The nursing diagnosis of "spiritual distress", a necessary re-evaluation

The subject of the study consisted in identifying the spiritual needs of the terminally ill patients, so as to investigate and specify the implementation field of the diagnosis of "spiritual distress" by the French nurses relative to the values and beliefs. The key moments, when the spiritual needs can express themselves also had to be spotted, in order to investigate the possible role of the nurse faced with the spiritual needs of the patients. The study was carried out on a population of 27 AIDS and cancer patients, hospitalized in two units of palliative cares of the Paris region and on a population of 20 nurses of these same units. It was made during the year 1996 by means of interviews with patients, comprising 51 open or half-open questions and questionnaires for nurses, comprising 20 questions. These tools have been structured on the basis of 4 main lines namely spirituality, religion, the ill being called "spiritual distress", nursing diagnosis (for the nurses). The results from the patients show that nearly all of them have had a feeling of ill being which would be of spiritual nature, where existential questioning prevails concerning the meaning of life, of death, of pain, of illness whereas only slightly more than a third of the nurses think that it happens frequently to the patients. The spiritual distress can be described as the failure of giving a meaning to one's life. Religion is mainly evoked in terms of rites with "mosaic" beliefs specific to each individual. The big majority of the nurses concerned by this study have an intuitive knowledge of the main features of the nursing diagnosis of "spiritual distress". This knowledge does not seem to be linked really to the training they had, but rather to their professional experiences and maybe to the personal life story. This nursing diagnosis does not seem to be adapted to our western culture. Its lack of discriminatory power and of flexibility does not make it very useful for the caretaker who needs to clarify beforehand the concepts of spiritual needs and of religious needs. As for the actions, the appeal to the religion representatives or to the psychologist is not always what the patients want even though the ill being appears mainly when the patients feel lonely ... we therefore resort to actions of relation of help with an active listening and help to the rereading of life for which the nurse is in a rather good position, according to the patients.     

Australian nurse educators identify gaps in expert practice

In Australia, nurses face a double-barreled challenge to their role. With the rapid adoption of new health care technologies coupled with increasing economic constraints, they find themselves "doing more with less." In this context of continuous change, it is useful to determine what expert nurse clinicians deem the most essential skills, attitudes and knowledge required for practice in complex technological environments. Separate panels of 28 educators and 43 cardiac nurse clinicians participated in a national Delphi study rating the importance to the nursing role of 107 items drawn from the international literature on expert practice and technology. Indicating the importance of each item in both the "real" and "ideal" worlds of practice, educators identified 58 items where they felt actual practice was substantially far from the ideal. For 16 of these items relating to empowerment of patients, nursing research, and technology policy, the educators rated clinical behavior below the median of the real world scale, indicating substandard performance of a role or inadequate assimilation of a concept. The implications for the definition of expert practice and for curricula development are discussed.     

A study comparing the perception of patients, nurses and doctors about the educational needs of cancer patients

Because of the advances in the treatment of cancer, patients live longer and require more comprehensive information in order to understand their illness, treatment procedure and role in the health care process. Each treatment involves combined therapeutic approaches, so information must be presented to the patient in such a way as to promote maximum understanding and acceptance. The purposes of this study were to explore and compare patients', nurses' and doctors' perception of the educational needs of cancer patients and to identify areas of agreement and disagreement in the perception of these needs by patients, nurses and doctors. Three groups took part in the study; 78 cancer patients, 39 nurses and 35 doctors. They all were selected from one general teaching hospital. Data were collected using a questionnaire, developed by the investigators. The questionnaire was made up of 2 sections; an importance rating scale and a knowledge/providing information rating scale. Each rating scale consisted of 20 specific informational items that were elicited through interviews with 60 cancer patients. The data were analyzed using percentages, means, Pearson correlation coefficients, t-test, and ANOVA. The results of this study were as follows; 1. Nurse subjects achieved a higher total score (85.6154) on the rating of importance than did the patients (81.5238) or the doctors (79.3125). The difference between the three group's total score was significant (F = 6.164, p less than .01) and the difference between the nurses' total score and doctors' was also statistically significant (t = 3.95, p less than .001). 2. On the whole, the rankings for the mean score of importance for the 20 items differed among the three groups of subjects. For the patient subjects, the highest mean ratings were for "the symptoms of recurring illness", "progress of illness", and "plan and duration of treatment" showing these to be the items that they considered important. The nurse subject felt that it was most important for oncology patients to know about "plan and duration of treatment", "how to minimize problems with loss of appetite, nausea, vomiting", and "amount of activity the patient can do around the work setting". Doctors felt it was most important for the patient to know about "prognosis of illness", "progress of illness", and "plan and duration of treatment". "Plan and duration of treatment" was the common item that all three groups perceived as important for patient learning.(ABSTRACT TRUNCATED AT 400 WORDS)     

妇女儿童医院护士职业价值观调查分析

目的调查妇女儿童医院护士职业价值观现状,为护理人力资源管理提供参考依据。方法采用护士职业价值观量表对某妇女儿童医院174名临床护士进行调查。结果妇女儿童医院护士职业价值观总均分为（3．38±0．45）分;其中得分较高的条目为保持所从事专业的实践／临床工作能力、保持患者对医护人员的信任、拒绝参与违背自己专业价值观伦理要求的护理工作;得分较低的条目为参加影响资源分配的公共决策、参与同事之间的评估活动和做患者的代言人,扮演患者倡导者的角色。结论护理管理者应经常组织科室团队活动,给予普通临床护士参与意见沟通的机会,发挥主观能动性,不断提高护士对职业价值观的认同。     

上海市社区护士及慢病患者"互联网+护理服务"期望模式及服务项目的调查分析

目的调查上海市社区护士及慢病患者对"互联网+护理服务"模式及服务项目的期望情况,以期为完善上海市"互联网+护理服务"提供理论参考。方法采用便利抽样法,于2021年1—2月选取上海市静安区15家社区卫生服务中心的255名护士及150例慢病患者为研究对象,分别采用护士"互联网+护理服务"调查问卷和患者"互联网+护理服务"调查问卷对其进行调查。本研究共发放护士"互联网+护理服务"调查问卷255份,回收有效问卷250份,有效回收率为98.0%(250/255);共发放患者"互联网+护理服务"调查问卷150份,回收有效问卷148份,有效回收率为98.7%(148/150)。结果250名社区护士中有31.6%(79/250)的护士了解"互联网+护理服务";29.6%(74/250)的护士愿意参与"互联网+护理服务"。148例慢病患者中有50.0%(74/148)的患者不了解"互联网+护理服务";48.0%(71/148)的患者表示愿意参与"互联网+护理服务"。慢病患者需求较多的服务项目为血糖监测(27.0%,40/148)、皮下注射(25.0%,37/148)、肌内注射(23.6%,35/148);社区护士执行意愿较高的服务项目为血糖监测(42.0%,105/250)、静脉血采集(41.2%,103/250)、肌内注射(40.0%,100/250)。社区护士与慢病患者在期望的执业护士职称、期望的执业护士工作年限方面比较,差异均有统计学意义(P<0.05)。结论社区护士及慢病患者对"互联网+护理服务"的认知水平有待提高,有关部门应通过媒体、网络等手段提升"互联网+护理服务"知晓度,在完善"互联网+护理服务"规章制度时,应对护患供需双方进行充分调研,以数据导向作为政策的落脚点,切实满足患者需求,保障患者健康。     

How accurately do nurses perceive patients' needs? A comparison of general and psychiatric settings

This paper examines to what extent nurses' perceptions of patients' needs correspond to the patients' views of their own needs. A questionnaire was designed to assess patients' emotional and physical needs in general medical wards and in acute psychiatric wards. Sixty patients, 30 psychiatric and 30 general, together with their 'key' nurses, took part in the study. Results indicate that, despite there being no evidence of appreciable disagreement between the 'average' psychiatric nurse and the 'average' psychiatric patient, there is little evidence that individual nurses and their patients, whether psychiatric or general, agree. The nurses' inability to perceive patients' needs on an individual basis is consistent with other studies which suggest that nurses use stereotypes when perceiving patients' needs. Implications for nursing care are discussed.     

Cardiac surgery patients’ evaluation of the quality of theatre nurse postoperative follow-up visit

Theatre nurses at the Department of Cardiothoracic Surgery in Örebro, Sweden, have since 2001 routinely conducted a follow-up visit to postoperative cardiac patients. A model with a standardized information part and an individual-caring conversation including both a retrospective and a prospective part designed the visit. The purpose of this study was to evaluate the quality of the postoperative follow-up visit conducted by the theatre nurses and find out if the quality was related to gender or type of admission.The method was prospective and explorative, including 74 cardiac surgery patients who had had a postoperative follow-up visit by a theatre nurse in Sweden. The instrument measuring quality, from the patient’s perspective, measured the quality of the visit, and consisted of 16 items modified to suit the study.The results showed an overall high quality rating, with statistically significant higher scores for six items between patients who had undergone emergency surgery, in comparison with elective patients. When comparing gender, women had statistically significant higher scores in two items.In conclusion, this postoperative follow-up visit by the theatre nurse was a valuable and useful tool especially for the patients who had undergone emergency surgery. In the follow-up visit the theatre nurse creates a caring relationship by meeting the patient as an individual with his/her own experience and needs for information about the surgery, intra and postoperative care, and recovery.     

Haemoglobinopathies and healthcare provision for ethnic minorities

The level of training and competence in dealing with haemoglobinopathies (which mainly affect ethnic minorities in the UK) may not be totally adequate among nurses. Nurses indicated that they received little or no information in their teaching for working from a multiracial perspective and what they had learned was through experience and personal research since qualifying as nurses. Knowledge of the biological basis of inheritance, methods of acquisition of thalassaemia and sickle-cell anaemia and the ethnic profile of people affected by these conditions may not be totally adequate among nurses. Many nurses wanted more training, including those who had already received instruction, since this was described as "far too vague", "not constructive", "minimal", or "embarrassingly insufficient", recommending that instruction be given by a sickle-cell anaemia/thalassaemia counsellor with a contribution from patients. A combination of poor quality, or lack, of instruction, together with time and resource pressures, is responsible for this limited understanding, resulting in insufficient awareness of the health needs of ethnic minorities leading to inequalities in healthcare provision.     

住院病人护理需求的质性研究

目的深入了解住院病人存在的护理需求，为护士有针对性的护理服务措施提供依据。方法应用Maslow的需要层次壶论为框架访谈了江西省某医院11位住院病人和8位临床护士。结果经过分析了解到病人在住院期间可能存在的59项护理需求和病人对医院工作的一些要求。结论医院各部门和护士要重视病人的护理需求。使病人在住院期间得到高品质的护理服务。     

Spirituality in critical care: patient comfort and satisfaction

Creating an environment of compassion where patients feel that their emotional and spiritual needs are met is at the heart of holistic care. Patient satisfaction surveys address this powerful aspect of care and nurses find themselves in the position of making an impact. The nurse is at the bedside when crisis occurs, both physical and spiritual. Superficial attention to matters of spirituality is no longer acceptable. Nurses need to examine spirituality within themselves and be available when the patients give the invitation to join them in the struggle for peace. The critical care unit is most vulnerable because the intensity of illness is so great. Conscious or unconscious, the patient needs human touch and consolation, which transcends technology. Indifference to this is all but negligence on the part of the nurse. Addressing this through careful care planning and joining the "fellowship of pain" brings the nurse into the healing process. "Burnout" decreases as care increases, and nurses experience the healing process themselves as well.     

Using referral guidelines to support best care outcomes for patients

District nurses play a pivotal role in individuals' care pathways by meeting their needs in the community. However, district nurses are frequently referred patients for whom other interprofessional colleagues have more suitable skills to help in achieving their optimum care outcome. Various major reports have identified a clear need to define what district nurses do and how they will respond appropriately to patients' needs. However, there remains only tacit understanding of district nurse referral criteria across the country and within community organizations. This article discusses how a set of facilitative district nurse referral guidelines have been devised to support individuals in achieving their best care outcome. We also debate approaches to managing referrals to district nursing services and the pressing need to ensure these are effectively managed in practice.     

Medication Calculation Ability of Registered Nurses

A convenience sample of 110 registered nurses in four western states completed a demographic questionnaire and a 20-item medication calculation test to investigate errors in medication calculation that contribute to medication error rates. Intravenous questions were most difficult, then oral, the intramuscular/subcutaneous items. Nurses erred more when more than one calculation was required and when milligram to grain conversion was needed. Nurses who rated their skill and comfort with medication calculation above average scored higher. Yet 81 percent of the nurses were unable to correctly calculate medications 90 percent of the time and 43.6 percent of the test scores were below 70 percent accuracy. Strategies are suggested which may be used in staff development to identify registered nurse medication calculation abilities and to enhance these skills in practicing nurses.     

影响成为临床护理专家的因素及对策

目的 :为了解在临床工作的护士对临床护理专家的了解程度 ,及影响成为CNS的因素 ,进行调查与分析。方法 :对外科临床工作的 5 2名护士采用问卷式调查 ,调查表为笔者自行设计 ,共有 10项内容 ,采用单项选择法 ,按每项的积累人次计算出百分比。结果 :影响护士成为CNS的主要原因为工作忙累、学习时间少、工作压力大等。结论 :解决护士工学矛盾 ;缓解压力 ;充分利用时间进行理论与实践的充实、不断更新知识 ,加速护理人才的培养 ,使之成为CNS。     

District nurses’ role in palliative care provision: A realist review

Objectives

The aim of this review is to construct a detailed account of the role of the district nurse (generalist registered nurse providing nursing care in primarily home settings) in providing palliative care, to determine if and how district nursing care provides effective care to such patients at home, and to examine the utility of a realist review for the above purpose.

Design

Realist review of literature.

Data sources

Papers in English reporting aspects of the district nurse role in the provision of palliative care are included. Electronic databases (Ovid Medline, Cinnahl, British Nursing Index, Embase, PsycINFO and EBM reviews) were searched, supplemented by citation tracking and grey literature searches.

Review methods

Assumptions about district nursing practice with palliative care patients are derived from a range of sources. Reviewed papers are interrogated to support, refute or develop these statements.

Results

Forty six papers employing a range of research methods are incorporated into the review. Studies focus on district nurses, patients, family carers and other professionals and include work from a range of countries. Studies highlight the value district nurses place on palliative care provision, the importance of developing a relationship with patients, and the emotional difficulties of providing such care. District nurses have key skills in providing physical care and in coordinating the work of others, but struggle more with psychological aspects of care. District nurses report feeling undervalued, and express some reluctance to work with other health and social care professionals to provide care.

Conclusions

There is little in this synthesis to shed light on the outcomes of care or to explicitly guide practice. District nurses clearly articulate what they consider to be important, but research in this area is limited and needs to undergo a renaissance to examine what is important: namely what district nurses do in practice; what patients and family carers views are on what they do and do not do; and how district nurses can improve care outcomes. The inclusiveness of realist review works well for this field of study.     

ICU护士对患者家属需求的认知及相关因素调查

目的 调查ICU护士对家属需求的认知程度及相关因素,以便对护理人员进行有针对性的培养,从而提高ICU的护理质量.方法 采用方便抽样的方法对上海市2所三级甲等医院中的60名ICU护士进行问卷调查.结果 ICU护士对家属需求的认知程度最高的3项为:在第一次进入ICU时,能向家属主动介绍ICU的规章制度,能保证给患者最好的照顾,能用通俗易懂的话向家属解释有关患者的病情;在对探视需求的认识上比较不同学历和不同工作年限的护士均有统计学意义(P<0.05),其中本科及本科在读学历和4年以上的认识程度最高;在对于患者病情信息的需求的认识上不同学历和不同工作年限均有差异,本科及本科在读学历和4年以上的认识程度最高(P<0.05);在对于患者家属对ICU条件与环境需求认识程度上仅不同工作年限有统计学意义4年以上的认识程度最高(P<0.05).结论 提高了对不同年龄段及学历层次的ICU护士的针对性培养、完善相关的配套服务措施.     

A review of basic patient rights in psychiatric care

Although patient rights is a concept that all nurse managers need to be aware of, this concept often becomes confusing when applied to patients undergoing psychiatric treatment. It is important for the nurse manager to understand the basic rights that psychiatric patients are entitled to, to best be able to help staff nurses under his/her supervision to protect these rights. The nurse manager on a psychiatric unit often serves as a reference for staff nurses, and even for physicians, when questions regarding patient rights present themselves. The nurse manager should be certain to discuss these issues with the facility's legal and risk management team to be aware of particulars of the law of the state in which the facility is located, as state laws may differ somewhat in their treatment of psychiatric patients.     

Perceptions of caring by nurse educators.

The purpose of this paper is to report on nurse educators' perceptions of caring behaviors. A review of the literature indicated a lack of consensus between nurses and patients of exactly what constitutes caring behaviors. Since subjects in previous studies were based on nurses educated at various levels, it was hypothesized that a more homogeneous sample of nurses with advanced education might provide different findings. Using the Larson CARE-Q, 110 nurse faculty, managers, and clinical specialists/practitioners were asked to indicate what they believed were the most and least important caring behaviors. Because the 72 educators' findings were similar to those of 38 other nurses with advanced education, their responses were combined. A clear difference between the perceptions of nurses and patients was obtained, and the data support the results of previous studies--nurses have a tendency to consider comfort and trusting relationship items as most important while patients perceive behaviors associated with physical care as most important. No significant differences were found between educators according to type of programs or functional groups, and few differences were found according to age, years of experience, or clinical areas.     

Concordance between nurses' perception of their ability to provide spiritual care and the identified spiritual needs of hospitalized patients: A cross‐sectional observational study

Spiritual care is essential to the well‐being of patients, and nurses provide spiritual care as a fundamental part of nursing practice. In this study, we investigated the spiritual care needs of hospitalized patients to determine whether the perceived knowledge of nurses corresponded with these spiritual care needs. A cross‐sectional study was conducted on 1351 hospitalized patients and 200 registered nurses recruited from a medical center in central Taiwan. A questionnaire, including the 21–item Spiritual Care Needs Inventory (patient and nurse version) and basic demographic information, was distributed to eligible participants. The top three items of the spiritual care needs expressed by the hospitalized patients were respect for privacy and dignity, showing concern, and guidance in gaining a sense of hope in life; the percentages of nurses not knowing how to provide these spiritual care needs were 0%, 1%, and 15%, respectively. The spiritual care needs of patients showed a significant relationship with the knowledge of nurses, suggesting that the perceived knowledge of the nurses generally corresponded with the spiritual care items that the patients required most.