ISRN Nursing

An Analysis of Canadian Psychiatric Mental Health Nursing through the Junctures of History, Gender, Nursing Education, and Quality of Work Life in Ontario, Manitoba, Alberta, and Saskatchewan

Mary Smith and Nazilla Khanlou — Sun, 28 Apr 2013 15:57:43 +0000

A society that values mental health and helps people live enjoyable and meaningful lives is a clear aspiration echoed throughout our Canadian health care system. The Mental Health Commission of Canada has put forth a framework for a mental health strategy with goals that reflect the virtue of optimal mental health for all Canadians (Mental Health Commission Canada, 2009). Canadian nurses, the largest group of health care workers, have a vital role in achieving these goals. In Canada, two-thirds of those who experience mental health problems do not receive mental health services (Statistics Canada, 2003). Through a gendered, critical, and sociological perspective the goal of this paper is to further understand how the past has shaped the present state of psychiatric mental health nursing (PMHN). This integrative literature review offers a depiction of Canadian PMHN in light of the intersections of history, gender, education, and quality of nursing work life. Fourteen articles were selected, which provide a partial reflection of contemporary Canadian PMHN. Findings include the association between gender and professional status, inconsistencies in psychiatric nursing education, and the limitations for Canadian nurse practitioners to advance the role of the psychiatric mental health nurse practitioner.

The Factors Affecting the Refusal of Reporting on Medication Errors from the Nurses' Viewpoints: A Case Study in a Hospital in Iran

Tue, 09 Apr 2013 16:32:48 +0000

Objective. Medication errors are the most common types of medical errors which considerably endanger the patient safety. This survey aimed to study the factors influencing not reporting on medication errors from the nurses’ viewpoints in Abbasi Hospital of Miandoab, Iran. Methods. This was a cross-sectional, descriptive and analytical study conducted in 2012 in which all nurses () working in different inpatient units were studied using a consensus method. Required data were collected using a questionnaire. Collected data were analyzed through some statistical tests including Independent -test, ANOVA, and chi-square. Results. According to the results, the most important reasons for not reporting on medication errors were related to the managerial factors (), factors related to the process of reporting (), and fear of the consequences of reporting (), respectively. Also, there was a significant relationship between employment status and fear of the Consequences of reporting on medication errors (). Conclusion. This study results showed that managerial factors had the greatest role in the refusal of reporting on medication errors. Therefore, for example, establishing a mechanism to improve quality rather than focus only on finding the culprits and blaming them can result in improving the patient safety.

Nurse Managers' Perceptions Related to Their Leadership Styles, Knowledge, and Skills in These Areas—A Viewpoint: Case of Health Centre Wards in Finland

Wed, 03 Apr 2013 09:17:42 +0000

The purpose of this study was to explore nurse managers’ perceptions related to their leadership styles, knowledge, and their skills in these areas in health centre wards in Finland. The data were collected from nurse managers () in health centre hospitals in Finland using a structured questionnaire (response rate 63%). Six leadership styles—visionary, coaching, affiliate, democratic, commanding, and isolating—were reflected on. Almost all respondents in every age group considered four leadership styles—visionary, coaching, affiliate, and democratic—to be very important or important. Nurse managers estimated their knowledge and skills in leadership styles to be essentially fairly sufficient or sufficient. Nurse managers’ abilities to reflect, understand, and, if necessary, change their leadership style influence the work unit’s success and employees’ job satisfaction. Nurse managers, especially new nurse managers, need more theoretic, evidence-based education to cope with these expectations and to develop their professional abilities. Together with universities, health care organizations should start planning nurse manager education programmes that focus on strategic issues, leadership, job satisfaction, challenging situations in leadership, change management, work unit management (e.g., economy, efficiency, and resources), and how the nurse managers consider their own wellbeing.

The Value of Peer Learning in Undergraduate Nursing Education: A Systematic Review

Robyn Stone, Simon Cooper, and Robyn Cant — Wed, 03 Apr 2013 09:15:47 +0000

The study examined various methods of peer learning and their effectiveness in undergraduate nursing education. Using a specifically developed search strategy, healthcare databases were systematically searched for peer-reviewed articles, with studies involving peer learning and students in undergraduate general nursing courses (in both clinical and theoretical settings) being included. The studies were published in English between 2001 and 2010. Both study selection and quality analysis were undertaken independently by two researchers using published guidelines and data was thematically analyzed to answer the research questions. Eighteen studies comprising various research methods were included. The variety of terms used for peer learning and variations between study designs and assessment measures affected the reliability of the study. The outcome measures showing improvement in either an objective effect or subjective assessment were considered a positive result with sixteen studies demonstrating positive aspects to peer learning including increased confidence, competence, and a decrease in anxiety. We conclude that peer learning is a rapidly developing aspect of nursing education which has been shown to develop students’ skills in communication, critical thinking, and self-confidence. Peer learning was shown to be as effective as the conventional classroom lecture method in teaching undergraduate nursing students.

A Statewide Case Management, Surveillance, and Outcome Evaluation System for Children with Special Health Care Needs

Wed, 06 Mar 2013 16:07:13 +0000

Objectives. To evaluate the feasibility of implementing a statewide children with special health care needs (CSHCN) program evaluation, case management, and surveillance system using a standardized instrument and protocol that operationalized the United States Health and Human Services CSHCN National Performance Measures. Methods. Public health nurses in local public health agencies in Washington State jointly developed and implemented the standardized system. The instrument was the Omaha System. Descriptive statistics were used for the analysis of standardized data. Results. From the sample of CSHCN visit reports (), 314 problems and 853 interventions were documented. The most common problem identified was growth and development followed by health care supervision, communication with community resources, caretaking/parenting, income, neglect, and abuse. The most common intervention category was surveillance (60%), followed by case management (24%) and teaching, guidance, and counseling (16%). On average, there were 2.7 interventions per problem and 6.7 interventions per visit. Conclusions. This study demonstrates the feasibility of an approach for statewide CSHCN program evaluation, case management, and surveillance system. Knowledge, behavior, and status ratings suggest that there are critical unmet needs in the Washington State CSHCN population for six major problems.

Do High Frequency Ultrasound Images Support Clinical Skin Assessment?

Thu, 21 Feb 2013 10:23:37 +0000

High frequency ultrasound imaging has been reported as a potential method of identifying the suspected tissue damage in patients “at risk” of pressure ulceration. The aim of this study was to explore whether ultrasound images supported the clinical skin assessment in an inpatient population through identification of subcutaneous tissue damage. Skin on the heels and/or sacral coccygeal area of fifty vascular surgery inpatients was assessed clinically by tissue viability nurses and with ultrasound pre operatively and at least every other day until discharge. Images were compared to routine clinical skin assessment outcomes. Qualitative classification of ultrasound images did not match outcomes yielded through the clinical skin assessment. Images corresponding to 16 participants were classified as subgroup 3 damage at the heels (equivalent to grade 2 pressure ulceration); clinical skin assessment rated no heels as greater than grade 1a (blanching erythema). Conversely, all images captured of the sacral coccygeal area were classified as normal; the clinical skin assessment rated two participants as grade 1b (non-blanching erythema). Ultrasound imaging is a potentially useful adjunct to the clinical skin assessment in providing information about the underlying tissue. However, further longitudinal clinical assessment is required to characterise images against actual and “staged” pressure ulceration.

Subjectively Evaluated Effects of Domestic Violence on Well-Being in Clinical Populations

Marika Poutiainen and Juha Holma — Tue, 05 Feb 2013 13:23:09 +0000

Effects of domestic violence are reflected in victims' physical, psychological, and sexual health as well as in victims' subjective evaluations of health or subjective well-being. The principal aim of this study was to study the extent to which the consequences of domestic violence are reflected in patients' subjectively evaluated well-being, life management, and sense of security in an emergency department, a maternity department, and a reception unit of a psychiatric hospital. A questionnaire on the effects of domestic violence was administered to 530 patients. 61 patients reported either current or previous domestic violence that affected their current well-being and life management. Domestic violence was reported to have an effect on subjective well-being and sense of security: the more recent or frequent the experience of violence was, the greater was considered its impact on well-being and sense of security. Routine inquiry can uncover hidden cases of abuse and hence would be of great benefit in the healthcare context. Early identification of abuse victims can prevent further harm caused by violence.

Prevention, Rehabilitation, and Mitigation Strategies of Cognitive Deficits in Aging with HIV: Implications for Practice and Research

David E. Vance — Sun, 03 Feb 2013 07:35:52 +0000

Highly active antiretroviral therapy has given the chance to those living with HIV to keep on living, allowing them the opportunity to age and perhaps age successfully. Yet, there are severe challenges to successful aging with HIV, one of which is cognitive deficits. Nearly half of those with HIV experience cognitive deficits that can interfere with everyday functioning, medical decision making, and quality of life. Given that cognitive deficits develop with more frequency and intensity with increasing age, concerns mount that as people age with HIV, they may experience more severe cognitive deficits. These concerns become especially germane given that by 2015, 50% of those with HIV will be 50 and older, and this older cohort of adults is expected to grow. As such, this paper focuses on the etiologies of such cognitive deficits within the context of cognitive reserve and neuroplasticity. From this, evidence-based and hypothetical prevention (i.e., cognitive prescriptions), rehabilitation (i.e., speed of processing training), and mitigation (i.e., spaced retrieval method) strategies are reviewed. Implications for nursing practice and research are posited.

Iranian Nurses’ Attitudes and Perception towards Patient Advocacy

Mohadeseh Motamed-Jahromi, Abbas Abbaszadeh, Fariba Borhani, and Homa Zaher — Sun, 30 Dec 2012 12:02:49 +0000

Patient advocacy is an inherent component of professional nursing ethics; in other words, nurses' enough knowledge would be essential to gain a positive attitude towards nursing advocacy. Using a descriptive-analytic design, this study aimed to assess the correlation between nurses' perception and attitudes towards patient advocacy, amongst 385 nurses in Kerman, Iran; hence, a three-part questionnaire was applied: part I, a demographic data sheet, part II, attitude measuring instrument, and part III, perception measuring instrument in nursing advocacy. The results implied that fairly positive attitudes and perception were found amongst the participants, and nurses’ attitudes, in general, were positively correlated to their perception toward nursing advocacy. This means that with an improvement in perception, the attitude would also improve. In addition to our findings, it seems that these nurses needed more advocacy educational programs and support from responsible employers.

Cancer-Specific Stress and Mood Disturbance: Implications for Symptom Perception, Quality of Life, and Immune Response in Women Shortly after Diagnosis of Breast Cancer

Duck-Hee Kang, Na-Jin Park, and Traci McArdle — Thu, 20 Dec 2012 10:30:02 +0000

Purpose. To determine the levels of cancer-specific stress and mood disturbance in women shortly after diagnosis of breast cancer and to assess their associations with symptom perception, quality of life, and immune response. Design. Descriptive and correlational. Sample and Setting. One hundred women with newly diagnosed breast cancer were recruited from interdisciplinary breast clinics. Methods. Baseline data were collected using standardized questionnaires and established bioassay prior to the initiation of cancer adjuvant therapy. Blood samples were collected about the same time of day. Results. High cancer-specific stress was significantly correlated with high mood disturbance, which, in turn, was correlated with high symptom perception, poor quality of life, and an immune profile indicating high neutrophils and low lymphocytes. Conclusions. High cancer-specific stress and related mood disturbance show extensive negative relationships with multiple behavioral, clinical, and biological factors. Implications for Nursing. Routine screening for cancer-related stress and mood disturbance should be incorporated into nursing practice for all patients diagnosed with cancer. Given broad negative associations with other biobehavioral factors, early identification of patients at risk and provision and evaluation of stress and mood management programs may have a beneficial effect on subsequent health outcomes over time.

Gender, Work, and Health for Trans Health Providers: A Focus on Transmen

Judith A. MacDonnell and Alisa Grigorovich — Mon, 17 Dec 2012 14:37:33 +0000

Well-documented health research points to trans people’s vulnerability to health inequities that are linked to deeply embedded structural and social determinants of health. Gender and work, as social determinants of health for trans people, both shape and are shaped by multiple factors such as support networks, social environments, income and social status, shelter, and personal health practices. There is a gap in the nursing literature in regards to research on work and health for diverse trans people and a virtual silence on the particular issues of trans-identified health providers. This qualitative study used comparative life history methodology and purposeful sampling to examine links among work, career, and health for transmen who are health providers. Semistructured interviews were completed with four Canadian transmen involved in health care professional and/or practice contexts with diverse professions, age, work, and transitioning experiences. Critical gender analysis showed that unique and gender-related critical events and influences shape continuities and discontinuities in their careerlives. This strength-based approach foregrounds how resilience and growth emerged through participants’ articulation with everyday gender dynamics. These findings have implications for nursing research, education, and practice that include an understanding of how trans providers “do transgender work” and supporting them in that process.

Evaluation of Nurses’ Perceptions on Providing Patient Decision Support with Cardiopulmonary Resuscitation

Nicole Pyl and Prudy Menard — Wed, 05 Dec 2012 16:30:54 +0000

The decision whether to receive cardiopulmonary resuscitation (CPR) is a decision in which the personal values of the patient must be considered along with information about the risks and benefits of the treatment. A decision aid can be used to provide patient decision support to a patient who is seriously ill and needs to consider CPR options. The goal of this project was to identify the barriers and facilitators to using a CPR decision aid, through evaluating nursing perceptions on providing patient decision support. Using a needs assessment, it was determined that implementing a patient decision aid for CPR status in the Acute Monitor Area (AMA) of The Ottawa Hospital would be an excellent quality improvement project. The nurses who chose to participate were given an education session regarding patient decision support. Questionnaires were distributed to evaluate their views of patient decision support and decision aids before and after the education session and implementation of the CPR decision aid. Questionnaire results did not indicate a significant change between before or after education session and decision aid implementation. Qualitative reports did indicate that nurses generally have positive attitudes toward patient decision support and decision aids. The nurses identified specific barriers and facilitators in their commentaries. This clinically relevant data supports the idea that patient decision support should be integrated into daily nursing practice.

Health Is Belonging: Lived Experiences during Recovery after Pancreaticoduodenectomy

Thomas Andersson, Kristin Falk, Kristofer Bjerså, and Anna Forsberg — Wed, 05 Dec 2012 13:23:43 +0000

The aim of this study was to explore the lived experience of the symptoms, health, and illness reported by patients recovering after pancreaticoduodenectomy ad modum Whipple due to pancreatic or periampullary cancer. Thirteen patients with pancreatic or periampullary cancer who underwent pancreaticoduodenectomy ad modum Whipple between 2006 and 2008 were interviewed during postoperative recovery. Data were analysed using the phenomenological-hermeneutic method. The structural analysis of patient experiences revealed that recovery after pancreaticoduodenectomy was described as recapturing everyday life, being healthy, and looking to the future. Participants experienced symptoms but did not dwell on them, instead they stated that their general health was good. They strived to regain their former precancer selves and be a part of as well as contribute to the social context. Overall, the participants’ view of the future was positive, and improvement in their health generated further confidence and encouragement. This study suggests that persons recovering from pancreaticoduodenectomy ad modum Whipple due to a pancreatic or periampullary tumour experience health despite postoperative symptoms. They manage their symptoms by means of different strategies and express a positive view of the future. Nurses working with such patients should adopt a person-centred approach focusing on patient perspectives, participation, and possibilities.

How Does an Online Patient-Nurse Communication Service Meet the Information Needs of Men with Recently Diagnosed Testicular Cancer?

Tue, 04 Dec 2012 07:26:20 +0000

Online communication has become a potential means of communication between patients and health care providers, but so far few studies are published about online communication as part of nursing care. The aim of this study was to explore how an online patient-nurse communication (OPNC) service meets the information needs of men with newly diagnosed testicular cancer. We applied a qualitative approach by examining the content of online messages sent by patients to nurses in a specialist cancer unit. In addition, individual interviews were conducted with patients who had used the OPNC service. Four themes became distinct through a synthesis of the material from the interviews and the messages: “a means for managing illness-related concerns at home,” “a means for ensuring information flow,” “a means for strategic information seeking,” and “not yet available when needed most.” Individualized information provided by nurses with access to their medical record was shown to be important to these patients. The findings of this study indicate that not only may access to an OPNC service help patients fulfill their otherwise unmet information needs, but also it may prevent delays and discontinuity in care due to informational gaps and lead to improved patient safety.

Communication Training Improves Sense of Performance Expectancy of Public Health Nurses Engaged in Long-Term Elderly Prevention Care Program

Motoko Tanabe, Yoshimi Suzukamo, Ichiro Tsuji, and Sin-Ichi Izumi — Mon, 19 Nov 2012 13:19:24 +0000

This study examines the effectiveness of a communication skill training based on a coaching theory for public health nurses (PHNs) who are engaged in Japan’s long-term care prevention program. The participants in this study included 112 PHNs and 266 service users who met with these PHNs in order to create a customized care plan within one month after the PHNs’ training. The participants were divided into three groups: a supervised group in which the PHNs attended the 1-day training seminar and the follow-up supervision; a seminar group attended only the 1-day training seminar; a control group. The PHNs’ sense of performance expectancy, and user’s satisfaction, user’s spontaneous behavior were evaluated at the baseline (T1), at one month (T2), and at three months (T3) after the PHNs’ training. At T3, the PHNs performed a recalled evaluation (RE) of their communication skills before the training. The PHNs’ sense of performance expectancy increased significantly over time in the supervised group and the control group , resp.). The difference score between T3-RE was significantly higher in the supervised group than the control group (). No significant differences in the users’ outcomes were found.

Predictors' Factors of Nutritional Status of Male Chronic Obstructive Pulmonary Disease Patients

Wed, 14 Nov 2012 11:33:49 +0000

Chronic obstructive pulmonary disease (COPD) is a systemic disease that leads to weight loss and muscle dysfunction resulting in an increase in mortality. This study aimed to determine the prevalence rate of malnutrition and nutritional status and also factors associated with nutritional status. A total of 149 subjects were involved in the cross-sectional study. The study was conducted at two medical centers in Kuala Lumpur, Malaysia. The results of the study showed that malnutrition was more prevalent (52.4%) in the subjects with severe stages of COPD as compared to mild and moderate COPD stages (26.2%) (). Fat-free mass depletion as assessed using fat-free mass index (FFMI) affected 41.9% of the subjects. Plasma vitamin A, peak expiratory flow (PEF), and handgrip were the predictors for body mass index (BMI) (, ). Plasma vitamin A and force expiratory volume in one second (FEV1) were the predictors of FFMI (, ). BMI was the predictor of respiratory factors, that is, FEV1% predicted (, ). It can be concluded that there is a need to identify malnourished COPD patients for an appropriate nutrition intervention.

Guided Self-Help for Prevention of Depression and Anxiety in Women with Breast Cancer

Wed, 24 Oct 2012 09:16:09 +0000

Depression and anxiety are prevalent in women with breast cancer. We developed a self-help kit as a self-learning package of necessary preparatory information (basic knowledge on chemotherapy, side effects, and problem-solving skills). We provided an oncology nurse-guided self-help kit with a cognitive behavioral therapy approach to 46 women with breast cancer in the intervention group and usual care to 36 in the control group in outpatient chemotherapy settings. The oncology nurse monitored and facilitated the patient’s progress using the diary during the patient’s chemotherapy. We also provided professional-led support group programs. Depression, anxiety, and quality of life were measured at baseline, 1 week, 3 months, and 6 months. The chi-square test and t were used to examine differences between the two groups, and repeated measures analysis of variance was used to test the effects of the intervention on the measures over time. All depression and anxiety scores were improved in both the intervention and control groups, but there were no significant differences between the two groups. Further studies are needed to evaluate the effectiveness of an oncology nurse-guided self-help approach for cancer patients.

Translating Community Connectedness to Practice: A Qualitative Study of Midlevel Health Workers in Rural Guatemala

Sun, 14 Oct 2012 15:49:45 +0000

Background. The performance of midlevel health workers is a critical lever for strengthening health systems and redressing inequalities in underserved areas. Auxiliary nurses form the largest cadre of health workers in Guatemala. In rural settings, they provide essential services to vulnerable communities, and thus have great potential to address priority health needs. This paper examines auxiliary nurses’ motivation and satisfaction, and the coping strategies they use to respond to challenges they confront in their practice. Methods. Semistructured interviews were conducted with 14 auxiliary nurses delivering health services in Alta Verapaz, Guatemala. Results. Community connectedness was central to motivation in this rural Guatemalan setting. Participants were from rural communities and conveyed a sense of connection to the people they were serving through shared culture and their own experiences of health needs. Satisfaction was derived through recognition from the community and a sense of valuing their work. Auxiliary nurses described challenges commonly faced in low-resource settings. Findings indicated they were actively confronting these challenges through their own initiative. Conclusions. Strategies to support the performance of midlevel health workers should focus on mechanisms to make training accessible to rural residents, support problem-solving in practice, and emphasize building relationships with communities served.

Counselling for Patients and Family Members: A Follow-Up Study in the Emergency Department

Eija Paavilainen, Mari Salminen-Tuomaala, and Päivi Leikkola — Wed, 12 Sep 2012 08:04:55 +0000

Although the research indicates that patients and family members are not fully satisfied with the counselling they receive, little is known about the quality of counselling in more detail. The purpose of the study was to describe patients’ and their family members’ experiences about counselling in emergency department, and follow how these experiences possibly change after the educational intervention for the whole nursing staff of the ED ward. The pre-test-post-test follow-up design was implemented including online continuing education for ED staff. The data were collected via questionnaires from patients and their family members in two phases and analyzed statistically. After online education of staff, experiences of patients and family members concerning counselling were better than before the education. Especially, family members’ satisfaction had increased. However, our results also indicated that patients and family members desire more information for example, regarding medications. Care practices had developed towards family-centeredness, which patients and family members appreciate. Online education proved also in some degree its usefulness in educating ED staff, by offering the same education to a staff which works in shifts. Furthermore, family presence and participation practices should be developed by offering possibilities for families to stay with each other on ED ward.

Nursing Student Perceptions of Reflective Journaling: A Conjoint Value Analysis

Thomas J. Hendrix, Maureen O'Malley, Catherine Sullivan, and Bernice Carmon — Wed, 05 Sep 2012 16:21:36 +0000

This study used a statistical technique, conjoint value analysis, to determine student perceptions related to the importance of predetermined reflective journaling attributes. An expert Delphi panel determined these attributes and integrated them into a survey which presented students with multiple journaling experiences from which they had to choose. After obtaining IRB approval, a convenience sample of 66 baccalaureate nursing students completed the survey. The relative importance of the attributes varied from a low of 16.75% (format) to a high of 23.58% (time). The model explained 77% of the variability of student journaling preferences (𝑟2=0.77). Students preferred shorter time, complete confidentiality, one-time complete feedback, semistructured format, and behavior recognition. Students with more experience had a much greater preference for a free-form format (𝑃<.05) when compared to students with less journaling experience. Additionally, the results of English as a second language students were significantly different from the rest of the sample. In order to better serve them, educators must consider the relative importance of these attributes when developing journaling experiences for their students.

Retrospective Study of Japanese Patients with Schizophrenia Treated with Aripiprazole

Thu, 30 Aug 2012 10:45:15 +0000

Aim. The purpose of this retrospective study was to evaluate changes in clinical indicators which influence the quality of life (QOL) of patients with schizophrenia treated by antipsychotic therapy before and after switching to aripiprazole. Methods. A retrospective chart review of 27 patients diagnosed with schizophrenia and who were switched from one antipsychotic to aripiprazole was performed. Clinical indicators about the daily dosage of antipsychotics and antiparkinsonian drugs, psychiatric condition, and glucose/lipid metabolism, clinical evaluation by nursing observation were used to measure the responsiveness of subjects to aripiprazole. Results. Of the 27 subjects, 14 responded to the switch to aripiprazole with significant improvement of the Brief Psychiatric Rating Scale (BPRS) score (𝑃=0.04), significant decrease in dosage of antipsychotics in 71% of patients (𝑃=0.03), and tendency toward reduction in dosage of antiparkinsonian drugs (𝑃=0.07) and body mass index (BMI) (𝑃=0.06). However, 8 of 27 subjects had a significant increase in lipid levels after switching to aripiprazole (𝑃=0.01). Conclusion. QOL for subjects who responded to the switch to aripiprazole improved as indicated by lower doses of antipsychotic and antiparkinson medications, improvement in BPRS score, and a decrease in BMI. Results indicate little influence on patient's QOL.

Organizational Interventions concerning Palliation in Community Palliative Care Services: A Literature Study

Mette Raunkiær and Helle Timm — Thu, 02 Aug 2012 08:32:04 +0000

Background. Studies indicate problems between different professional groups working with palliative care and the organisation of palliative home care at nursing homes. The purpose of this study is to examine international experiences and cooperative development initiatives regarding the organisation of community palliative care services. Method. The study has been carried out as a literature study based on bibliographic searches in international databases with selected key words. Results and Conclusion. The study of the literature identified 19 studies described in 20 articles that relate to development efforts and interventions regarding the organisation of palliative care in communities. Nearly, all of the studies were based on health care professionals' assessments of users (the relatives). However, it is unknown whether or how patients and relatives experience a positive effect of the interventions. The literature study shows that it is a great methodological challenge to complete and evaluate studies concerning organisation and cooperation using methods that make the results useful for others.

Using a Socioecological Framework to Understand the Career Choices of Single- and Double-Degree Nursing Students and Double-Degree Graduates

Noelene Hickey, Linda Harrison, and Jennifer Sumsion — Tue, 17 Jul 2012 16:07:26 +0000

Untested changes in nursing education in Australia, such as the introduction of double degrees in nursing, necessitate a new research approach to study nursing career pathways. A review of the literature on past and present career choice theories demonstrates these are inadequate to gain an understanding of contemporary nursing students’ career choices. With the present worldwide shortage of nurses, an understanding of career choice becomes a critical component of recruitment and retention strategies. The purpose of this paper is to demonstrate how an ecological system approach based on Bronfenbrenner’s theory of human development can be used to understand and examine the influences affecting nursing students’ and graduates’ career development and career choices. Bronfenbrenner’s socioecological model was adapted to propose a new Nursing Career Development Framework as a way of conceptualizing the career development of nursing students undertaking traditional bachelor of nursing and nontraditional double-degree nursing programs. This Framework is then applied to a study of undergraduate nurses’ career decision making, using a sequential explanatory mixed method study. The paper demonstrates the relevance of this approach for addressing challenges associated with nursing recruitment, education, and career choice.

Nurses’ Role in Caring for Women Experiencing Intimate Partner Violence in the Sri Lankan Context

Sepali Guruge — Mon, 16 Jul 2012 09:28:12 +0000

Intimate partner violence has short- and long-term physical and mental health consequences. As the largest healthcare workforce globally, nurses are well positioned to care for abused women. However, their role in this regard has not been researched in some countries. This paper is based on a qualitative study that explored how Sri Lankan nurses perceive their role in caring for women who have experienced partner violence. Interviews with 30 nurses who worked in diverse clinical and geographical settings in Sri Lanka revealed that nurses’ role involved: identifying abuse, taking care of patients’ physical needs, attending to their safety, providing support and advice, and making referrals. Barriers to providing care included lack of knowledge; heavy workload; language barriers; threats to personal safety; nurses’ status within the healthcare hierarchy; and lack of communication and collaboration between various stakeholder groups within the healthcare system. Nurses also identified a lack of appropriate services and support within hospitals and in the community. The findings reveal an urgent need for the healthcare system to respond to nurses’ educational and training needs and help them function autonomously within multidisciplinary teams when caring for abused women. The findings also point to a need to address institutional barriers including the lack of appropriate services for abused women.

Military Wives' Transition and Coping: Deployment and the Return Home

Suzanne Marnocha — Sat, 14 Jul 2012 15:00:42 +0000

The objective of this qualitative study is to explore the experiences of wives of deployed soldiers. Semistructured interviews were used to answer the research questions. Meleis' Transitions Theory was used to guide the understanding of the wives' experiences. Phase One: news of deployment, property of awareness, themes of emotional chaos and making preparations. Phase Two: during deployment, property of engagement, themes of taking the reins and placing focus elsewhere, along with the property of change and difference, with themes of emotional and physical turmoil, staying strong, and reaching out. Phase Three: after deployment, property of time span, themes of absence makes the heart grow fonder and reestablishing roles. The study concluded that the wife often feels forgotten during deployment. Nurses can give better care by understanding how the different phases of deployment and separation affect the wife's coping ability and her physical and emotional health.

Mapping the Diagnosis Axis of an Interface Terminology to the NANDA International Taxonomy

Thu, 05 Jul 2012 10:39:05 +0000

Background. Nursing terminologies are designed to support nursing practice but, as with any other clinical tool, they should be evaluated. Cross-mapping is a formal method for examining the validity of the existing controlled vocabularies. Objectives. The study aims to assess the inclusiveness and expressiveness of the nursing diagnosis axis of a newly implemented interface terminology by cross-mapping with the NANDA-I taxonomy. Design/Methods. The study applied a descriptive design, using a cross-sectional, bidirectional mapping strategy. The sample included 728 concepts from both vocabularies. Concept cross-mapping was carried out to identify one-to-one, negative, and hierarchical connections. The analysis was conducted using descriptive statistics. Results. Agreement of the raters’ mapping achieved 97%. More than 60% of the nursing diagnosis concepts in the NANDA-I taxonomy were mapped to concepts in the diagnosis axis of the new interface terminology; 71.1% were reversely mapped. Conclusions. Main results for outcome measures suggest that the diagnosis axis of this interface terminology meets the validity criterion of cross-mapping when mapped from and to the NANDA-I taxonomy.

The Patient's View of Nursing Care after Hip Fracture

Ami Hommel, Marie-Louise Kock, Jeanette Persson, and Elisabeth Werntoft — Tue, 03 Jul 2012 11:12:58 +0000

Background. The pathway for patients with a hip fracture described in this study is a fast track. Many studies have focused on prevention of various complications but, so far, the patient’s view of nursing care has not been highlighted. Aim. The aim of the study is to illuminate the patient’s view on nursing care when treated for a hip fracture. Method. Ten patients were interviewed. A content analysis design was conducted. Findings. From the analysis, four main categories emerged: waiting times; pain/pain relief and mobilisation; attitude/information and sense of security; complications. Conclusion. Patients generally felt satisfied with the nursing provided. The staff created a feeling of security and showed interest and empathy for the patient. However, patients experienced a stressful waiting for surgery, and patients who developed confusion waited more than 24 hours for surgery. Therefore, waiting time must be decreased. Furthermore, patients’ descriptions of a variety of pain problem show, for example, that good collaboration between the nurse and physiotherapist is critical for achieving good pain relief before mobilisation. Nursing staff need to be attentive and should elicit the patient’s feelings through patient-focused communication in order to relieve anxiety about going home.

Biofeedback Intervention for Stress and Anxiety among Nursing Students: A Randomized Controlled Trial

Paul Ratanasiripong, Nop Ratanasiripong, and Duangrat Kathalae — Thu, 28 Jun 2012 08:49:38 +0000

Purpose. It has been well documented that nursing students across the world experience stress and anxiety throughout their education and training. The purpose of this randomized controlled study is to investigate the impact of biofeedback intervention program on nursing students' levels of stress and anxiety during their first clinical training. Methods. Participants consisted of 60 second-year baccalaureate nursing students. The 30 participants in the biofeedback group received training on how to use the biofeedback device to assist in stress and anxiety management for 5 weeks while the 30 in the control group did not receive any training. Findings. Results indicated that the biofeedback group was able to maintain the stress level while the control group had a significant increase in the stress level over the 5-week period of clinical training. Additionally, the biofeedback group had a significant reduction in anxiety, while the control group had a moderate increase in anxiety. Conclusions. The better the nursing students can manage their stress and anxiety, the more successful they can be in their clinical training. Ultimately, the more psychologically healthy the nursing students are, the more likely they will flourish and graduate to become productive and contributing members of the nursing profession.

Predictors of Prolonged Stay in the Intensive Care Unit following Cardiac Surgery

Wed, 27 Jun 2012 10:01:16 +0000

The prediction of intensive care unit length of stay (ICU-LOS) could contribute to more efficient ICU resources' allocation and better planning of care among cardiac surgery patients. The aim of this study was to identify the preoperative and intraoperative predictors for prolonged cardiac surgery ICU-LOS. An observational cohort study was conducted among 150 consecutive patients, who were admitted to the cardiac surgery ICU of a tertiary hospital of Athens, Greece from September 2010 to January 2011. Multivariate regression analysis revealed that patients with increased creatinine levels preoperatively (odds ratio (OR) 3.0, 𝑃=0.049), history of atrial fibrillation (AF) (OR 6.3, 𝑃=0.012) and high EuroSCORE values (OR 2.6, 𝑃=0.017) had a significant greater probability to stay in the ICU for more than 2 days. In addition, intraoperative hyperglycemia (OR 3.0, 𝑃=0.004) was strongly associated with longer ICU-LOS. In conclusion, the high perioperative risk, the history of AF and renal dysfunction, and the intraoperative hyperglycemia are significant predictors of prolonged ICU stay. The early identification of patients at risk could allow the efficient ICU resources' allocation and the reduction of healthcare costs. This would contribute to nursing care planning depending on the availability of healthcare personnel and ICU bed capacity.

Identifying the Turning Point: Using the Transtheoretical Model of Change to Map Intimate Partner Violence Disclosure in Emergency Department Settings

Cristina Catallo, Susan M. Jack, Donna Ciliska, and Harriet L. MacMillan — Tue, 26 Jun 2012 13:04:45 +0000

Background. The transtheoretical model of change (TTM) was used as a framework to examine the steps that women took to disclose intimate partner violence (IPV) in urban emergency departments. Methods. Mapping methods portrayed the evolving nature of decisions that facilitated or inhibited disclosure. This paper is a secondary analysis of qualitative data from a mixed methods study that explored abused women’s decision making process about IPV disclosure. Findings. Change maps were created for 19 participants with movement from the precontemplation to the maintenance stages of the model. Disclosure often occurred after a significant “turning point event” combined with a series of smaller events over a period of time. The significant life event often involved a weighing of options where participants considered the perceived risks against the potential benefits of disclosure. Conclusions. Abused women experienced intrusion from the chaotic nature of the emergency department. IPV disclosure was perceived as a positive experience when participants trusted the health care provider and felt control over their decisions to disclose IPV. Practice Implications. Nurses can use these findings to gauge the readiness of women to disclose IPV in the emergency department setting.