Aim: Near miss event reporting is widely used in industry to highlight potentially unsafe areas or practice. The aim of this study was to see if a descriptive method of recording near misses was an appropriate method for use in an ophthalmic operating theatre and to quantify how many untoward events were recorded using this system.
Methods: The study was wholly conducted in a cataract theatre in the United Kingdom. The theatre nurse assigned to the patient in their journey through the operating theatre was asked to note any untoward events. As, at present, there is no consensus definition of near misses in ophthalmology the nurses recorded, in free text, any events that they considered to be a deviation from the normal routine in that theatre.
Results: Of the 500 cases randomly chosen, 96 “deviations from normal routine” were described in 93 patients—that is, 19% of cases. All forms distributed to the nurses were returned (100% response rate). The commonest abnormal events were intraoperative (69), with a lesser number being recorded preoperatively (27). When these events were further classified, it was thought that 25 could be classified as near misses. One true adverse event was recorded during the study.
Conclusions: The results suggest that experienced nursing staff in an ophthalmic theatre are a reliable source for collecting data regarding near misses. A consensus is now required to define near misses in ophthalmology and to devise a user friendly input system that can use these definitions to consistently record these potentially vital events.
BACKGROUND. There are calls for the role of the practice nurse to be developed and extended. Before areas for further training and education can be identified, baseline data are needed on practice nurses' current activity and workload. AIM. A study was undertaken to analyse the activity of practice nurses in two large inner city general practices and to assess the skills mix of the nursing staff required to meet the needs of the practices. METHOD. The study practices had a combined list of 26,000 patients, 80% of patients attracting a deprivation allowance. Each practice employed three practice nurses. A nurse activity index with 45 codes was constructed to describe patient-nurse consultations. Activity codes were categorized into traditional treatment tasks, extended role tasks or diagnosis and management tasks. For eight months, practice nurses in practices Y and Z recorded activity index codes for each patient consultation. Practice Y also recorded the source of referral and the age and sex of the patient. RESULTS. There were 13,898 practice nurse consultations during the study period, equivalent to an annual nurse consultation rate of 0.8 per patient. Compared with the practice population as a whole, the patients attending the practice nurses in practice Y were older (mean age 43 years versus 37 years, P < 0.001). Those attending the practice nurses in practice Y were also more likely to be female (61% of consultations were with female patients compared with 50% of the practice population as a whole, P < 0.001). In practice Y, patients referred themselves to the practice nurse in 42% of consultations, 32% were follow-up consultations and in 25% of cases the patient had been referred by a doctor. The most common reasons for nurse consultation were blood tests (15% of procedures in practice Y and 18% in practice Z) and dressings (13% in both practices). Most procedures in practices Y and Z were in the traditional treatment category (61%), 26% were in the extended role category and 9% in the diagnosis and management category (3% coded 'other', 1% uncoded). Between practices, the greatest difference in recorded procedures was for asthma check ups (7% of procedures in practice Y compared with 2% in practice Z). CONCLUSION. This study describes the workload of practice nurses in two inner city practices over eight months. Other practices could use the activity index to make comparisons over time and between practices. Up to 60% of nurses' work in the study practices could be done by a nurse without extended training and up to 30% could be done by a health care assistant, but with some loss of quality. It is suggested that half the nursing hours available to a practice should be offered by a nurse with extended training in order to undertake and develop extended role tasks and diagnosis and management tasks.
Background: Volatile anaesthetics are chemically related to organic solvents used in industry. Exposure to industrial solvents may increase the incidence of multiple sclerosis (MS).
Aim: To examine the risk among nurse anaesthetists of contracting MS.
Methods: Nurses with MS were identified by an appeal in the monthly magazine of the Swedish Nurse Union and a magazine of the Neurological Patients Association in Sweden. Ninety nurses with MS responded and contacted our clinic. They were given a questionnaire, which was filled in by 85 subjects; 13 of these were nurse anaesthetists. The questionnaire requested information about work tasks, exposure, diagnosis, symptoms, and year. The number of active nurse anaesthetists was estimated based on information from the National Board of Health and Welfare and The Nurse Union. Incidence data for women in the region of Gothenburg and Denmark were used as the reference to estimate the risk by calculation of the standardised incidence ratio (SIR).
Results: Eleven of the 13 nurse anaesthetists were exposed to anaesthetic gases before onset of MS. Mean duration of exposure before diagnosis was 14.4 years (range 4–27 years). Ten cases were diagnosed in the study period 1980–99, resulting in significantly increased SIRs of 2.9 and 2.8 with the Gothenburg and the Danish reference data, respectively.
Conclusion: Although based on crude data and a somewhat approximate analysis, this study provides preliminary evidence for an excess risk of MS in nurse anaesthetists. The risk may be even greater than observed, as the case ascertainment might have been incomplete because of the crude method applied. Further studies in this respect are clearly required to more definitely assess the risk.
A mailed survey of occupational health and safety practices in industrial manufacturing plants with more than 50 employees was carried out in South Carolina, with a response rate of 60 percent. The responding plants represented 73 percent of the total workforce in the industries. Data were analyzed in relation to the types of industry as delineated by the Standard Industrial Code. Eighty-three percent of the responding plants (a percentage that represented more than 92 percent of the total workforce in the industries) had some arrangements for the medical or nursing care of employees. For the study, occupational health services were defined at three levels: basic (mandatory), secondary (beneficial to management), and tertiary (health promotion-preventive medicine). The basic services provided by most of the industries surveyed appeared to be adequate. Secondary services were well developed except in the apparel and lumber industries. Tertiary services, in terms of five selected preventive programs, were moderately developed only in the paper, petroleum, and chemical industries. Only alcohol abuse control programs were commonly offered in the other types of industry. The size of the workforce in a plant partly dictated the level of occupational health services it offered but did not always account for all inter-industry variation.
BACKGROUND. A study of practice nurse workload in 1989 by the East Anglian reporting system revealed that nurses were undertaking a wide range of activities, with 12% of nursing time being spent on administration. The 1990 contract for general practitioners emphasized the role of general practice in health promotion. AIM. The 1989 study was repeated by the East Anglian reporting system in 1992 to investigate changes in practice nurse workload. METHOD. Nurses in 22 practices recorded all the procedures they performed and their duration, over a two week period. RESULTS. The number of practice nurses in each practice had increased from 0.7 full time equivalents in 1989 to 1.2 in 1992. The proportion of time spent on administration had increased to 19%. The number of different procedures performed by practice nurses had risen from 36 in 1989 to 54 in 1992, with most new activity in well person and new patient clinics. CONCLUSION. Changes have taken place in the volume and range of work undertaken by practice nurses. There is potential for practice nurses to use the results both for negotiation and for education.
BACKGROUND: Primary care teams have been encouraged to develop the care they provide to patients with mental health problems, and a greater role for practice nurses has been advocated. However, little is known about practice nurses' current level of involvement or their perceived strengths and limitations in caring for patients' mental health problems. AIM: To describe practice nurses' current experiences of caring for patients with mental health problems and to explore their perceptions about enlarging this role. METHOD: Pilot interviews were carried out with a purposeful sample of practice nurses to design a postal questionnaire, which was then sent to 635 practice nurses identified from family health services authority lists in six health authorities in the north-east of England. RESULTS: Completed questionnaires were returned by 445 (70%) practice nurses. Most nurses (83%) reported that they commonly saw patients with a range of mental health problems arising indirectly or directly in consultations. Many practice nurses (52%) lacked any formal mental health training and identified a broad range of training needs. A majority (80%) of responders had concerns about their abilities to address mental health problems effectively, given their existing workloads. However, most (61%) were keen to expand their role in mental health care if appropriate support and training were forthcoming. CONCLUSION: There is considerable potential for practice nurses to realize a greater and more effective role in the care of mental health problems in primary care. Developing practice nurses' contribution will require further training and support.
Western governments have initiated reforms to improve the quality of care for nursing home residents. Most of these reforms encompass the use of regulations and national quality indicators. In the Norwegian context, these regulations comprise two pages of text that are easy to read and understand. They focus particularly on residents’ rights to plan their day-to-day life in nursing homes. However, the research literature indicates that the implementation of the new regulations, particularly if they aim to change nursing practice, is extremely challenging. The aim of this study was to further explore and describe nursing practice to gain a deeper understanding of why it is so hard to implement the new regulations.
For this qualitative study, an ethnographic design was chosen to explore and describe nursing practice. Fieldwork was conducted in two nursing homes. In total, 45 nurses and nursing aides were included in participant observation, and 10 were interviewed at the end of the field study.
Findings indicate that the staff knew little about the new quality regulations, and that the quality of their work was guided by other factors rooted in their nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines and also that they always seemed to know what to do. Having routines and always knowing what to do mutually strengthen and enhance each other, and together they form a powerful force that makes daily nursing care a taken-for-granted activity.
New regulations are challenging to implement because nursing practices are so strongly embedded. Improving practice requires systematic and deeply rooted practical change in everyday action and thinking.
Qualitative methods; Nursing homes; Nursing practice; Regulations; And routines
A prototype program of doctoral study has been developed at the University of Maryland School of Nursing to prepare students with nursing expertise in the conceptualization and research of computer based information systems in hospitals, industry and other health care organizations. The graduate will be prepared to design effective nursing information systems; create innovative information technology; conduct research regarding integration of technology with nursing practice, administration, and education; and develop theoretical, practice, and evaluation models for nursing informatics.
A well established "midlevel" of patient care, such as nurse practitioners and/or physician assistants, exits in many countries like the US, Canada, and Australia.
In Germany, however there is only one kind of profession assisting the physician in practices, the practice nurse. Little is known about the present involvement of practice nurses in patients' care in Germany and about the attitudes of GPs, assistants and patients concerning an increased involvement. The aim of our study was to get qualitative information on the extent to which practice nurses are currently involved in the treatment of patients and about possibilities of increased involvement as well as on barriers of increased involvement.
We performed qualitative, semi-structured interviews with 20 GPs, 20 practice nurses and 20 patients in the Heidelberg area. The interviews were digitally recorded, transcribed and content-analysed with ATLAS.ti.
Practice nurses are only marginally involved in the treatment of patients. GPs as well as patients were very sceptical about increased involvement in care. Patients were sceptical about nurses' professional background and feared a worsening of the patient doctor relationship. GPs also complained about the nurses' deficient education concerning medical knowledge. They feared a lack of time as well as a missing reimbursement for the efforts of an increased involvement. Practice nurses were mostly willing to be more involved, regarding it as an appreciation of their role. Important barriers were lack of time, overload with administrative work, and a lack of professional knowledge.
Practice nurses were only little involved in patient care. GPs were more sceptical than patients regarding an increased involvement. One possible area, accepted by all interviewed groups, was patient education as for instance dietary counselling. New treatment approaches as the chronic care model will require a team approach which currently only marginally exists in the German health care system. Better medical education of practice nurses is indispensable, but GPs also have to accept that they cannot fulfil the requirement of future care alone.
Foot ulceration is one of the most common complications associated with diabetes that needs to be managed. In Iran, prevalence of diabetes foot ulcer is 3%. According to studies, evidence-based nursing (EBN) is an effective alternative to facilitate clinical decision making in patient care and may lead to quality improvement in nursing practice. The aims of this study are to assess the effects of EBN education on the knowledge, attitude, and practice of nurses who take care of patient with diabetes foot ulcer.
Materials and Methods:
A quasi-experimental study (based on IOWA model as a framework to improve nursing practice) was conducted using a before-and-after design. All of nurses (consisted of 19 baccalaureate nurses) who are working in an endocrinology ward were chosen and taught using EBN approach through different workshops. Before and after educational intervention, the data about nurses’ knowledge, attitude, and practice were gathered by questionnaire and then compared. The nurses’ performance in patient care was evaluated in 3 months by one checklist. The data were analyzed using descriptive and inferential statistics.
There were statistically significant differences in knowledge, attitude, and practice of nurses before and after intervention (P = 0.001). The nurses’ performance in caring for patient with diabetes foot ulcer, based on clinical guideline, showed the improvement in clinical practice.
Education of EBN can improve the nurse's knowledge and attitude to EBN, and be used as a basis on which to influence the professional practice of nursing.
Clinical nursing; diabetes foot ulcer; evidence-based nursing practice; IOWA model of evidence based practice; Iran
Nurses play a crucial role in patient-care. Therefore, assessing nurses’ clinical competence is essential to achieve qualified and safe care. The aim of this study was to determine and compare the competence assessments made by head nurses and practicing nurses in a university hospital in Iran in 2009.
A cross-sectional survey was conducted to make comparisons of both self-assessment of nurse competence as well as assessment made by their respective head nurses working in a university hospital setting in Iran. The instrument employed for data collection was Nurse Competence Scale (NCS), whose reliability and validity have been previously confirmed. The clinical competence of the nurses in 73 skills under 7 categories was determined based on a Visual Analogue Scale (VAS) (0 to 100). They were also asked to indicate the extent to which their competence was actually used in clinical practice on a four-point scale of Likert. The data was analyzed through descriptive and inferential statistics.
Comparison of self-assessment (87.03 ± 10.03) and the assessment done by head nurses (80.15 ± 15.54) showed a significant difference but no precise differences were found between the assessment methods for the frequency of using these competencies.
The results of this study indicated no consensus between the nurses owns assessment and their head nurse assessment. Therefore, it is necessary to use a combination of nurses’ competence assessment methods in order to reach a more valid and precise conclusion.
Clinical competence; competence assessment; head nurse; nurse; self-assessment
Nurses’ research utilization (RU) as part of evidence-based practice is strongly emphasized in today’s nursing education and clinical practice. The primary aim of RU is to provide high-quality nursing care to patients. Data on newly graduated nurses’ RU are scarce, but a predominance of low use has been reported in recent studies. Factors associated with nurses’ RU have previously been identified among individual and organizational/contextual factors, but there is a lack of knowledge about how these factors, including educational ones, interact with each other and with RU, particularly in nurses during the first years after graduation. The purpose of this study was therefore to identify factors that predict the probability for low RU among registered nurses two years after graduation.
Data were collected as part of the LANE study (Longitudinal Analysis of Nursing Education), a Swedish national survey of nursing students and registered nurses. Data on nurses’ instrumental, conceptual, and persuasive RU were collected two years after graduation (2007, n = 845), together with data on work contextual factors. Data on individual and educational factors were collected in the first year (2002) and last term of education (2004). Guided by an analytic schedule, bivariate analyses, followed by logistic regression modeling, were applied.
Of the variables associated with RU in the bivariate analyses, six were found to be significantly related to low RU in the final logistic regression model: work in the psychiatric setting, role ambiguity, sufficient staffing, low work challenge, being male, and low student activity.
A number of factors associated with nurses’ low extent of RU two years postgraduation were found, most of them potentially modifiable. These findings illustrate the multitude of factors related to low RU extent and take their interrelationships into account. This knowledge might serve as useful input in planning future studies aiming to improve nurses’, specifically newly graduated nurses’, RU.
The Greenlandic Healthcare Reform (2010) required improved quality of services for health promotion, prevention of infectious and lifestyle diseases, family nursing and evidence-based clinical nursing.
To investigate current nursing practice in Greenland and to identify whether it meets the requirements of healthcare reform.
This ethnographic study utilised documentary analysis, participant observation and qualitative interviewing carried out in remote areas of Greenland during 2011–2012. Eight registered nurses, four women and four men, aged between 35 and 55, participated in this study. Four were working at healthcare centres in towns and four were working at nursing stations in villages. The nurses were educated in Greenland or a Nordic country and had been practicing nursing for at least 2 years in an Arctic region. They were observed for 1–5 days, and subsequently interviewed. Interviews included in-depth questioning, based on emerging outcomes from observation. Interviews were recorded and transcribed; they were analysed within a phenomenological–hermeneutic approach.
Nurses in rural and remote areas navigate their health promotion and preventive work with conflict between health strategies and everyday realities, where unpredictable tasks often lead to prioritisation of urgent, acute work. There is interaction between personal and professional skills. Everyday life is characterised by opportunities and challenges in the grey areas, namely nursing, medical and social work.
The nature of nursing practice in rural and remote Greenland is characterised by a high degree of variability and complexity, with a requirement for a wide range of knowledge and skills. Nurses need to be better prepared with regard to acute medical care, preventive care, social work, humanistic approaches and information technology to implement the ideology of health strategies.
Ethnographic study; Greenland; nursing practice; remote and rural areas
The aims of this study were to develop detailed clinical models (DCMs) for nursing problems related to perinatal care and to test the applicability of these detailed clinical models.
First, we extracted entities of nursing problems by analyzing nursing-problem statements from nursing records, reviewing the literature, and interviewing nurse experts. Second, we extracted attributes and possible values needed to describe the entities in more detail by again analyzing nursing statements, reviewing the literature, and consulting nurse experts. Third, DCMs were modeled by linking each entity with possible attributes with value sets and optionalities. Fourth, entities, attributes and value sets in the DCMs were mapped to the International Classification for Nursing Practice (ICNP) version 2. Finally, DCMs were validated by consulting a group of experts and by applying them to real clinical data and nursing care scenarios published in the literature. The adequacy of the entities, attributes, value sets, and optionalities of the attributes were validated.
Fifty-eight entities were identified, 41 entities from nursing records, 12 entities from literature review and 5 entities from nurse experts. Sixty-five attributes with values were identified, 25 attributes from nursing records, 34 attributes from literature review, and 6 attributes from nurse experts. In total 58 DCMs were developed and validated.
The DCMs developed in this study can ensure that electronic health records contain meaningful and valid information, and support the semantic interoperability of nursing information.
Information sharing, model, standards; data collection; knowledge representation
This paper identifies the views of Iranian clinical nurses regarding the utilization of nursing research in practice. There is a need to understand what restricts Iranian clinical nurses to use research findings. The aim of this study was to identify practicing nurses' view of aspects which they perceived constrain them from research utilization that summarizes and uses research findings to address a nursing practice problem.
Data were collected during 6 months by means of face-to face interviews follow by one focus group. Analysis was undertaken using a qualitative content analysis.
Findings disclosed some key themes perceived by nurses to restrict them to use research findings: level of support require to be research active, to be research minded, the extent of nurses knowledge and skills about research and research utilization, level of educational preparation relating to using research, administration and executive challenges in clinical setting, and theory-practice gap.
This study identifies constraints that require to be overcome for clinical nurses to actively get involved in research utilization. In this study nurses were generally interested to use research findings. However they felt restricted because of lack of time, lack of peer and manager support and limited knowledge and skills of the research process. This study also confirms that research utilization and the change to research nursing practice are complex issues which require both organizational and educational efforts.
To test the impact of the implementation of Magnet principles of improving nurses’ work environments.
Magnet hospital designation developed in the United States in the 1980s to recognise hospitals that had created excellent patient care environments and supported the professional practice of nursing. A pilot initiative in England was the first test of the applicability of Magnet standards outside the US.
Research methods included surveys of nurses in the demonstration hospital in a predesign and postdesign and comparisons to survey results of nurses practicing in a national sample of 30 National Health Service Trusts.
Prior to beginning the Magnet journey, the demonstration hospital had a nurse work environment that was somewhat less positive than the national sample NHS hospitals. Nurses practicing in the demonstration hospital were somewhat less satisfied with their jobs than nurses in other NHS hospitals. Following a two-year period during which the evidence-based Magnet standards were implemented and Magnet Designation was awarded, the quality of the nurse practice environment had improved significantly, as had job satisfaction of nurses and their appraisals of the quality of patient care. The quality of the nurse practice environment after Magnet designation was better than that of a national sample of NHS trusts. Improved nurse outcomes were because of the improved practice environment rather than staffing enhancements.
Implementation of the Magnet hospital intervention was associated with a significantly improved nursing work environment as well as improved job-related outcomes for nurses and markers for quality of patient care. Relevance to clinical practice. Nurses can use Magnet principles to improve the quality of their work environments.
Magnet hospitals; nurses; nursing
The specific aims were to (1) define fever from the nurse’s perspective; (2) describe fever management decision-making by nurses and (3) describe barriers to evidence-based practice across various settings.
Publication of practice guidelines, which address fever management, has not yielded improvements in nursing care. This may be related to differences in ways nurses define and approach fever.
The collective case study approach was used to guide the process of data collection and analysis. Data were collected during 2006–7. Transcripts were coded using the constant comparative method until themes were identified. Cross-case comparison was conducted. The nursing process was used as an analytical filter for refinement and presentation of the findings.
Nurses across settings defined fever as a (single) elevated temperature that exceeded some established protocol. Regardless of practice setting, interventions chosen by nurses were frequently based on trial and error or individual conventions – ‘what works’– rather than evidence-based practice. Some nurses’ accounts indicated use of interventions that were clearly contraindicated by the literature. Participants working on dedicated neuroscience units articulated specific differences in patient care more than those working on mixed units.
By defining a set temperature for intervention, protocols may serve as a barrier to critical clinical judgment. We recommend that protocols be developed in an interdisciplinary manner to foster local adaptation of best practices. This could further best practice by encouraging individual nurses to think of protocols not as a recipe, but rather as a guide when individualizing patient care. There is value of specialty knowledge in narrowing the translational gap, offering institutions evidence for planning and structuring the organization of care.
acute care; adult patients; case study; elevated temperature; evidence-based fever management; fever; nursing
Background—Flexible sigmoidoscopy is a technical
skill that has been successfully performed by suitably trained
colorectal nurse practitioners in the USA. However, no recognised
training course exists for nurse practitioners in the UK.
Aims—To design and evaluate a training programme
for nurse endoscopists.
Methods—A multidisciplinary committee of nurses
and clinicians developed a structured programme of study and practice.
This involved a staged process of observations, withdrawals, and
ultimately, full procedures. Once training had been completed the nurse
practitioner was permitted to practice independently. Patients with
colorectal symptoms referred for flexible sigmoidoscopy were examined
for the final stages of training and independent practice. A
prospective evaluation of the training and practice of the first
trained nurse flexible sigmoidoscopist was performed. Barium enema,
video, clinical follow up, and histology were used to validate the
results of the flexible sigmoidoscopies.
Results—The training programme required that 35 observations, 35 withdrawals, and 35 supervised full procedures were
performed prior to the development of independent practice. Subsequent
to the completion of this programme 215 patients have been examined independently by the nurse practitioner. Ninety three per cent of the
examinations were judged successful and pathology was identified in
51%. The nurse endoscopist successfully identified all
"significant" pathology whereas barium enema failed to identify
pathology in 12.5%. There were no complications.
Conclusion—With suitable training nurse
endosocopists are able to perform flexible sigmoidoscopy safely and effectively.
nurse endoscopists; flexible sigmoidoscopy
Corporate social responsibility (CSR) has become an integral element of how the alcohol industry promotes itself. The existing analyses of CSR in the alcohol industry point to the misleading nature of these CSR practices. Yet, research has been relatively sparse on how the alcohol industry advances CSR in an attempt to facilitate underlying business interests, and in what ways the ongoing display of industry CSR impacts public health. This paper aims to investigate the alcohol industry’s recent CSR engagements and explain how CSR forms part of the industry’s wider political and corporate strategies.
Our study used qualitative methods to collect and analyse data. We searched for materials pertaining to CSR activities from websites of three transnational alcohol corporations, social media platforms, media reports and other sources. Relevant documents were thematically analysed with an iterative approach.
Our analysis identified three CSR tactics employed by the alcohol companies which are closely tied in with the industry’s underlying corporate intents. First, the alcohol manufacturers employ CSR as a means to frame issues, define problems and guide policy debates. In doing this, the alcohol companies are able to deflect and shift the blame from those who manufacture and promote alcoholic products to those who consume them. Second, the alcohol corporations promote CSR initiatives on voluntary regulation in order to delay and offset alcohol control legislation. Third, the alcohol corporations undertake philanthropic sponsorships as a means of indirect brand marketing as well as gaining preferential access to emerging alcohol markets.
The increasing penetration and involvement of the alcohol industry into CSR highlights the urgent needs for public health counter actions. Implementation of any alcohol control measures should include banning or restricting the publicity efforts of the industry’s CSR and informing the public of the alcohol industry’s notion of social responsibility. More significantly, an internationally binding instrument should be called for to enable countries to differentiate between genuine concerns and spurious altruism, and in doing so, resist the industry’s attempt to erode alcohol control.
Alcohol industry; Corporate social responsibility; Politics; Alcohol policies; Framework convention
The aim of this study was to develop and validate Detailed Clinical Models (DCMs) for nursing assessments and interventions.
First, we identified the nursing assessment and nursing intervention entities. Second, we identified the attributes and the attribute values in order to describe the entities in more detail. The data type and optionality of the attributes were then defined. Third, the entities, attributes and value sets in the DCMs were mapped to the International Classification for Nursing Practice Version 2 concepts. Finally, the DCMs were validated by domain experts and applied to case reports.
In total 481 DCMs, 429 DCMs for nursing assessments and 52 DCMs for nursing interventions, were developed and validated. The DCMs developed in this study were found to be sufficiently comprehensive in representing the clinical concepts of nursing assessments and interventions.
The DCMs developed in this study can be used in electronic nursing records. These DCMs can be used to ensure the semantic interoperability of the nursing information documented in electronic nursing records.
Semantics; Concept Formation; Terminology; Nursing Process; Documentation
Evidence-based practice (EBP) is one of the main professional competencies for health care professionals and a priority for medicine and nursing curriculum as well. EBP leads to improve effective and efficient care and patient outcomes. Nurse educators have responsibility to teach the future nurses, and an opportunity to promote patient outcomes. Therefore, the aim of this study was to describe nurse educators’ knowledge and attitude on EBP.
Materials and Methods:
This was a descriptive study conducted in nursing faculties of two major universities of medical sciences affiliated to Ministry of Health and Medical Sciences in Tehran, Iran. Data were gathered using a three-section questionnaire. Content and face validity was further enhanced by submitting it to nursing research and education experts. Statistical analysis was carried out using SPSS 11 software.
According the results, nursing faculties’ knowledge of EBP was mainly moderate (47.1%). Significant statistical relationship was found between the level of knowledge with education and teaching experience in different nursing programs. Nurses generally held positive attitudes toward EBP (88.6%) and there was no statistical significant relationship with demographic variables.
Nursing educators are in a position to influence nursing research in clinical practice in the future. Therefore, it is critical to achieve implementation of EBP and be a change agent for a paradigm shift toward EBP.
Attitude; evidence-based practice; Iran; knowledge
Historically, physicians have not played a prominent role in the care of older adults who reside in nursing homes. Physicians have been criticized for abandoning their responsibilities to nursing home residents since the industry's rapid growth in the 1960s, following the enactment of Medicare and Medicaid. As many as 72% of private physicians do not go to nursing homes. This is true even of those family doctors and internists whose practices are disproportionately devoted to the elderly. Caring for institutionalized elderly patients over the long term presents challenges that even physicians experienced with geriatric patients in the community may find daunting. This study investigates reasons why physicians in the Los Angeles area hesitate or refuse to see nursing home patients.
When family members admit a loved one to a nursing home, they expect that the facility will assure the physical safety of the residents. However, this does not always occur. Safety concerns persisting in at least some modern American nursing homes involve adverse drug events, injurious falls, pressure ulcers, problems with tube feeding, faulty communications or other breakdowns during transfer to or from hospital, and equipment breakdowns or mix-ups. The adversarial legal, economic, political, and media environment surrounding the US nursing home industry poses serious practical impediments to alleviating these safety concerns more effectively. However, resident safety comprises only one part of the larger quality improvement picture in the nursing home context. While the threat of negative legal repercussions may be necessary to address safety issues, a fuller concern about improving the quality of care and quality of life for nursing home residents will also involve the development and implementation of a combination of positive incentives for facilities to do better.
GPs often perceive home-visit requests as a time-consuming aspect of general practice. The new general medical services contract provides for practices to be relieved of responsibility for home-visits, although there is no model for the transfer of care. One such model could be to employ nurse practitioners to manage such requests. Nurse practitioners can effectively substitute for GPs in managing same-day in-hours emergency care in the surgery, but their role in managing all such requests, including those requiring home visits, has not been assessed.
To explore the feasibility and clinical management outcomes of nurse practitioner management of same-day care requests, including those requiring home visits, to inform a proposed randomised controlled trial.
Design of study
Non-randomised comparative trial.
One large general practice (14 600 patients) in south London.
Nurse practitioner assessment and management of all same-day care requests for 2 days per week was compared with normal GP management on another 2 days, over a 6-month period. Clinical management outcome data were collected from patient records and from data-collection forms completed by a nurse practitioner and GPs. Patient and staff satisfaction was assessed by questionnaire.
The nurse practitioner was more likely than GPs to assess patients in person, less likely to give advice alone, and more likely to issue a prescription. There was no significant difference between the nurse practitioner and GPs regarding any other clinical management outcomes or patient satisfaction; however, the response rate of the patient satisfaction questionnaire in this pilot study was poor.
Nurse practitioner management of acute in-hours care requests, including home visits, appears feasible in practice and merits further assessment.
house calls; nurse practitioners; primary health care
Studies show that satisfaction with nurse practitioner care is high when compared with GPs. Clinical outcomes are similar. Nurse practitioners spend significantly longer on consultations.
We aimed to discover what nurse practitioners do with the extra time, and how their consultations differ from those of GPs.
Design of study
Comparative content analysis of audiotape transcriptions of 18 matched pairs of nurse practitioner and GP consultations.
Nine general practices in south Wales and south west England.
Consultations were taped and clinicians' utterances coded into categories developed inductively from the data, and deductively from the literature review.
Nurse practitioners spent twice as long with their patients and both patients and clinicians spoke more in nurse consultations. Nurses talked significantly more than GPs about treatments and, within this, talked significantly more about how to apply or carry out treatments. Weaker evidence was found for differences in the direction of nurses being more likely to: discuss social and emotional aspects of patients' lives; discuss the likely course of the patient's condition and side effects of treatments; and to use humour. Some of the extra time was also spent in getting doctors to approve treatment plans and sign prescriptions.
The provision of more information in the longer nurse consultations may explain differences in patient satisfaction found in other studies. Clinicians need to consider how much information it is appropriate to provide to particular patients.
communication; consulting styles; nurse practitioners