Exploring the facets of continence care: a continence survey of care homes for older people in Birmingham

Aims. This study aimed to explore continence prevalence, knowledge and care in Birmingham care homes, UK. Background. There is an increasing need to respond to rising numbers of care home residents suffering from incontinence in the UK. A lack of staff knowledge, training and treatment options can make this problematic. Method. A survey was developed and sent to 186 care homes in Birmingham catering for those 65 years old and over. A freepost envelope was provided for return of the completed form. Results. Sixty‐six (35%) surveys were returned providing a representative sample. Eighty per cent of nursing home residents and 49% of residential home residents were reported incontinent. Half of the staff (53%) had some form of qualification in caring/nursing. Absorbent products were used to manage incontinence in over 50% of homes. Advanced age was cited as the main cause of incontinence. Sixty‐eight per cent of homes used the continence advisory service and/or district nursing services. Conclusions. While results proved encouraging in relation to numbers of qualified staff there is a need for improved continence awareness. Focus on aetiology, assessment procedures and treatment options are needed. While external service use levels were encouraging there appeared to be a need for an exchange of knowledge between services to optimize care. Relevance to clinical practice. While there is an existing body of knowledge relating to continence prevalence and management in nursing homes this research base is lacking for residential care settings. This survey addresses this imbalance by combining information from both settings. This paper also provides an insight into the components that have an impact upon continence promotion, prevention and management. By establishing a picture of current practice an indication of areas for improvement can be exposed.     

Nurse executive director effectiveness: a systematic review of the literature

AIM: This report systematically reviews studies of nurse executive director effectiveness to identify recurring themes that might inform current practice and future research. BACKGROUND: Increasing competition in healthcare markets is increasing the demands on nurse executive directors. There is a need to identify factors that contribute to effectiveness in the role so that these can be developed and effectiveness improved. EVALUATION: Reports were identified using electronic databases, an internet search and review of references in all reports initially identified. The methodology of these reports was reviewed and recurring themes were identified. KEY ISSUES: Ten themes that might be associated with nurse executive director effectiveness emerged from the review. CONCLUSIONS: The literature relating to nurse executive director effectiveness is limited but there are sufficient recurring themes to inform current practice and to investigate in new research.     

推动证据向临床转化 (二)如何选择知识转化理论模式

本文作为证据临床转化方法学系列文章的第二篇,旨在详细阐述如何选择合适的知识转化理论模式,以指导和促进证据向临床的转化。本文分析了理论、模式和概念框架的内涵,并介绍了5个知识转化领域最常用的理论模式,包括KTA知识转化框架、渥太华研究应用模式、PARIHS框架、复旦循证护理路径图和基于证据的持续质量改进模式图。在此基础上,分析了在推动证据临床转化的过程中,选择合适的知识转化理论模式的重要性、依据及应注意的问题。     

The effectiveness of 'nursing beds': a review of the literature

A literature search was conducted to identify 'nursing led in-patient units' where the nurse is the designated leader of the clinical team. The review concentrates on studies which have attempted to measure the impact of nursing-led in-patient units and reviews both the methodology and outcomes. Three major bodies of work were identified. Lydia Hall's evaluation of the Loeb Center for Nursing and Rehabilitation (USA) is reviewed in some detail. This work was the model for 'nursing beds' at the two Oxfordshire Nursing Development Units (UK) in the 1980s. Studies evaluating these centres are reviewed and reports of similar UK units discussed. A third body of work evaluates a nurse-managed critical care environment. Common features include a case mix based on nursing need with nurses having authority to admit and discharge patients. While results are generally favourable, with improved patient independence, fewer readmissions, lower mortality and cost savings reported in some or all of the studies, all studies reviewed demonstrate the difficulties of applying an experimental model to real life clinical services. Methodological limitations render firm conclusions difficult. Techniques adopted from studies in field settings, the so-called 'quasi-experiment', are advocated as a remedy, as is further study of the process of care in investigating this model of care delivery.     

Faculty Development: How to Evaluate the Effectiveness of a Faculty Development Program in Emergency Medicine

Evaluation of the effectiveness of any faculty development program (FDP) is crucial to provide assessment of existing programs and to yield valid recommendations for designing future programs that better address the needs of individual faculty members and the sponsoring institutions. The author chose the validated Kirkpatrick's model with four levels of program outcomes (satisfaction data, learning data, performing data, and career change) to evaluate the effectiveness of an FDP in emergency medicine. Assessment of the effectiveness of this FDP can be performed by sponsoring organizations or by independent evaluators experienced in the field for better objectivity.     

预防呼吸机相关性肺炎护理质量评价指标的研究

目的制订预防呼吸机相关性肺炎护理质量评价指标。方法通过查阅预防呼吸机相关性肺炎循证临床实践指南及相关文献,初步确立量表的指标,采用Delphi法对18名专家进行2轮问卷咨询。结果第1轮专家的积极性系数为94.44%,第2轮专家的积极性系数为100.00%;确立了包含7个方面25个指标的质量标准评价量表;专家权威系数为0.88。结论该质量标准评价量表具有较好的可信性和权威性,护士可用于对预防呼吸机相关性肺炎护理的评价。     

The effectiveness of a group approach to clinical supervision in reducing stress: a review of the literature

There is little research evidence to suggest that clinical supervision reduces stress. However, this probably does not mean that clinical supervision is not valuable, just that the evidence is not yet there, because consensus exists that group clinical supervision may be beneficial in reducing stress in nurses. The work by Butterworth et al. is the only directly relevant study investigating the stress-reducing potential that a group approach to clinical supervision has, and this work establishes ground rules for future evaluation.     

Peer evaluation in nurses' professional development: a pilot study to investigate the issues

Peer evaluation in nursing is a method by which the nurse evaluates the work of a peer, according to set evaluation criteria. The aim of the study was to clarify the potential significance of peer evaluation with regard to nurses' career development and relates to the introduction of a career development programme for nurses in a Finnish University Hospital. The research concepts were created on the basis of literature analysis. The concepts served as a basis for data collection, and five open-ended questions were devised from them. Informants (n = 24) gave free-form essay-type answers to these questions. The material was analysed using qualitative content analysis. The results indicate that self-evaluation constitutes the basis for peer evaluation. Peer evaluation allows nurses to give and receive professional and personal support promoting professional development. Professional support offers possibilities for change and alternative action. Personal support requires respect for the peer's equality and individuality. Personal peer support can decrease feelings of uncertainty and insecurity caused by work. The conclusion is drawn that peer evaluation is a means of promoting nurses' professional development to further on-the-job learning in collaboration with peers.     

Promoting evidence-based practice: the roles and activities of professional nurses' associations

AIM: This paper reports a study exploring the role perceptions and current activities in evidence-based practice promotion of professional nurses' associations in the Netherlands. Background: The promotion of evidence-based practice contributes to professional standards in nursing and good quality care for patients. As professional nurses' associations can be key players in this process, the nature of their roles and current activities deserves to be explored. METHODS: Roles and activities were explored for 43 professional nurses' associations (83% of all national associations). Data were collected using interviews with the associations' board members. Findings from the interviews were validated with those from an analysis of the associations' policy reports and other publications in the previous 2 years. RESULTS: Board members primarily thought that they had roles in the selection and distribution of evidence. The roles of participant (n = 13) and performer (n = 13) in selecting evidence, and those of facilitator (n = 12), initiator (n = 15) and performer (n = 41) in the distribution of evidence were often addressed. A few respondents reflected on roles in generating evidence and implementing evidence-based practice in patient care. A majority of the associations was contemplating activities in the promotion of evidence-based practice. Specific activities for each of six relevant aspects in the promotion of evidence-based practice were found in fewer than five associations. CONCLUSION: Professional nurses' association roles in the promotion of evidence-based practice need to be viewed in relation to the tasks to be accomplished, especially those of selecting and distributing evidence. Although many organizations expressed motivation, professional nurses' associations have a long way to go in the promotion of evidence-based practice among their members.     

护士长如何运用人际人性特征做好护理管理工作

目的:探讨正确运用人际人性特征促进护理管理的有效方法。方法:分析在护理管理中引入人际人性特征概念的必要性和重要性,详细阐述人际人性特征中偏好正性刺激、自我性、情绪的人际间转移性、他人尊重性以及个别性的具体内容及对促进护理管理的启示。结论:学习并正确运用人际交往中的人际人性特征,更新护士长管理观念,树立以人为本的管理思想,拓宽护士长的视野,促进管理创新。     

Using satisfaction to measure the quality of palliative care: a review of the literature

BACKGROUND: The advent of clinical governance in British health policy has placed increased demands on health care providers and practitioners to ascertain the quality of their services. Traditional indicators of quality of health care, such as death or recovery rates, are not appropriate in palliative care. Thus, it is important to establish alternative approaches to measuring the quality of palliative care services and interventions. AIMS: Satisfaction levels have been used widely in palliative care to assess quality. A literature review was conducted which aimed to explore the strengths and weaknesses of using satisfaction as an indicator of the quality of palliative care services. It also aimed to provide a solid basis upon which further work could be built. METHODS: Five electronic databases were searched using key words and phrases and key authors. Hand searches were conducted of four journals that contributed significantly to the concept of satisfaction, and reference lists of reviewed papers were scrutinized. Relevant papers were reviewed, data were extracted and these data were thematically analysed. FINDINGS: There are a number of important unresolved issues in the literature with regard to using satisfaction as an indicator of the quality of palliative care services. First, few alternatives to satisfaction are available. Secondly, satisfaction is under-theorized and no widely accepted definition exists. Thirdly, there are methodological inconsistencies across studies. It is important to take into account these findings when planning and implementing change following service evaluation using satisfaction as a measure. CONCLUSIONS: Relying on findings of satisfaction surveys to determine clinical and policy amendments in palliative care may not result in improvements in overall quality of care. Using satisfaction as a method of assessing the quality of health care services is particularly problematic and requires further investigation in both practical and conceptual terms.     

The effectiveness of silver‐releasing dressings in the management of non‐healing chronic wounds: a meta‐analysis

Aim. The purpose of this study was to examine the efficacy of silver‐releasing dressings in the management of non‐healing chronic wounds. Background. Non‐healing chronic wounds often have a negative physical impact on patients and place a financial burden on healthcare systems. Silver dressings are wound products designed to control infection and provide a wound environment conducive to healing. However, validation of the clinical efficacy of these dressings is lacking. Design. Systematic review and meta‐analysis. Methods. A systematic search of the major electronic databases PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO, OCLC and Proquest between 1950–June 2007 was conducted. Hand searches of selected periodicals, textbooks and checking reference lists and contacting experts was also performed. Results. Eight studies were selected from a potentially relevant 1957 references screened. Analysis incorporated data from 1399 participants in the eight randomised control trials. We found that silver dressings significantly improved wound healing (CI₉₅: 0·16–0·39, p < 0·001), reduced odour (CI₉₅: 0·24–0·52, p < 0·001) and pain‐related symptoms (CI₉₅: 0·18–0·47, p < 0·001), decreased wound exudates (CI₉₅: 0·17–0·44, p < 0·001) and had a prolonged dressing wear time (CI₉₅: 0·19–0·48, p = 0·028) when compared with alternative wound management approaches. An analysis of sensitivity in these studies by subgroup analysis generally supported these associations. Furthermore, studies indicated an improvement in quality of life (CI₉₅: 0·04–0·33, p = 0·013) using silver dressings in wound management with no associated severe adverse events. Conclusion. This meta‐analysis confirms the effectiveness of silver dressings in wound healing and improving patients’ quality of life. However, it also highlights the need for additional well‐designed randomised controlled trials to evaluate the effectiveness of silver‐related dressings further. Relevance to clinical practice. The results of this study provide objective data on the effectiveness of silver‐related dressing when applied to non‐healing chronic wounds.     

Communication at the bedside to enhance patient care: A survey of nurses' experience and perspective of handover

Street M, Eustace P, Livingston PM, Craike MJ, Kent B, Patterson D. International Journal of Nursing Practice 2011; 17 : 133–140 Communication at the bedside to enhance patient care: A survey of nurses' experience and perspective of handover Strategies to support continuity of care and improve patient safety during clinical handover have been developed. The aims of this study were to identify the strengths and limitations in current practice of nursing clinical handover and implement a new bedside handover process. A total of 259 nurses completed a cross‐sectional survey at change of shift on 1 day, which was followed by an audit of the pilot implementation of bedside handover. The survey results showed great variation in the duration, location and method of handover with significant differences in the experience of nurses employed part‐time compared with full‐time. Following implementation of standardized bedside handover on two wards, the audit revealed significant improvement in the involvement of patients, use of Situation‐Background‐Assessment‐Recommendation, active patient checks and checking of documentation. These findings suggest the use of standardized protocols and communication tools for bedside handover improve continuity of patient care.