The size of the pressure-sore problem in a teaching hospital

A series of three prevalence surveys were undertaken in a teaching hospital (where medical students are taught) in the West Midlands of England to identify the numbers of patients at risk of developing pressure sores and the actual number of patients with pressure sores, prior to the purchase of pressure-relieving equipment. All in-patients were assessed using the Waterlow score. Full details of all pressure sores and any pressure-relieving equipment in use was recorded. There was a mean pressure sore prevalence of 7.32%, the prevalence for each survey being 8.77%, 5.1% and 8.1% respectively. Grades 2 and 3 were the most commonly reported grades and the sacrum was the most frequent position. It was anticipated that there would be a difference in dependency between the patient populations in each of the three surveys. This was not so and, when using the Waterlow score, the numbers of patients found to be at no risk, at risk and at high risk remained remarkably stable. Only those in the very high risk category fluctuated. It is postulated that the difference between the prevalence in the three surveys is related to the difference in the numbers of patients seen to be at very high risk. These surveys have provided a basis for selecting pressure-relieving equipment and baseline information for monitoring the efficacy of the prevention programme.     

Quality assurance: is it professional insurance?

Quality assurance (QA) is being hailed as a 'new frontier' of nursing. Its diffusion into nursing theory and practice in the United Kingdom is outlined. QA is not an alien import; favourable preconditions already existed. The systems-reasoning of the nursing process, which sprawned a plethora of models, each geared to the 'orderly' progression of stages, objectives and process, is resonant with the values and measurement techniques of QA. A major limitation of QA is that it downplays the organizational complexity of hospitals. Although QA is projected as being in the service of clients, its major impetus is concerned with professional self-defence, as regards other professions, the state and litigious clients. Further, QA enlisted by nursing strongly reproduces the ethos and logic of the dominant medical model; patients are 'objectified' as the technical products of production. The 'medical gaze' is now being joined with the 'nursing gaze'.     

A double-blind clinical trial to compare the efficacy of an active based cream F14001 against a placebo non-active based cream for the treatment of pressure ulcers in a population of elderly subjects

A double-blind clinical trial was conducted to compare the efficacy of an active based cream against a placebo non-active based cream in the healing of superficial pressure ulcers in a population of geriatric hospital patients and residents in community nursing homes. The active group showed a small significant beneficial effect at week four. The overall results of the trial also demonstrated a significant improvement in ulcer size over the duration of the trial period in both active and placebo groups.     

An evaluation of a workshop for teachers of nursing by comparing the members' expectations with their opinions of the outcome

Fifty-seven teachers of nursing, who comprised 42 women and 15 men and who also comprised 12 senior tutors, 16 nurse tutors and 29 clinical teachers, participated in a study to evaluate a workshop which they attended.
The method of inquiry used was that of a survey by questionnaire. Two questionnaires were used, one being set at the beginning of the workshop and the other at the end of the proceedings. The learning objectives for the workshop were used as the questionnaire items and comprised 20 in all. When the before and after scores relating to the questionnaire items were compared through the use of t tests significant differences were found on 12 out of the 20 objectives. In the course of the paper the differences found are identified and discussed. Some of the limitations of the method of inquiry used are discussed and finally some conclusions are reached.     

A review of the health promotion and health beliefs of traditional and Project 2000 student nurses

In this study it was proposed that a more rigorous theoretical component in nursing education courses would produce a nurse who was a proficient health educator and promotor of health A sound knowledge base will enable the student to develop positive attitudes and beliefs towards promoting health and providing health education as a part of nursing practice To test this hypothesis, two groups of students were asked to complete a questionnaire and the answers subsequently compared The results and data analysis supported the hypothesis only in a limited way and a further study on a larger group of students would provide greater insight into the question     

The abdication of the role of health education by hospital nurses

As nurses are in a unique position to influence patients and so carry out health education to their'captive audience', it is pertinent to discuss why so many nurses appear to abdicate this role. Reasons are suggested that the nurses'own education has failed to equip her with the skills necessary for the fulfilment of this role. Even basic communication skills appear to be poorly developed, let alone the more complex and analytical skills required by the nurse in order to effectively deliver a planned programme of health education to either individual patients or groups. A Health Belief Model (HBM) has been discussed and is proposed as a useful framework around which the nurse can formulate her health teaching. Variables to be considered include motivation, value of illness threat reduction, probability that compliant behaviour will reduce the threat of illness, and modifying and enabling factors. The HBM should be incorporated into an individualized nursing care plan, so that health teaching is an integral part of the patient's planned care in hospital. The ward sister is the key figure in implementing such procedures, and it is to her that education should also be directed     

Altruism is not enough: barriers in the development of nursing as a profession

This paper discusses the goals and strategies used by nurses to achieve professional status. It describes the several interest groups in nursing and identifies the plurality of their goals and the sometimes conflicting strategies used by them. The paper illustrates the constraints experienced by the Royal College of Nursing in policy making and proposes a pluralist structure as a basis for future planning.     

Nurse/patient dependency — is it iatrogenic?

It is often assumed that nursing care is given in response to the patient's degree of incapacity. This study indicates that rather than nursing care arising as a response to patients' dependency, nursing care is producing dependency. A considerable proportion of the measured dependency of 168 elderly patients arose from the type of nursing care they received--it was iatrogenic. Task allocation nursing was found to be positively unhealthy for elderly long-stay patients, whilst individualized care (nursing process) was associated with lower patient dependency, a shorter hospital stay and a better chance of surviving the hospital stay. The findings demonstrate the inadequacy of nurse staffing formulas which are based on patient dependency. It is suggested that despite the rising numbers of very old people in the population, the elimination of nurse-induced dependency could reduce the level of dependency in geriatric wards.     

Nurses need to become better patient educators

Education is an important and necessary part of patient care. To achieve this nurses need to develop patient teaching as a major part of their role. There is little evidence that nurses are doing this effectively at present. Many obstacles seem to interfere with this practice but all of them seem to originate from inadequate preparation.This paper looks at the nurse's role as a patient educator, at its effectiveness now, and at the current obstacles. It suggests that urgent curriculum review is necessary so that this important area does not continue to be neglected.