Showing papers in "Journal of Clinical Nursing in 2005"

Pain: a review of three commonly used pain rating scales.

Abstract: Aims and objectives. This review aims to explore the research available relating to three commonly used pain rating scales, the Visual Analogue Scale, the Verbal Rating Scale and the Numerical Rating Scale. The review provides information needed to understand the main properties of the scales. Background. Data generated from pain-rating scales can be easily misunderstood. This review can help clinicians to understand the main features of these tools and thus use them effectively. Method. A MedLine review via PubMed was carried out with no restriction of age of papers retrieved. Papers were examined for methodological soundness before being included. The search terms initially included pain rating scales, pain measurement, Visual Analogue Scale, VAS, Verbal Rating Scale, VRS, Numerical/numeric Rating Scale, NRS. The reference lists of retrieved articles were used to generate more papers and search terms. Only English Language papers were examined. Conclusions. All three pain-rating scales are valid, reliable and appropriate for use in clinical practice, although the Visual Analogue Scale has more practical difficulties than the Verbal Rating Scale or the Numerical Rating Scale. For general purposes the Numerical Rating Scale has good sensitivity and generates data that can be statistically analysed for audit purposes. Patients who seek a sensitive pain-rating scale would probably choose this one. For simplicity patients prefer the Verbal Rating Scale, but it lacks sensitivity and the data it produces can be misunderstood. Relevance to clinical practice. In order to use pain-rating scales well clinicians need to appreciate the potential for error within the tools, and the potential they have to provide the required information. Interpretation of the data from a pain-rating scale is not as straightforward as it might first appear.

The needs and experiences of family members of adult patients in an intensive care unit: a review of the literature.

Abstract: Aims and objectives. Insight into the needs and experiences of family members is an initial but necessary step in providing appropriate care for both family members and the patient. This literature review aims to structure the available scientific knowledge on needs and experiences of family members of intensive care unit patients with particular extension to coma patients. Qualitative as well as quantitative studies are discussed. Method. Literature review. Results. Needs are divided into four categories: cognitive, emotional, social and practical needs. The need for accurate and comprehensible information that leaves room for hope is universal. Family members want to speak to a doctor every day about the condition of and the prognosis for the patient, and want a nurse to explain to them about the care, the unit, the equipment and what they can do for the patient during visiting hours. Family members place great importance on being called at home if the condition of the patient changes. Emotional needs as hope, reassurance and being able to remain in the vicinity of the patient are crucial. Family members always give priority to the welfare of their relative. In their confused state, they often do not get around to paying attention to themselves. Caregivers underestimate all of the needs of family members and do not do enough to meet these needs. Relevance to clinical practice. Priority needs should be central in the nurses’ approach of family members. The initiative for meeting the needs must be with the caregivers. Future, focused and well-designed qualitative research over a longer period of time could clarify the process that family members go through and explain the results of quantitative studies.

Stress and coping among families of patients with traumatic brain injury: a review of the literature

Abstract: Aims and objectives. This literature review aims to structure the available information on the psychological reactions of family members confronted with traumatic brain injury. The stress–coping theory and the systems theory provide the theoretical framework for this review. Method. Literature review. Results. The level of stress experienced by the family members of patients who have traumatic brain injury is such that professional intervention is appropriate, even after 10–15 years. Not the severity of the injury but the nature of the injuries determines the level of stress. Partners experience more stress than parents. Children have specific difficulties. Young families with little social support, financial, psychiatric and/or medical problems are the most vulnerable. Coping with traumatic brain injury can be described in phases. The better family members can cope with the situation, the better the patient's recovery. There are functional and non-functional coping mechanisms and coping is influenced by such factors as gender, social and professional support and the possibility to have reciprocal communication or an affective relation with the patient. Relevance to clinical practice. Support from professionals reduces the stress being experienced and encourages people to cope effectively. Conflicts with professional carers should be avoided. Every attempt should be made to develop models of long-term support and care that alleviate sources of burden on relatives. Further research is necessary to develop such models.

Living with a stoma: a review of the literature.

Abstract: Aims and objectives. This systematic review looks at the psychological and social impact of stoma surgery on peoples’ lives. Background. The formation of a stoma can have a negative effect on a person's quality of life and affect lifestyle in a number of ways. Methods. The review examines nursing literature from 1990 to date and focuses on how stoma patients’ lives are affected by the presence of a stoma. It informs nursing practice so nurses are better able to help individuals improve, maintain or recover their health following ostomy surgery. Results. The findings of the review indicate that stoma surgery can impact on individuals’ lives in many different ways. Relevance to clinical practice. Knowledge of the problems stoma patients can experience can help nurses plan care in an individualized way. Recommendations for nursing practice and future research are made.

Chronic obstructive pulmonary disease: a phenomenological study of patients' experiences.

Abstract: Aim. The purpose of this study is to explore the experience of living with chronic obstructive pulmonary disease by investigating the subjective phenomenon as described by the patient. Background. Chronic obstructive pulmonary disease is now recognized as one of the most common chronic respiratory diseases in the United Kingdom, with a high prevalence of morbidity and mortality. As the disease progresses, symptoms increase which gradually influence all aspects of the lives of those affected by it. Method. A phenomenological approach was identified as the most appropriate method to gain an understanding of living with chronic obstructive pulmonary disease. The data were obtained from 10 participants using unstructured interviews to capture detailed experiences verbatim. Analysis, based on the framework of Diekelmann et al. (The NLN Criteria for Appraisal of Baccalaureate Programs: A Critical Hermeneutic Analysis, NLN Press, New York, 1989), was employed to interpret the data and determine shared themes that evolved during the course of the research. Results. The data revealed valuable insights, from a patient's perspective, into the impact chronic obstructive pulmonary disease had on their daily lives. The accounts obtained from participants, many of who had severe chronic obstructive pulmonary disease, illustrate the detrimental effects of this debilitating disease. Breathlessness was identified as the most troublesome symptom leading to anxiety, panic and fear. Participants also described feeling frustrated and tired because of their breathlessness, which led to loss of social activity. This also resulted in a loss of their role within the family including loss of intimacy in personal relationships. Despite this, half of the participants felt they had a fairly good quality of life. Conclusion. The use of phenomenology as a research methodology fulfilled the aim of gaining a greater understanding of the experiences of living with chronic obstructive pulmonary disease. It provided valuable insights into how patients view the overall impact and their subsequent degree of coping with chronic obstructive pulmonary disease from day to day. Relevance to clinical practice. Whilst there is no cure for chronic obstructive pulmonary disease and medical interventions have limited effect, health professionals can do much to improve patient's symptoms and experiences of living with chronic obstructive pulmonary disease by listening to how their symptoms affect them and adapting coping strategies. It is hoped that the themes revealed in this study generate additional understanding and insight for future innovative practice.

Clinical education facilitators: a literature review

Abstract: Aims and objectives. The aim of this literature review, set within an Irish context, is to present a broad overview of former and existing clinical support personnel, explore the concept of facilitation and examine what is known about the role of the clinical education facilitator. Background. The importance of providing a supportive clinical environment to enhance clinical teaching and learning is strongly portrayed in the literature. While the past two decades have borne witness to various clinical support personnel, the literature identifies conflicting demands that these personnel face. No suggestions are advanced as to how to overcome these difficulties, which inevitably influence the quality and quantity of their clinical teaching role. An identifiable gap exists over who has prime responsibility for clinical teaching. It is timely that alternative possibilities for organizing clinical teaching are investigated. A new post emerging in practice settings is that of the clinical education facilitator who is meant to be the key linchpin in clinical areas for reducing the theory–practice gap. Method. Relevant literature for this review was sourced using the computerized databases CINAHL, Medline and Synergy. Manual searching of relevant nursing journals and sourcing of secondary references extended the search. Government reports and other relevant documents were obtained through pertinent websites. Results. Papers that explicitly examined the concept of facilitation and explored the posts of clinical education facilitators were included; six research papers were accessed and reviewed. In addition seven non-empirical papers were included. Conclusions. It is clear that considerable lack of role clarity resides over what constitutes clinical facilitation and the role of the clinical facilitator. Thus, it is paramount to strengthen this support role with Irish empirical evidence. Relevance to clinical practice. A major advantage in having a ward-based clinical education facilitator is the benefit of having access to someone who can concentrate solely on clinical education and support with attempts to narrow the theory–practice divide.

Music and its effect on the physiological responses and anxiety levels of patients receiving mechanical ventilation: a pilot study.

Abstract: Aims and objectives. The aim of this study was to investigate the effects of music on the anxiety of patients on mechanical ventilation, as assessed by objective parameters and a subjective validated anxiety scale. Background. Mechanical ventilation, although sometimes lifesaving, is often associated with levels of anxiety requiring sedatives, which has inevitable implications on costs and complications. Design. A randomized controlled trial design. Methods. A total of 64 subjects was randomly assigned to undergo either 30 minutes of music intervention or a rest period. The subjects were asked to answer the Chinese State Trait Anxiety Inventory scale before and after the study period and physiological indices and resting behaviours were recorded before and after the study period in both groups. The subjects’ satisfaction with music was also obtained after music intervention. Results. The findings indicate that patients on mechanical ventilation that listened to a single 30-minute session of music appeared to show greater relaxation as manifested by a decrease in physiological indices and an increase in comfortable resting behaviours. Conclusion. Music can provide an effective method of reducing potentially harmful physiological responses arising from anxiety in mechanically ventilated patients. Relevance to clinical practice. As indicated by the results of this study, music therapy can act as a simple and safe nursing intervention to allay anxiety and promote patient comfort. Interest and comments on music therapy provided as a relaxation technique should be elicited from both nurses and patients.

A life shaped by pain: women and endometriosis.

Abstract: Aims and objectives. The research aim was to explore women's perceptions of living with endometriosis, its effects on their lives and the strategies used to manage their disease. Background. Symptomatic endometriosis significantly affects women's quality of life. Characteristically the condition causes severe pain and has a negative impact on the ability to work, on family relationships and self-esteem. There has been little discussion about women's experience of endometriosis in nursing literature. Design. A qualitative research design informed by feminist research principles was chosen for this project. Methods. Eighteen women agreed to take part in the research. The individual, audio taped interviews were semi-structured and interactive. The interviews were analysed using a thematic analysis approach. Results. The dominant feature of data from the interviews was the experience of severe and chronic pain impacting on all aspects of life. Analysis related to pain resulted in four themes: manifestations of pain, the pain trajectory, intractable pain and controlling pain. Conclusion. The diagnostic process typically took 5–10 years indicating that primary health care practitioners need higher levels of ‘suspicion’ for this condition. Case studies and problem-based scenarios focusing on endometriosis in health professional education programmes would enhance diagnostic skills and knowledge development. No formal pain management follow up after diagnosis and treatment meant women actively sought information from other sources as they made major lifestyle changes in the areas of activity and nutrition. Pain management services specifically for women with endometriosis would provide much needed support with this neglected aspect of the disease. Relevance to clinical practice. This is a fertile area for the development of the Nurse Practitioner role which, also drawing on the considerable collective expertise of women with endometriosis, could provide significant information and support for women as they manage this highly complex condition.

Advanced nursing practice: policy, education and role development

Abstract: Aims and objectives. This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. Background. The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. Conclusion. The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. Relevance to clinical practice. In a rapidly changing people-centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.

Sleep quality in hospitalized patients.

Abstract: Aims and objectives. The objective of this study was to evaluate and compare sleep quality of the hospitalized patients and matched healthy controls. Background. Although the functions of sleep are not clearly understood, it is generally accepted that it is necessary for the maintenance of good health. Hospitalized patients’ sleep may not be refreshing or restorative. The reasons for this can be categorized into three groups: environmental, physiological and psychological. Design and methods. This research was conducted at the Cumhuriyet University Hospital in Turkey. One hundred and fifty hospitalized patients (psychiatry = 50; orthopaedic + general surgery + cardiovascular surgery + urology = 50; internal medicine + chest diseases + infectious diseases + physical therapy and rehabilitation = 50) and 50 healthy controls constituted the sample. The researchers administered to the patient and control groups Sociodemographic Information Form and the Pittsburgh Sleep Quality Index. We compared sociodemographic and illness variables with sleep characteristics. The following statistical analyses were used in order to evaluate the data: variance analysis, Tukey HSD test, Student's t-test, Kruskall–Wallis test. Results. We found that patients in psychiatric ward experienced worse sleep quality than the other patients, worse in female patients than male patients, and worse sleep characteristics in patients than controls. Conclusions. Health professionals must be educated about sleep and must provide intervention when needed. Relevance to clinical practice. The enhancing of sleep quality accelerates to the recovery from illness.

Conceptualizing place in the care of older people: the contributions of geographical gerontology.

Abstract: This paper introduces the subdiscipline of geographical gerontology to the readers of International Journal of Older People Nursing, and the ways in which geographers and others have conceptualized place in relation to the experiences of older people and their health and well-being Particular attention is paid to place as a process; its role in the exertion and negotiation of power; and as an experience open to interpretation; and how these relate to clinical practitioners This review sets the scene for the following papers on practice and the future research agenda

Metabolic control, self-management and psychosocial adjustment in women with type 2 diabetes.

Abstract: Aims. To examine factors associated with metabolic control, self-management (diet and exercise behaviour), and psychosocial adjustment (diabetes-related distress) in women with type 2 diabetes. Design. Cross-sectional design using baseline data of women with type 2 diabetes enrolled to participate in a pilot study of a nurse coaching intervention (n = 53). Ethical issues. Appropriate ethical review and approval was completed. Informed consent from participants was obtained. Outcome measures. Physiological measures included body mass index and glycosylated haemoglobin (HbA1c). Self-management measures included the Dietary Subscale of the Summary of Diabetes Self-Care Activities Questionnaire and a modified Paffenbarger Physical Activity Questionnaire. Psychosocial measures included the Problem Areas in Diabetes Survey (diabetes-related distress), the Diabetes Questionnaire, the Diabetes Self-Management Assessment Tool Support and Confidence Subscale, and the Social Functioning Scale. Descriptive, bivariate, and multivariate analyses were completed. Results. The most consistent predictor of metabolic control, dietary self-management, and diabetes-related distress was support and confidence in living with diabetes. Additionally, women had difficulty meeting optimal goals for exercise, yet reported higher levels of other physical activity. Limitations. This study was an exploratory analysis with a homogeneous sample of women with type 2 diabetes enrolled in an intervention study and measurements included multiple self-report instruments. Conclusions. Interventions to increase women's perceived self-confidence and support may contribute to positive health outcomes in women with type 2 diabetes. Relevance to clinical practice. Assessment of social support and self-confidence in diabetes self-management in women with type 2 diabetes may assist in determining individualized goals and strategies. Enhanced social support and self-confidence in diabetes self-management may subsequently improve metabolic control, self-management and psychosocial adjustment to diabetes.

Overcoming the barriers to patient-centred care: time, tools and training.

Abstract: Aims and objectives. To investigate whether nurses experience barriers to delivering high quality care in areas that are of particular concern to patients and to describe which aspects of care are most affected when nurses lack the required resources, such as time, tools and training to do their job. Background. Patient surveys conducted in the National Health Service of the United Kingdom tend to show there is variation in the extent to which they are satisfied with care in a number of important areas, such as physical comfort, emotional support and the coordination of care. Design. A sample of nurses working in 20 acute London hospitals was asked to complete a postal questionnaire based on a prototype employee survey developed in the United States and adapted by the authors for use in the United Kingdom. Method. Staff in the human resources departments of participating hospitals mailed the questionnaires to nurses’ home addresses. After two reminders, 2880 (out of 6160) useable responses were returned, giving a response rate of 47%. Results. Nurses are aware that there are deficits in standards of care in areas that are particularly important to patients. The majority feel overworked (64%) and report that they do not have enough time to perform essential nursing tasks, such as addressing patients’ anxieties, fears and concerns and giving patients and relatives information. Their work is often made more difficult by the lack of staff, space, equipment and cleanliness. They are often unable to control noise and temperature in clinical areas. Nurses in acute London hospitals are subject to high levels of aggressive behaviour, mainly from patients and their relatives, but also from other members of staff. More positively, high proportions of the nurses in our survey expressed the desire for further training, particularly in social and interpersonal aspects of care. Relevance to clinical practice. This paper goes beyond reporting problems with the quality and safety of care to try to understand why patients do not always receive optimum care in areas that are important to them. In many cases nurses lack the time, tools and training to deliver high quality care in acute London hospitals. We suggest a number of low-cost interventions that might remove some of the barriers to patient-centred care. The questionnaire we have developed could be a useful tool for improving quality locally.

Pressure ulcers: validation of two risk assessment scales

Abstract: Aims and objectives. To compare the predictive value of two pressure ulcer risk assessment scales (Braden and Norton) and of clinical judgement. To evaluate the impact of effective preventive measures on the predictive validity of the two risk assessment scales. Methods. Of the 1772 participating older patients, 314 were randomly selected and assigned to the ‘turning’ group; 1458 patients were assigned to the ‘non-turning’ group. Using the Braden and the Norton scale the pressure ulcer risk was scored twice weekly during a four-week period. Clinical assessment was monitored daily. The patients at risk in the ‘turning’ group (Braden score <17 or Norton score <12) were randomly assigned to a two-hour turning schedule or to a four-hour turning schedule in combination with a pressure-reducing mattress. The ‘non-turning’ group received preventive care based on the clinical judgement of the nurses. Results. The diagnostic accuracy was similar for both scales. If nurses act according to risk assessment scales, 80% of the patients would unnecessarily receive preventive measures. The use of effective preventive measures decreased the predictive value of the risk assessment scales. Nurses predicted pressure ulcer development less well than the Braden and the Norton scale. Only activity, sensory perception, skin condition and existence of old pressure ulcers were significant predictors of pressure ulcer lesions. Relevance to clinical practice. The effectiveness of the Norton and Braden scales is very low. Much needless work is done and expensive material is wrongly allocated. The use of effective preventive measures decreases the predictive value of the risk assessment scales. Although the performance of the risk assessment scales is poor, using a risk assessment tool seems to be a better alternative than relying on the clinical judgement of the nurses.

Child in hospital: family experiences and expectations of how nurses can promote family health

Abstract: Aims and objectives. This study set out to explore, from the family's point of view, ways in which nursing staff can promote family health during the child's hospital stay. Background. Having a child in hospital is a major source of stress and anxiety for the whole family. Earlier studies have described parental coping strategies, ways to strengthen those strategies and to support parental participation in child care, but no one has studied the promotion of family health during the child's hospitalization from the family's point of view. Design. Interviews were conducted in 2002 with 29 families who had a child with a chronic illness which were receiving or had received treatment on the paediatric wards of two Finnish hospitals. Methods. Data analysis was based on the grounded theory method, proceeding to the stage of axial coding. Data collection and analysis phases proceeded simultaneously. Results. Five domains were distinguished in the promotion of family health: (1) reinforcing parenthood, (2) looking after the child's welfare, (3) sharing the emotional burden, (4) supporting everyday coping and (5) creating a confidential care relationship. Conclusions. The results strengthen the knowledge base of family nursing by showing how nursing staff can promote family health during the child's hospital stay. Relevance to clinical practice. The results have a number of practical applications for nursing, both for clinical practice and research. The results can be used in paediatric hospital wards caring for chronically ill children and their families. The five domains of family health promotion described here should be tested in other paediatric wards and in other geographical locations.

Use of preferred music to decrease agitated behaviours in older people with dementia: a review of the literature.

Abstract: Journal of Clinical Nursing 14, 1133–1140Use of preferred music to decrease agitated behaviours in older people withdementia: a review of the literatureAims and objectives. This paper reviews study findings of preferred music on agi-tated behaviours for older people with dementia and provides implications forfuture research and practice.Background. Music has been suggested as a feasible and less costly intervention tomanage agitated behaviours in older people with dementia. However, no review ofthe literature focusing on study findings of preferred music on agitated behaviours inolder people with dementia had been reported.Methods. A review was undertaken using electronic databases with specified searchterms for the period of 1993–2005. The references listed in the publications selectedwere also searched for additional studies.Results. Eight research-based articles met the inclusion criteria and were included inthe review. The preferred music intervention demonstrated positive outcomes inreducing the occurrence of some types of agitated behaviours in older people withdementia. The findings from these studies were relatively consistent in findingimprovement in agitated behaviours although the findings in one study did not reachstatistical significance. The small sample sizes and some variations in the applicationof the preferred music intervention mean that caution is needed in drawing con-clusions from these studies.Conclusions. This review highlights that preferred music has positive effects ondecreasing agitated behaviours in older people with dementia; however, the meth-odological limitations indicate the need for further research.Relevance to clinical practice. Findings from the review highlight the beneficialoutcomes of preferred music in reducing agitated behaviours for older people withdementia. The incorporation of preferred music has the potential to provide atherapeutic approach to the care of older people with dementia.Key words: agitated behaviours, dementia, nurses, nursing, preferred music

Maintenance haemodialysis: patients' experiences of their life situation

Abstract: The aim of this study was to examine how patients suffering from CKD on maintenance haemodialysis experience their life situation. The focus was on how treatment encroaches on time and space and ho ...

Self-care in diabetes: model of factors affecting self-care

Abstract: Aims and objectives. The aim of this paper is to explore self-care in diabetes and to present a model of factors that affect self-care according to reviewed literature. Background. Self-care in diabetes is crucial to keep the disease under control. Self-care consists at least four aspects: (i) self-monitoring of blood glucose, (ii) variation of nutrition to daily needs, (iii) insulin dose adjustments to actual needs and (iv) taking exercise regularly. It is known that diverse factors influence self-care such as knowledge, physical skills and emotional aspects and self-efficacy which have been listed as being of high importance. Methods. The searched databases were ProQuest, PsycINFO and Medline from 1995 to 2002. The search terms were ‘self-care’ or ‘self-management’ coexisting with diabetes and ‘self-efficacy’. The search was limited to English and adults with type 1 diabetes. Results. The main components of the model clarify how knowledge, physical skills and emotional factors as well as self-efficacy influence self-care which again affects metabolic control. Flexible self-care indicates high level of self-care when patients are able to care for and manage the disease in a responsible and flexible way that does not affect their life extensively, resulting in adequate glycosylated haemoglobin value. Self-efficacy is a strong predictor of flexible self-care and affects metabolic control through increased perceived ability to conduct self-care. Conclusions. The review illuminated that benefits of self-care should be emphasized and knowledge of the Diabetes Complication and Control Trial results can contribute to better self-care. However, factors affecting flexible self-care still require better identification. Relevance to clinical practice. The review emphasizes and adds to the topic, that in daily practice health care practitioners must assess diabetes-related knowledge, physical skills and emotional factors in combination with self-efficacy and the four self-care areas. The effects of self-monitoring of blood glucose needs better clarifications as it is now regarded the cornerstone of flexible self-care.

Children's accounts of their preoperative information needs

Abstract: Aims and objectives. To explore the information needs of children aged 7–11 years relating to planned admission for surgery. To identify the knowledge of a group of children prior to admission and their own identified information needs. Background. There is widespread agreement that children should be given information prior to surgery but continuing debate about the most appropriate form and content of preadmission preparation. There is little research evidence about children's concerns, fears and misconceptions about hospitals and surgery. Previous investigations have examined the views of parents/carers and health care professionals rather than the direct reports of children themselves. This study was designed to explore whether children could identify their own information needs prior to admission for elective surgery. Design. Qualitative. Method. Nine children aged 7–11 years were interviewed using the write and draw technique to ascertain their preadmission information needs. Data collection occurred several weeks prior to the child's first admission to hospital for planned surgery. Results. Children reported that they had not received direct information from the hospital or from health professionals. They obtained information from a variety of sources including leaflets for parents, television and the experiences of relatives and friends. Some children knew very little about hospitals and their own planned operation. Children identified 61 questions about their forthcoming admissions, including questions about: getting information; procedures; anaesthesia; timing; hospital environment; family support; feelings/pain; their condition; and concerns. Conclusions. Children aged 7–11 years can identify their own information needs and so contribute to the development of preadmission education. Relevance to clinical practice. Patients attending a children's hospital can have little information provided prior to admission. Information about hospital should be presented directly to children in the most accessible and flexible form.

Breast self-examination and breast awareness: a literature review.

Abstract: Aim. To explore the literature on breast self-examination and breast awareness. Objectives. To clarify the confusion surrounding breast awareness and breast self-examination. To critique the evidence for breast awareness as a health promotion tool. Background. Over 41 000 women are diagnosed with breast cancer each year in the United Kingdom. Compared with other European countries, women in England have poor survival prospects, for breast cancer, due in part to advanced disease at first presentation. In the United Kingdom, women are encouraged to be breast aware from the age of 18. However, the evidence suggests that women do not engage in breast awareness and are frightened and confused about their role in breast health promotion. Methodology. Four databases were used: Medline, Ebsco including CINAHL and Sociological Abstracts and the Cochrane Database of Systematic Reviews. The search terms ‘breast awareness’ and ‘breast self-examination’ were used and combined with ‘breast cancer’, ‘breast screening’ and ‘health promotion’. Conclusion. The evidence on breast self-examination is clear, there is no benefit to breast cancer mortality and results suggest that breast self-examination may do more harm than good. Breast awareness provides women with some acknowledgement of the part they can play in being empowered to fight breast disease, not in terms of statistics used for mortality but on the qualitative effects of reductions in morbidity. Relevance to clinical practice. The Royal College of Nursing of The United Kingdom is actively encouraging all nurses to promote breast awareness along with clear guidelines for doing so. The United Kingdom National Health Service Cancer Plan: a plan for investment, a plan for reform, encourages preventive care, information giving, good communication as well as evidence-based practice. In breast care this can reduce confusion for women and encourage empowerment in breast health promotion.

Effects of a feeding skills training programme on nursing assistants and dementia patients

Abstract: Aims and objectives. The purposes of this study were to develop a comprehensive feeding skills training programme for nursing assistants and to test the effects of this training programme on their knowledge, attitude and behaviour and the outcome of dementia patients including total eating time, food intake and feeding difficulty. Background. Dementia patients have a high probability of feeding problems that result in a substantial risk of malnutrition. Assisting residents with eating is a major task for nursing assistants and they require better training to provide adequate quality of nutritional care. Design methods. A quasi-experimental study was conducted. Two convenience-chosen dementia-specialized long-term care facilities in North Taiwan were randomly assigned into either a control or a treatment group. Sixty-seven nursing assistants were enrolled (treatment: 31; control: 36). Twenty nursing assistants and the same number of dementia patients were observed during mealtime. The treatment group participated in a feeding skills training programme including three hours of in-service classes and one hour of hands-on training, whereas the control group did not receive any training. Results. The treatment group had significantly more knowledge (F = 47·7, P < 0·001), more positive attitude (F = 15·75, P = 0·001) and better behaviours (t = 6·0, P < 0·001) than the control group after the intervention. Dementia patients in the treatment group had significantly longer total eating time (t = 2·7, P < 0·05) and higher Edinburgh Feeding Evaluation in Dementia scores (more feeding difficulty) (t = 2·1, P < 0·05) than the control group. There was no significant difference on food intake between the two groups (t = 0·8, P = 0·49). Conclusion. This feeding skills training programme has been found to change nursing assistants’ knowledge, attitude, and behaviour as well as increasing the eating time for the dementia patients. Relevance to clinical practice. This study raises attention regarding on-the-job training for nursing assistants. Furthermore, the feeding problems among dementia patients should be further explored as well as the nutritional care.

Supporting learners in clinical practice: capacity issues.

Abstract: Supporting learners in clinical practice: capacity issues Aim. The aim of this paper is to report a study exploring, from the perspective of key stakeholders (mentors of nurses, managers of nurses, and modern matrons) in one English acute sector hospital, how decisions are made on how many learner nurses can be supported in clinical practice. The objective was to identify what factors are taken into consideration in making these decisions. Background. Supporting increasing numbers of students is a demand of current service provision in the English National Health Service, as part of an expansion in the numbers of all healthcare professionals. This is particularly the case in nursing, where the government announced a required increase in numbers of qualified nurses of 20 000. This expansion of numbers has implications for the quality of placement learning in clinical placements. Methods. Data were collected using three focus group interviews with a total of 12 participants in 2003/04. Recruitment was on a purposive basis. Subsequent analysis identified themes, which were compared across groups. A short questionnaire was also used to establish participants' biographical details prior to the focus groups. Findings. Three key themes were identified: 'capacity issues', 'enhancing support in practice' and 'issues impacting on learning in practice'. 'Capacity issues' identified factors that impact on the capacity of placements to support learners. 'Enhancing support in practice' identified necessary roles and strategies to enhance learning in practice. Finally, 'issues impacting on learning in practice' identified learner groups where support could be enhanced through structured management of the placement experience. Conclusions. Decisions on learner numbers to be supported at any one time are complex, with a multitude of dimensions. These include identification of types of learners and numbers of mentors available to support them and other operational issues. 'Educational staff are needed at operational and strategic levels to support learning in practice. Timely and appropriate audit information to support allocation decisions and identify strategies to enhance the quality and support of learning in practice, are also required. Relevance to clinical practice. Increases in learner numbers and National Health Service modernization have had an impact on clinical placements' capacity to support learning, and potentially, on learners' achievements in practice. Findings from this study are thus important in evaluating the impact of these policy initiatives.

A randomized clinical trial of the effectiveness of a discharge planning intervention in hospitalized elders with hip fracture due to falling.

Abstract: A randomized clinical trial of the effectiveness of a discharge planning intervention in hospitalized elders with hip fracture due to falling Aim. The objective of this study was to examine the effectiveness of a discharge plan in hospitalized elderly patients with hip fracture due to falling. Background. Hip fractures are an important cause of morbidity and mortality among older people. Hip fracture patients require ongoing medical and long-term care services. Discharge plan services can play a very important role for these patients, since the services improved their outcome conditions. Methods. Hip fracture patients aged 65 years and older (n ¼ 126), hospitalized due to falling and discharged from a medical centre in northern Taiwan, were randomly assigned to either a comparison group (the routine care) or experimental group (the discharge planning intervention). The outcomes used to determine the effectiveness of the intervention were: length of hospitalized stay, rate of readmission, repeat falls and survival, and activities of daily living. Results. The discharge planning intervention decreased length of stay, rate of readmission and rate of survival and improved activities of daily living for inter- vention group compared with those of control group. Mean total SF-36 scores of patients in the experimental group were higher than for the control group and both groups had improved quality of life. Conclusion. The discharge planning benefited older people with hip fractures. Relevance to clinical practice. A discharge planning intervention by a nurse can improve physical outcomes and quality of life in hip fracture patients.

Health care worker beliefs about influenza vaccine and reasons for non-vaccination--a cross-sectional survey.

Abstract: Aims and objectives. To identify reasons for poor uptake of influenza vaccine in healthcare workers. Background. When influenza is circulating in the community, influenza vaccination of healthcare workers may reduce morbidity and sick leave and may also reduce mortality in older hospitalized patients. Despite this, vaccine uptake in healthcare workers remains low. Design. Cross-sectional survey. Methods. Self-completed questionnaires were distributed to 144 nurses and healthcare assistants in two Liverpool hospitals. Results. Vaccination uptake in this sample was 7.6%. The main reasons given for not being vaccinated were: did not think it was needed (29%), not aware of the vaccine (18%) and concerned about side-effects (11%). The main perceived benefits of vaccination were reducing sick leave (44%) and personal protection against influenza (28%). Conclusion. In this study, many healthcare workers demonstrated a lack of awareness and understanding of the vaccine, especially in relation to its benefits and side-effects. Relevance to clinical practice. Vaccinating healthcare workers against influenza can reduce staff sickness during times of winter pressure as well as reducing mortality in frail, older hospitalized patients. It is therefore important that hospitals maximize vaccine uptake by increasing awareness and promoting the benefits of influenza vaccine amongst healthcare workers as well as ensuring that all staff have the opportunity to receive the vaccine.

Prevalence of pressure ulcers in Germany.

Abstract: Aims and objectives. This article establishes the prevalence of pressure ulcers in hospitals and nursing homes for national and international comparison. Background. Although many European countries evaluate the prevalence of pressure ulcers, it has not recently been examined in German healthcare facilities. Design. Descriptive study design, point prevalence survey in 2001 and 2002. A total of 11 584 patients and residents in 66 institutions throughout Germany took part in the study. Methods. Prevalence rates were calculated for the different types of institutions, different years, different risk groups and different disciplines. All calculations were made by including as well as excluding pressure ulcer grade 1. The Braden scale (cut-off ≤20) was applied to define at risk and not at risk patients/residents. Results. The prevalence including (excluding) grade 1 pressure ulcers was 11.7% (5.2%) for the whole sample, while in the group at risk it was 24.5% (11.5%). The size of the group at risk in the nursing homes was 63.9% and less than 40% in the hospitals. Comparisons between disciplines showed a great range of prevalence rates. The use of special surface devices for persons at risk was more common in nursing homes than in hospitals. Conclusion. The prevalence of pressure ulcers bears resemblance to results produced by other studies, but it is uncertain if these similarities are more than coincidental. Due to the influence of sampling the use of a standardized samples method is essential. For comparisons of groups with differences regarding their risk assessment it would be more appropriate to use the prevalence of patients and residents at risk. Relevance to clinical practice. The study provides accurate data about the extent of the problem of pressure ulcers in German healthcare facilities.

Music and its effect on anxiety in short waiting periods: a critical appraisal.

Abstract: Music and its effect on anxiety in short waiting periods: a critical appraisal Aims and objectives. This paper undertakes a critical appraisal of the methodological issues associated with studies that have investigated the extent to which music decreased the anxiety experienced by patients in short-term waiting periods such as day surgery. Background. Investigations and surgery undertaken on a day basis have significantly increased in number over the last decade. Music has been evaluated as an appropriate nursing intervention in relation to pain, discomfort and anxiety in a number of clinical settings but its usefulness for decreasing anxiety in short-term waiting periods such as day surgery is only beginning to be understood. Conclusion. A number of methodological limitations are identified by this critical review, particularly in relation to the design of research studies. Recommendations to strengthen research in this area are suggested and include (i) describing methods clearly and with detail to allow assessment of the validity and rigour of study results; (ii) using permuted block randomization; (iii) recruiting from a variety of surgical procedures and cultural groups; and (iv) standardizing the health care provided during waiting period. Relevance to clinical practice. Music as a simple and cost-effective intervention to reduce the anxiety experienced in limited time periods will have enormous impact on clinical practice where patients wait and undergo invasive investigations, procedures or surgery. However, the evidence of its utility in these unique environments is only beginning to emerge and this critical review provides a basis for considerations for future research.

Nursing diagnoses: factors affecting their use in charting standardized care plans.

Abstract: Aims and objectives. The purpose of this study was to explore factors that may affect nurses’ use of nursing diagnoses in charting standardized nursing care plans in their daily practice. Background. Care plans have been viewed as providing a structured approach to the assessment, planning and delivery of patient care. Nonetheless, the challenge for many institutions is to help professional nursing staff refine their understanding of nursing diagnoses and charting skills, to identify patient problems and propose appropriate care plans. Method. Twelve clinical nurses working at a medical center in Taiwan underwent one-on-one in-depth interviews from May to July 2000. Data analysis was based on Miles and Huberman's data reduction, data display, and a conclusion verification process to investigate the charting process. Findings. Nurses tended to match patient conditions to the designated nursing diagnoses, be unfamiliar with statements of related factors, use objective data to describe patient conditions, ignore descriptions of nursing goals, dutifully check interventions without always executing them, and choose the same evaluation to meet hospital requirements. Conclusions. These findings suggest that using educational programmes for enhancing nurses’ ability to use nursing diagnoses and exploring the process of diagnostic reasoning would improve the quality of patient documentation. Relevance to clinical practice. The trend in health care is to focus on chart audit to reveal indicators of quality of care. Therefore, the experience of nurses in this study could be applied to in-service training programmes by institutions that are replacing traditional, manually written care plans with a standardized care planning system, thus helping other nurses through this transition process.

Nurse consultants: their characteristics and achievements

Abstract: Aim. This paper reports one aspect of a larger study of nursing research strategies in one English region, focusing particularly on nurse consultants’ characteristics and achievements in the role. Background. Nurse consultant posts have only been established in the United Kingdom since 1999 and, although much comment has appeared in the professional literature, there is very little research-based evidence of how the roles are developing. The role is intended to integrate four domains: expert practice; professional leadership and consultancy; education, training and development; and practice and service development. Design. A cross-sectional design, using a convenience sample, was adopted. Methods. Ten nurse consultants working in a variety of settings and specialties participated in in-depth, tape-recorded interviews. The data were analysed using the Framework approach. Results. Four themes were identified from the data: characteristics of the postholder, role achievement, support systems and National Health Service influences. The first two themes are discussed in this paper and the data show that the nurse consultants varied in terms of their academic background and previous experience. Not all had the recommended minimum of Master's degree level preparation and some had limited research experience. These background characteristics seemed to influence the degree to which they were able to achieve the four domains of the role, with those with lower qualifications and from a mental health background appearing to struggle most. Conclusions. New appointments to these roles should only be made when candidates possess the recommended levels of educational preparation and professional experience of change management. It is also important that there is clarity about the scope of the role, which should not include management responsibilities. On-going research is essential to evaluate how the roles develop for postholders, the extent to which they fulfil policymakers’ expectations and what difference they make to patient care from a patient perspective. Relevance to clinical practice. The findings show that holders of such posts need to have appropriate previous knowledge, skills and personal characteristics, as these seem to influence their ability to integrate the four domains of the role and thus achieve the requirements of the post.

Health promoting hospitals: the role and function of nursing

Abstract: Background. In 1986, the World Health Organisation's (WHO) Ottawa Charter for Health Promotion sought to create a framework that conveyed the notion of capacity building, related to specific settings, and a structured process for health promotion action. It provided the platform from which the health promoting hospital movement was later launched. Nearly two decades on, the health promoting hospital (HPH) movement has grown considerably and continues to expand, against the backdrop of having to adapt to the changing needs and demands of clients and the evolving social context of their communities. Many nurses, it is argued here, are often unaware of health promoting hospitals concepts or, when they are, do little to contribute to them. Method. A critical review of the available health promoting hospital and related literature has been conducted for discussion. Findings. The literature revealed that hospitals are being urged to reject practices based purely on health-limiting and limited biomedical frameworks, in favour of moving towards models based on health promoting hospitals and public health-orientated hospitals. This requires radical reform that focuses on the social and health policy context of organizations, the socio-political empowerment of its employers and clients, and the personal/collective positive health and welfare of its employers and clients. Many health service agencies are beginning to emphasize population health within communities as part of a concerted move away from an original primary focus on acute inpatient hospital-based service provision. Conclusion. Hospitals need to adapt and expand their efforts to focus on health promotion activities, in collaboration with the ever-widening community networks of health and social agencies. This requires the commitment of all health care professional groups. Nurses who practice in the hospital setting should be aiming to initiate and promote radical health promotion reform as set out in the health promoting hospital movement. This paper argues that nursing per se could be making much larger inroads and efforts to affect and implement wide-ranging health promotion activities in hospital organizations. Nurses should view the HPH movement as another opportunity truly to embrace evolving broad-based health promotion concepts, as a means to forge and own their own health agenda, and also as a means to move beyond the traditional reliance of a limited health education role. Relevance to clinical practice. Hospitals and their employees must be seen to advocate, support and implement wide-reaching social and community-based reform, as part of a necessary commitment to ‘seamless’ health care provision. The health promoting hospital movement represents a collective vehicle for enabling such activities. If nurses wish to be at the forefront of current health service strategies they must be seen to embrace the radical health promotion reforms that are emerging from the current literature and put forward in this article.

Triage in emergency departments: national survey

Abstract: AIM: This paper reports a study the aim of which was to describe how triage-related work was organized and performed in Swedish emergency departments. BACKGROUND: Hospitals in many developed countr ...