Long-term care nurses' knowledge of end-of-life care

Long-term care (LTC) facilities usually contract with hospice agencies to provide palliative (comfort) care to their terminally ill residents, yet only 1% of nursing home residents enroll in hospice care. Integrating hospice services with nursing home services presents many challenges. One of the most critical challenges is the lack of education in palliative care among physicians, licensed nurses, and certified nursing assistants in LTC settings. A study of 164 licensed nurses from 24 LTC facilities in north central Texas found deficiencies in their knowledge of palliative care. The mean score on the Palliative Care Quiz for Nursing was 12.3 of a possible 20 (62%, SD = 2.7). Implications for practice include a critical need for in-service education on end-of-life content for practicing LTC nurses and integration of such content in all curricula for future nurses.     

Algorithm for resuscitation: a systematic plan for immediate care of the injured or postoperative patient.

A systematic integrated approach to the diagnostic, monitoring and fluid volume therapy was developed for use in patients with accidental and elective surgical trauma. An algorithm (patient care protocol) is proposed for expeditious resuscitation in emergency situations using: (a) BP as the criteria for initiation of rapid fluid therapy, (b) hematocrit for the choice of blood transfusion or plasma expanders, and (c) CVP, urine output, arterial pressure and wedge pressure as criteria for slowing down or stopping the rate of volume therapy. History, physical examination, laboratory work, X-rays, monitoring and diagnostic procedures are interdigitated in a systematic fashion according to priorities of the most common life-threatening aspects of the total resuscitation problem. In chaotic emergency situations, it is impossible to plan for all possible contingencies; to try to do so results in an impossibly complex and unwiedly plan. However, we believe that almost any reasonable plan is better than no plan at all.     

Nephrology nursing care plan and patient education plan for the patient receiving Epogen

This article presents a nursing care plan and patient education plan for patients receiving recombinant human erythropoietin in the form of Epogen (Epoetin alfa). Eight nursing diagnoses and a standard and outcomes for patient education are included.     

Israeli nurses' knowledge of health care reforms

Israeli nurses’ knowledge of health care reforms Objectives. This study examines health care reforms’ implementation processes from the perspective of nurses’ knowledge regarding the reforms. The research has been carried out in the Israeli context, where health care reforms were initiated in 1995. Three specific research questions were formulated: (a) What is the level of nurses’ knowledge regarding the recommendations of the Netanyahu committee? (b) What is the level of nurses’ knowledge concerning the basic principals of the National Insurance Law? and (c) Are there knowledge differences relating to employment setting (hospital, community, and educational settings), nurses’ roles (managerial vs. staff nurses), years of experience, and level and type of education? Method. The stratified nonproportional random sample consisted of a total of 468 nurses. Of these nurses, 206 were employed in community settings (136 in curative care, and 70 in preventive care), 137 were employed in hospital settings, and 125 worked in schools and departments of nursing. Research tools, developed for the purpose of this study, included the nurses’ knowledge questionnaire comprised of five subscales, and the knowledge relevancy questionnaire. Results. Overall, data demonstrated a low to moderate level of knowledge on all knowledge scales. Knowledge level on the criteria questions was particularly low. Contrary to the low level of knowledge, nurses regarded health care reforms’ knowledge as highly relevant to their work life. Curative setting, an extensive work experience, managerial position, and non‐nursing academic degree were all positively related to higher levels of reforms’ knowledge. Conclusion. These findings should encourage both policy makers and managers in various health care organizations to develop programs for informing health care providers on central aspects of health care reforms considered most relevant to the practice setting.     

Critical care nurses' knowledge of arterial pressure monitoring.

BACKGROUND: Direct monitoring of arterial blood pressure provides continuous, real-time information about patients' physiological status. Critical care nurses set up and maintain monitoring systems and use the obtained data to guide clinical decisions. Inaccurate measurements may lead to misdiagnosis and mismanagement. PURPOSE: To describe critical care nurses' knowledge in 3 content areas related to direct monitoring of arterial blood pressure: physiology, technical aspects, and waveform and data interpretation. METHODS: Via poster advertisements, 391 critical care nurses in 6 intensive care units at 2 hospitals were invited to complete an 18-item, criterion-referenced questionnaire on monitoring arterial blood pressure and a demographic data sheet. Summary statistics were used to analyze data from 68 subjects. Analysis of variance was used to determine if total and subset scores differed among demographic subgroups. RESULTS: Scores ranged from 11.1% to 61.1% correct answers, with a mean of 36.7% (SD, 11.8%). Item analysis indicated a knowledge deficit in all content areas at all cognitive levels. Questions with highest scores addressed waveform damping and using mean arterial pressure to guide treatment; lowest scores were related to dynamic response characteristics and reflected pressure waves. Mean scores did not differ among demographic subgroups. CONCLUSIONS: The results suggest a general knowledge deficit in arterial blood pressure monitoring. This study should be replicated on a larger scale to validate its findings and to improve the validity and reliability of the research tool. National research-based standards of practice for hemodynamic monitoring should be developed and disseminated among critical care nurses.     

A survey of European intensive care nurses' knowledge levels

BackgroundThe application of knowledge to the care of critically ill patients is a hallmark of professional nursing practice. However, the educational preparation of intensive care nurses varies from country to country, and there has been little research that has investigated knowledge levels of European critical care nurses.ObjectiveThe aim of this study was to examine the knowledge levels of European intensive care nurses.DesignThe study was an international cross-sectional survey, with data collected from 20 European countries.Setting and participants318 European intensive care units participated, and data were collected from 1142 intensive care nurses.MethodsData were collected between May and December 2009 using a 100-item multiple choice online questionnaire to assess intensive care nursing knowledge. The questionnaire was available in 16 languages, and data were collected in 11 knowledge areas.ResultsA response rate of 60% was achieved; the majority of participants was female (77%). The largest groups of nurses had more than five years’ experience and were under 30 years of age. The overall mean knowledge score was 66% (SD 12). The main factor that contributed to variance in scores was nurses’ length of intensive care experience; in ten categories knowledge scores were progressively higher according to experience. If 50% is considered to be a pass mark, 90% of participants would have passed. However, in only six countries did all participants achieve a ‘pass’ score, and in five countries more than 10% of participants failed to meet this ‘pass’ criterion. The knowledge category which scored lowest was respiration and ventilation (mean score 56%, SD 15).ConclusionsAlthough knowledge levels differed among countries, there were no major differences. However, the relatively low scores achieved in the respiration/ventilation category are a cause of concern, and suggest that this is an education area that should be prioritised. The results should be considered within the context of each country's healthcare and professional education systems, and strategies should be developed to improve knowledge in several key areas.     

Critical care nurses' knowledge in preventing nosocomial pneumonia.

OBJECTIVE: The purpose of this study was to identify knowledge deficits concerning nosocomial pneumonia (NP) prevention among critical care nurses. The study also determined whether NP knowledge was associated with nurse characteristics. DESIGN: A survey design using a mailed self-administered questionnaire. SETTING: New Zealand critical care nurses were identified through the Nursing Council of New Zealand. SUBJECTS: 134 critical care nurses. MAIN OUTCOME MEASURES: NP prevention knowledge score (the proportion of 24 items answered correctly). RESULTS: The NP knowledge score ranged from 21% to 92%. The mean (and median) was 48%. Items related to knowledge about NP risks had the highest mean score (67%) compared to items addressing NP prevention (43%) or the role of devices in the transmission of NP (45%). No nurse demographic or workplace characteristic was associated with NP knowledge. CONCLUSIONS: Several important deficits in nosocomial pneumonia knowledge were identified indicating a need for critical care nurses to have greater exposure to nosocomial pneumonia prevention education, guidelines, and research.     

Distressing situations in the intensive care unit: a descriptive study of nurses' responses.

Moral distress is a significant stressor for nurses in critical care. Feeling that they are doing the "right thing" is important to nurses, and situations of moral distress can make them question their work. The purpose of this study was to describe critical care nurses' levels of moral distress, the effects of that distress on their personal and professional lives, and nurses' coping strategies. The study consisted of open-ended questions to elicit qualitatively the nurses' feelings about moral distress and a quantitative measure of the degree of distress caused by certain types of situations. The questionnaires were then analyzed to assess the nurses' opinions regarding moral distress, how their self-perceived job performance is affected, and what coping methods they use to deal with moral distress. The most frequently encountered moral distress situations involved critically ill patients whose families wished to continue aggressive treatment when it probably would not benefit the patient in the end.