Educating nursing students about quality care and safe practices in the AIDS epidemic

Nursing students, as future health care providers, need comprehensive instruction about AIDS--the many manifestations of both the disease itself and the pandemic. As health educators and practitioners, nurses play a major role in safeguarding the health care setting and the community by their efforts in preventing transmission of the AIDS virus. Nurses are and will continue to be responsible for administering the major portion of the direct health care that AIDS patients require and for teaching basic nursing skills to other care givers. According to a 1987 survey of 461 nursing programs conducted by the American Association of Colleges of Nursing, AIDS content is being incorporated into the curriculums of the majority of programs that responded. Students require an in-depth knowledge of AIDS to enable them to address effectively the needs of AIDS patients and their families. Because of the complex psychosocial, ethical, and legal issues, careful attention must be given to the development of students' skills in making clinical decisions that will promote effective nursing intervention when addressing problems in nursing care. Curriculums should also include assessment of the special needs of members of minority groups that are disproportionately affected by AIDS. Schools of nursing in colleges and universities can serve as key resources for developing curriculums, policies, and practice patterns that will assist the nursing community and the public in responding to the AIDS epidemic.     

The quality of obstetric care in family practice: are family physicians as safe as obstetricians?

A literature review on the quality of obstetric care in family practice was conducted to determine whether family physicians are as competent in providing obstetric care as obstetricians. Three types of studies were reviewed: case series, historical cohorts, and population-based studies. No conclusion on the quality of obstetric care in family practice can be drawn from the available studies because of research design limitations. Available evidence suggests, however, that family physicians are as safe as obstetricians when delivering babies, particularly when they concentrate their efforts on providing personal prenatal care, refer high-risk pregnant women appropriately, and practice less technologically oriented care on women who deliver normal-weight babies. In addition, no evidence emerged that family physicians provided significantly poorer obstetric care than obstetricians. In fact, the results from population-based studies suggest that family physicians may be safer than obstetricians in delivering normal-weight infants because of their hypothesized less use of technological interventions in that low-risk group of patients. Further studies, especially prospective randomized trials in which the outcomes are assessed in a blinded fashion and case mix is rigorously controlled, are needed to provide a definitive answer. As practical, ethical, and economic constraints are likely to preclude such studies, the case-control design may provide a reasonable alternative.     

Improving quality of care with practice guidelines

In sum, I believe that we know how to develop good practice guidelines today, even though we currently invest paltry sums to do so. Well-constructed guidelines can have a substantial positive impact on quality. By focusing on problems of overuse, costs can be reduced as well. Implementation of guidelines is an absolutely central step in the application of this important quality improvement tool. Practitioners of continuous quality improvement require few external incentives to capitalize on the value of guidelines in the effort to improve quality and are likely to experience their full potential benefit. They may require some prodding to address problems of overuse. Others will need additional inducements. Using reimbursement to reward the attainment of high quality, publishing data on provider performance on various quality measures, and recognizing the salutary effect of adherence to guidelines on liability can provide such incentives.     

Reporting about health care quality: a guide to the galaxy

A review of research on the reporting of health care quality information and related fields in applied social and cognitive science led to identification of seven basic principles that should be followed when planning to report health care quality information to consumers or other audiences: (a) know the audience: who they are, what they care about, and what actions they can take; (b) identify constraints that limit what is feasible; (c) consider barriers and facilitators to achieving objectives; (d) identify specific behaviors to target for change, and prioritize objectives; (e) design a report that specifically incorporates priorities and reflects trade-offs; (f) develop a plan for promotion and dissemination from the beginning; and (g) build in ongoing testing and evaluation to identify successes and areas needing improvement. Case studies provide many examples of unsuccessful reporting efforts that might have succeeded had these guiding principles been followed.     

Nursing responsibility and conditions of practice: are we justified in holding nurses responsible for their behaviour in situations of patient care?

Abstract This paper analyses a situation where a patient's suffering provoked feelings of compassion in a student nurse, and distress at her patient's circumstances. The reported behaviour of qualified nurses within the situation suggests that they lacked compassion, had inadequate knowledge, and that they failed to understand their patient's plight. An account of the situation is followed by an exploration of the nature of moral agency, and understanding in nursing. Nurses' capacity for moral imagination is shown to be of crucial importance to the care that patients receive. The extent of nurses' responsibility for their behaviour is considered, and in particular, the extent of nurses' responsibility during times when they experience strain. Argument leads to the conclusion that we are justified in holding nurses responsible for their behaviour in situations of patient care, although we must not judge a nurse's behaviour too hastily. Attention is drawn to the need for a moral climate to sustain those nurses who struggle to give good patient care, despite the strain that is ever present within today's world of health care.     

Evaluating the administration of an office-based health survey in a primary care practice

Self-administered waiting room questionnaires are popular tools for gathering health information from patients, but these data cannot be used for research purposes without confirming adequate sampling of the practice population and assessing the completeness and accuracy of patients' responses. Long-term data collection also requires avoiding an imposition on clinic operations. We developed a protocol to test these questions in a 9-week pilot study of 884 survey-eligible patients visiting a family practice clinic. We found an adequate proportion of eligible patients were approached (74%) and participated (89%), they provided relatively complete (82-98%) and accurate responses, and the impact on office operations was minimal (<2 min of staff time per participant). Some demographic differences in participation and survey item completion were identified. A systematic process for testing survey performance allowed us to not only document these findings, but also to rapidly identify problems and introduce solutions while the survey was in progress.     

Nursing practice in the health care of children at a basic health unit

This study aimed at identifying nursing actions in the follow-up of growth and development of children under five years old who were assisted at two Basic Health Units in Franca, Brazil. The empirical study was based on observation of nursing activities in the vaccination, pre-consultation, post-consultation and newborn screening test collection sectors, using video recording. We concluded that basic follow-up actions concerning growth and development, breastfeeding stimulation, food orientation, vaccination and prevalent disease prevention are permeating nursing care, although in a fragmented way in communication and ties established with clients.     

Focus on clinical practice: improving the quality of care

In this diverse issue, we have a report on the high cost of diabetes quality improvement programs. Two studies using health information technology, including one that embedded a questionnaire and tool for bipolar disorder into an electronic health record to improve diagnosis, and another that collected information about anxiety and depression for adolescents with a personal digital assistant. Other articles considered sources of disparities in screening for colorectal cancer in rural Georgia, and the characteristics of sepsis in HIV patients. Clinicians will likely find interesting how patients interpret and report provider reactions to interpersonal violence situations. We also have a review of the symptoms patients report in a community practice sample; breast cancer survivors' perspectives on acupuncture for treating hot flashes; clinical reviews about Alzheimer disease and prasugrel; and several interesting brief case reports.     

Nursing care to premature children: a review of the literature about follow up

Neonatal care has improved greatly in recent years, focusing its efforts on low weight and premature children. Literature has considered prematurity under several focuses, recommending the following of growth and development in a systematic way. The present study tries to present a review of the literature on nursing care in the follow-up to premature children, in order to promote a reflection about the health care given to this customers. Authors searched in the data bank of the University of S?o Paulo, international periodicals and recent books. In general, studies focus on nursing role and strategies, such as home visits, in order to provide follow-up for the children and give orientations to mothers, as well as give support to the families. Studies emphasize the importance of multiprofessional teams working with mothers, children and families from neonatal intensive care to the post-neonatal period. The following of children brings out the need of reorganization and integration of health services, as well as the improvement of the relationships between professionals and families. Therefore, it is important to characterize the follow-up of this children, enabling the way for a more effective role in nursing care.     

Nursing care theory and practice: teaching and the labor market

This study identifies how faculty nurses and clinical nurses experience the relationship between teaching and the labor market in Nursing. Data were collected by means of interviews and documentary analysis. Methodological and content categories were utilized for analysis. It became evident that teaching is far from the clinical practice and that it is based on contents which do not have correspondents; there is a phase displacement between what is taught in undergraduation and the incorporation of new technologies, practices and knowledge. Action towards reflections about nursing teaching in order to approach it to clinical work areas is pointed out.     

Developing professional ethics for child and youth care work: Assuming responsibility for the quality of care

Child and youth care in North America is actively engaged in a process of doing ethics. This paper presents the context for this current ethics work, gives a brief history of ethics in the culture as it impacts on helping professions, and describes the function of professional ethics. The ethics work of the National Association for the Education of Young Children (NAEYC), the Child Life Council (CLC), and organized child and youth care in North America are detailed. The plan of action includes the process that has led to the completed draft of the Code of Ethics of North American Child and Youth Care Professionals, an outline for a process of doing ethics, and the formulation of research questions to enhance the understanding of ethics in practice.An earlier version of this paper was presented in May 1992 at the 39th International Congress of the International Federation of Educative Communities (FICE) in Luxembourg.     

Improving the quality of diabetes care in general practice

Objective: The evidence treatment gap for patients with type 2 diabetes. Design: A summary of convenience sample of seven general practices. Setting: Metropolitan and rural Victoria, Australia. Participants: 561 patients of general practices (75% from rural general practices). Main outcome measures: Demographic data, duration of diabetes, diabetes complications, HbA1c and lipid levels, blood pressure and score on PHQ‐9. Results: Patients with depression show more severe, progressive and intensively treated diabetes. The prevalence of depression in diabetes is about twice that of the general population. Conclusion: Australian guidelines for diabetes should recommend screening for depression.