A survey of commitment and compassion among nurses in residential aged care

AIM: To assess the views and attitudes of aged care staff providing direct care towards palliative care and to identify their learning needs. DESIGN: Survey design using purposive sampling methods. FINDINGS: Nurses and care assistants (n=222) employed within nine residential aged care facilities in regional Australia completed the survey. The majority had received 'on the job training' and were committed to providing end-of-life care. Differences in the level of confidence to deal with patient/family interactions and manage complex palliative care scenarios were evident between nurses and care assistants (p<0.05). Both nurses and care assistants perceived a need for further education in symptom management and communication, yet their content need differed significantly between groups. CONCLUSIONS: Nurses and care assistants in residential aged care facilities demonstrate commitment to the delivery of palliative care and express a need for increased palliative care competencies. The heterogeneity of roles and educational preparation within the aged care workforce indicate that tailored palliative care education initiatives are required to meet the learning needs of aged care nurses and care assistants, particularly in relation to end-of-life care. These data have implications for skill-mix and model of care development.     

Restructuring the American health care system: an analysis of Nursing's Agenda for Health Care Reform.

Equal access to health care for all citizens is a hotly debated issue of the American health care system. Different plans for reform that would allow equal access to health care have been proposed, but few include nurses as key health care providers. To correct this oversight, a coalition of more than 60 national nursing and health care organizations has created Nursing's Agenda for Health Care Reform, a blueprint for restructuring the health care system. This article reviews the agenda within the framework of the ethical theory of distributive justice. Distributive justice allows for the allocation of health care resources in a manner that is fair but not necessarily equal for all. The agenda addresses the basic level of health care needed by all Americans and supports the provision of primary care by nurse practitioners. Nurse practitioners need to be aware of plans to reform the health care system and should be supportive of those plans that enhance nurse participation in the health care system. Nursing's Agenda for Health Care Reform is a plan that encourages the health care consumer's participation and promotes nursing care as the link between the consumer and the health care system.     

What critical care nurses need to know about health care access when caring for elders in acute care settings

Health care system issues, in general, and access to care, in particular, are not problems typically studied by critical care nurses. Rather, initial and continuing education focuses on clinical aspects of care. This focus is necessary to assure that critical care nurses have the expertise to care for patients who need astute surveillance for complicated physical problems and their emotional sequelae, as well as in-depth knowledge and skills related to care coordination for patient stabilization and transfer. However, evidence is growing that patients benefit when critical care nurses expand their knowledge about access to care. This article provides insights regarding access to health care and how it relates to many of the admission and readmission patterns that critical care nurses observe.     

Knowledge,facilitators and barriers to the practice of person-centred care in aged care workers: a qualitative study

The current study describes aged care workers' interpretation of the concept of person-centred care; and identifies the barriers that exist to impede its practice, and the facilitators that encourage person-centred care practice. Data were collected from interviews with aged care workers from two residential aged care facilities providing both high and low care for residents with and without physical and psychological issues based in Australia. Data were analysed to identify and explore categories of meaning for barriers and facilitators. Analysis is grounded in Brooker's VIPS framework for person-centred dementia care which is utilised as a comparative tool for analysing participants' understanding of person-centred care. Findings revealed that aged care workers have a reasonable but incomplete understanding of person-centred care. Insufficient time and residents' dementia behaviours acted as barriers to care workers' provision of person-centred care. Teamwork was found to facilitate person-centred care by increasing instrumental and relationship resources     

Admission and discharge guidelines for the pediatric patient requiring intermediate care

During the past three decades, the specialty of pediatric critical care medicine has grown rapidly, leading to a number of pediatric intensive care units being opened across the country. Many patients who are admitted to the hospital require a higher level of care than the routine inpatient general pediatric care, yet not to the degree of intensity as pediatric critical care; therefore, an intermediate care level has been developed in institutions providing multiple disciplinary subspecialty pediatric care. These patients may require frequent monitoring of vital signs and nursing interventions but usually do not require invasive monitoring. The admission of the pediatric intermediate care patient is guided by physiologic parameters depending on the respective organ system involved relative to the institution's resources and capacity in caring for a patient in a general care environment. This report provides admission and discharge guidelines for intermediate pediatric care. Intermediate care promotes greater flexibility in patient triage and provides a cost-effective alternative to admission to a pediatric intensive care unit. This level of care may enhance the efficiency of care and improve the healthcare affordability for patients receiving intermediate care.     

Health and social care policy for the elderly in Belgium

Current Belgian health care policy for the elderly can be classified broadly into institutional care, community care, and home care. Economic restrictions, smaller families, increased employment among women, geographic distances between family members, and the preference of the elderly to remain at home are factors challenging Belgian policy makers and health professionals to restructure the current health care system and provide integrated holistic health and social care to the elderly. These challenges are being addressed through initiatives to customize care for the elderly at home, in the community, or in care environments by improving coordination of care, programs of support for geriatric care and dementia, and research into new accommodation and health solutions.     

Reporting a research project on the potential of aged care nurse practitioners in the Australian Capital Territory

Aim. This paper reports a project investigating the potential role of the nurse practitioner in aged care across residential, community and acute care venues in the Australian Capital Territory. Background. Australia, like many other countries, faces unprecedented challenges in the provision of health care. Escalating health care costs, an ageing population, increasing prevalence of comorbidities and chronic illnesses, inefficient health care delivery, changing models of health care and shifting professional role boundaries are factors that have contributed to the development of advanced practice roles for nursing. Design. This was a mixed methods study using multiple data sources. Methods. Student aged care nurse practitioners were examined across the continuum of care in the acute, community and residential aged care settings. The potential role of the nurse practitioner in these areas was evaluated qualitatively and quantitatively to identify a model of care to enhance the delivery of efficient and effective health care. Results. The project findings have demonstrated that there is potential for significant improvement in client outcomes arising from a transboundary aged care nurse practitioner model. The improved outcomes are associated with a decrease in acute hospital admissions for residential care clients, timely intervention for a range of common conditions and strengthened multidisciplinary approaches to care provision for older people. Conclusions. Overall the project findings strongly support the potential of a transboundary aged care nurse practitioner role. This role would focus on skilled assessment, timely assessment and intervention, brokering around access to care and clinical leadership and education for nurses. Relevance to clinical practice. This paper offers further evidence of support for the role of nurse practitioners in complementing existing health services and improving delivery of care.     

Close relatives in intensive care from the perspective of critical care nurses

Aim. The aim was to describe critical care nurses’ experiences of close relatives within intensive care. Background. There is a lack of research describing critical care nurses' experiences of the significance of close relatives in intensive care. Knowledge in this area will support critical care nurses to develop good nursing care for the critically ill person and their close relatives. Design and method. The design of the study was qualitative. Data collection was carried out through focus group discussions with 24 critical care nurses in four focus groups during spring 2004. The data were subjected to qualitative thematic content analysis. Results. The focus groups discussions showed that the presence of close relatives was taken for granted by critical care nurses and it was frustrating if the critically ill person did not have any. Information from close relatives made it possible for critical care nurses to create individual care for the critically ill person. They supported close relatives by giving them information, being near and trying to establish good relations with them. Close relatives were important. Critical care nurses lacked forums for reflection and discussion about the care given. Relevance to clinical practice. This study indicates that close relatives are a prerequisite for critical care nurses to give good nursing care to meet the needs of the critically ill person. A communication based on mutual understanding is necessary if critical care nurses are to be able to support close relatives. Dealing constantly with situations that were ethically difficult without any chance to reflect was an obstacle for critical care nurses to improve their work with close relatives.     

Using computerized medical databases to measure and to improve the quality of intensive care

This article reviews the potential for using computerized databases to measure the quality of care in the intensive care unit. There are 2 types of computerized databases used to assess quality of care: administrative databases used primarily for purposes other than medical care and electronic medical record databases collected specifically for clinical purposes. Quality of care is a difficult property to measure but is generally assessed along 3 domains: structure, process, and outcome. There are several problems with using computerized medical databases to measure and improve quality of care. Many factors known to be important to measuring the severity of illness and process of care in critically ill patients are not captured in routine administrative databases. The criteria for the ethical use of electronic medical record data for research, clinical care, and quality improvement are identical to those that should be applied to using paper medical records. Standardizing a minimal intensive care unit dataset, identifying and measuring optimal processes of care, and understanding the limits of risk adjusted outcomes are all important steps in the process of the optimal use of computerized databases to study and improve the quality of care in the intensive care unit.     

Critical care admissions criteria in community based hospitals: a pilot study with implications for quality management

Critical care nurses are increasingly vulnerable to crises of decision-making. Lack of enforcement or vague admission guidelines in many critical care units--including physician coverage and time limits for newly admitted patients--might lead to quality of care concerns. Managers struggle with staffing shortages, decreasing resources to provide high-technology care, and in many instances the lack of administrative support to enforce criteria for utilization of critical care beds. This pilot study addresses quality of care concerns and other issues that are a great source of frustration for critical care nursing staff.     

Perceptions of parents and healthcare professionals on family centred care in Australian neonatal units

The experiences of families receiving family centred care and of healthcare professionals providing family centred care in Australian neonatal units were evaluated by online surveys, distributed to families and healthcare professionals across Australia. Parents rated experience of partnerships, information sharing, coordinated care and respectful care in the moderate range. Healthcare professionals rated capacity to provide family centred care as moderate for interpersonal sensitivity, information sharing and treating people respectfully. Neonatal units providing moderate acuity care showed greater capacity to provide family centred care than intensive care or low acuity care units. These data provide a baseline and indicate room for improvement. Reasons for varying levels of family centred care provided by healthcare professionals in different neonatal settings require further investigation. Education of all staff on family centred care is required and targeted collection of data from parents at intervals will indicate progress in providing a higher level of family centred care.     

Leadership Models in Health Care—A Case for Servant Leadership

Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients.     

Nurses in adult day care centers

Adult day care services are community-based group programs designed to support adults' personal independence by promoting their social, physical, and emotional well-being through an individual plan of care. Nurses are in a prime position to care for this population because they deliver holistic care and promote health. Scant literature is available that addresses how nurses provide care for this population. The purpose of this article is to describe how nurses can care for the adult day care population and to present an illustrative case study that demonstrates how nurses can positively affect the health of older adult day care clients.     

Home care nursing in Japan: a challenge for providing good care at home

Home care in Japan has developed over the past 30 years. Nurses have taken leadership in promoting home care and at the same time have expanded their roles. The roles of Japanese nurses in the field of home care are presented in the context of the historical perspective and view for the future. Home care nurses have performed care management for their community as well as for individual older clients living in their community. Currently, nurses work as high-tech and personal care providers and are developing a new role in health care enterprises. The number of nurses working as clinical nurse specialists will increase consistently with the rapid increase of master's programs. In the future, nurses should take a lead in developing health policy. The purpose of the article is to describe the current situation of home care clients and home care nursing in Japan. In addition, four issues of home care in Japan are described related to home care for older persons, high-tech home care, terminal care, and home care for psychiatric patients.     

A critical discourse analysis of provision of end-of-life care in key UK critical care documents

This article highlights certain practical and professional difficulties in providing end-of-life (EOL) care for patients in critical care units and explores discourses arising from guidelines for critical care services. BACKGROUND: A significant number of patients die in critical care after decisions to withdraw or withhold treatment. Guidelines for provision of critical care suggest, wherever possible, moving patients out of critical care at the EOL. This may not necessarily be conducive to a 'good death' for patients or their loved ones. There is a moral responsibility for both nurses and doctors to ensure that decision-making around EOL issues is sensitively implemented, that decisions about care includes families, patients when able, nurses and doctors, and that good EOL care is provided. METHODS: A critical discourse analysis (CDA) of four key UK critical care documents published since 1996. FINDINGS AND RECOMMENDATIONS: The key documents give little clear guidance about how to provide EOL care in critical care. Discourses include the power dynamic in critical care between professions, families and patients, and how this impacts on provision of EOL care. Difficulties encountered include dilemmas at discharge and paternalism in decision-making. The technological environment can act as a barrier to good EOL care, and critical care nurses are at risk of assuming the dominant medical model of care. Nurses, however, are in a prime position to ensure that decision-making is an inclusive process, patient needs are paramount, the practical aspects of withdrawal lead to a smooth transition in goals of care and that comfort measures are implemented.     

Rationing home-based nursing care: professional ethical implications

The purpose of this study was to investigate nurses' decisions about priorities in home-based nursing care. Qualitative research interviews were conducted with 17 nurses in home-based care. The interviews were analyzed and interpreted according to a hermeneutic methodology. Nurses describe clinical priorities in home-based care as rationing care to mind the gap between an extensive workload and staff shortages. By organizing home-based care according to tight time schedules, the nurses' are able to provide care for as many patients as possible. Furthermore, legal norms set boundaries for clinical priority decisions, resulting in marginalized care. Hence, rationing care jeopardizes important values in the nurse-patient relationship, in particular the value of individualized and inclusive nursing care. The findings are highly relevant for clinical practice, since they have major implications for provision of nursing care. They revive debates about the protection of values and standards of care, and nurses' role and responsibility when resources are limited.     

唑来膦酸联合放疗治疗恶性肿瘤骨转移性疼痛的护理

目的:回顾性总结使用唑来膦酸联合放疗的方式治疗恶性肿瘤骨转移性疼痛的护理要点。方法:选取我院2009年1月～2011年6月肿瘤科确诊治疗的80例恶性肿瘤骨转移的患者为研究对象,对有恶性肿瘤骨转性疼痛的患者给予唑来膦酸联合放疗治疗骨性疼痛,回顾性分析疼痛护理、用药护理、基础护理、心理护理、饮食护理、骨髓抑制护理和病理性骨折的预防及护理等多方面护理方式对患者治疗和预后的积极影响。结果:经过积极的治疗及护理,患者的恶性肿瘤骨转移性疼痛症状得到明显的改善,对所有出院患者进行调查问卷评分,患者的生活质量有显著的提高,在院期间对护理服务满意度高达97.50%。结论:有针对性的对唑来膦酸联合放疗治疗恶性肿瘤骨转移性疼痛的患者进行疼痛护理、用药护理、基础护理、心理护理、饮食护理、骨髓抑制护理和病理性骨折的预防及护理等多方面护理对患者的预后和治疗都有着积极的影响和良好的效果,值得临床推广使用。