shanxi, Jiangsu provinces, as well as Chongqing and Beijing. We found that most ICUs conducted oral examinations at patient admission, and that this care was largely provided by nurses. The most common oral care methods were foam swabs and mouth rinse containing antibiotics or disinfectants. Although the majority of ICUs provided continuing training for oral care, and most training was conducted by head nurses, the content and scope of training were not consistent among the hospitals in the study. The most popular sources of oral care knowledge were academic journals, Internet and professional books. Overall, it is clear that an evidence‐based oral care standard manual is urgently needed for oral practice in ICUs in mainland China.     

Continuous deep sedation until death in Belgium: a survey among nurses

ContextContinuous deep sedation (CDS) is a subject of important debate, but until now nurses have rarely been questioned about their involvement and perceptions.ObjectivesTo study the communication process between nurses and patients, relatives, or physicians before starting CDS, and how nurses perceive this end-of-life practice.MethodsIn 2007, we surveyed 1678 nurses in Flanders, Belgium, who, in an earlier survey, had reported caring for one or more patients who received an end-of-life decision within the previous year. Nurses were surveyed about their most recent case.ResultsThe response rate was 75.8%: 250 nurses reported a case of CDS (64.4% hospital, 18.4% home, and 17.2% nursing home). In, respectively, 25.8% and 75.4%, the patient and relatives had communicated with the nurse about the CDS. In 17.6%, there was no communication between the nurse and the physician about the CDS; in 29.1%, the physician and nurse only exchanged information; and in 23.4%, they made the decision jointly. Making the decision jointly was associated with a more positive evaluation of the cooperation with the physician (adjusted odds ratio 10.9 and 95% confidence interval 3.0, 39.2). Nurses perceived CDS as partly intended to hasten death partially in 48.4% and explicitly in 28.4% of cases, estimating possible or certain life shortening in 95.6%.ConclusionNurses in different health care settings are often involved in communication about CDS. They see it mainly as a practice intended to hasten death, with a life-shortening effect; guidelines should recommend clear discussions between caregivers in which the physician states the purpose and estimated effect of the decision.     

The distribution of advanced practice nurses in Arkansas: gaps in the care of rural underserved populations

PURPOSE: To examine the relationships between advanced practice nurses' (APN) practice sites and economic factors, racial and ethnic characteristics of the populations they serve, and the likelihood of APNs practicing in underserved areas. DATA SOURCES: Retrospective analysis of U.S. census data and records supplied by the Arkansas State Board of Nursing. CONCLUSIONS: Nurse practitioners (NPs) were the only APN group with equal distribution in rural or urban areas. Overall, APNs and NPs were more likely to practice in counties with higher rates of poverty and lower education levels. IMPLICATIONS FOR PRACTICE: More effort needs to be made in recruiting and retaining APNs in rural and underserved areas.     

Advanced nursing practitioners in primary care settings: an exploration of the developing roles

Recent health care policies have resulted in patients having access to an integrated system of care that is quick and reliable. In concert with these changes, opportunities for professional development in nursing have increased, together with a reduction in the numbers of doctors. Advanced Nurse Practitioners (ANPs) have, therefore, developed to meet the complex demands of health care systems. This paper reports on a study that aimed to explore the current role of ANPs in primary care in the West Midlands region of the UK and how ANPs within three different nursing disciplines in primary care developed their roles over time. The study utilized a qualitative exploratory design incorporating a longitudinal element. Twenty-one ANPs were interviewed during phase one, 15 of whom were interviewed again during phase two, approximately 15 months later. Their managers (where appropriate) were also interviewed during phase one. The findings reveal that the nature and focus of practice varies between disciplines. At the extreme practice end of the practice-strategic continuum, Practice Nurse ANPs' expertise lies in their advanced practical assessment and diagnosis of individual patients, with little opportunity for strategic development. Health Visitor and District Nurse ANPs operate at the strategic end of the practice-strategic continuum, but operate differently at this level. Health Visitors, being community and public health focused are involved in multi-agency work, practice development and policy formulation. District Nurses work with individual patients/carers and the nursing team, thus their involvement in strategic developments tends to focus at the patient care level, such as protocol and practice developments, although their work also involves work in all three other domains. Overall, the findings reveal a unique role for all three with a potential career pathway for ANPs to become Nurse Consultants in the future.     

Costly regional variations in primary health care test utilization in Sweden

Abstract

Objective: Laboratory tests are used increasingly in primary health care and they are thus associated with rapidly growing costs. Variations in clinical practice, an important determinant of expenditure for laboratory tests, could further increase the financial burden. The study's threefold objective was to determine the presence and extent of regional variations in test ordering between eight counties in Sweden, to investigate the influence on these variations by factors earlier described in the literature as explanatory, and to calculate the achievable savings that could be realized through optimized test ordering. Design: A retrospective study using test request data. Setting: A total of 223 primary health care centers in eight counties in Sweden. Main outcome measures: Thirteen ratios of commonly used laboratory tests, demographic data and the number of ordered tests per 1000 inhabitants served as the basis of comparison. The total savings per 100,000 inhabitants that could be achieved through optimized test ordering was estimated. Results: Large variations were found between all studied counties for all investigated ratios. However, none of the demographic variables investigated seemed to be able to explain the full extent of the variations. The range of achievable yearly savings per 100,000 inhabitants was €14,000–€185,000. Conclusion: The inter-county variations in Sweden are large and the savings associated with optimized test utilization are substantial. The investigated factors previously described as explaining the variations in test ordering only seem to explain a small part of the variation, and the variations are likely influenced by regional habits and traditions.     

The real‐life practice of acute inpatient mental health nurses: an analysis of ‘eight interrelated bundles of activity’

This study focuses on nursing in an inpatient mental health setting. Its analytic structure follows from a previous review of nursing studies by Allen, which did not include studies of mental health nursing. Allen's review concluded that the nurses’ role could be understood as that of healthcare intermediary and that nurses’ work could be analysed as eight interrelated bundles of activity. These bundles include such matters as managing the work of others. This study aims to assess the fit of this model to mental health nursing and to add to the body of work concerning the social organisation of nursing. The research materials discussed are derived from an ethnography of a psychiatric unit. The analytic framework employed leads us to conclude that the work of mental health nurses can be understood, too, as that of the healthcare intermediary. However, one bundle is found to fit less well and this is attributed to the fragile uncertainty of knowledge in psychiatry. The use of an additional bundle to describe in‐context nursing interventions is suggested. It is argued that getting to grips with the reflexive relationship between individual patient care and the social organisation in which this is practised is essential for any practice development efforts.