Nursing research in a developing country: a different edge.
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Developing Countries↗
Biomedical subjects
C Webb
Publications and source records attributed to C Webb.
Interpreting risk-adjusted length of stay patterns for VA hospitals.
OBJECTIVES: The Veterans Health System must become more competitive with the private sector in terms of efficiency of care. Studies have shown significantly longer lengths-of-stay (LOS) in facilities operated by the Department of Veterans Affairs (VA) compared with private sector facilities. Most comparisons, however, have not controlled well for casemix differences or have involved small numbers of patients. The aims of this study were: (1) controlling for casemix, to accurately measure the degree by which average length of stay in Veterans Affairs facilities exceeds that of private sector hospitals and (2) to demonstrate a methodology with which individual VA facilities can identify clinical and demographic subgroups of patients associated with the higher length-of-stay averages. METHODS: Subjects of the study were Veterans Health System patients hospitalized during 1991-1993 and veteran respondents to the 1991 National Hospital Discharge Survey. Hospitals' mean length of stay adjusted for patients' diagnosis related groups, severity, demographics, and travel distances were measured. RESULTS: Veterans Affairs medical centers' average risk-adjusted length of stay was 36% higher (8.9 days compared with 6.5 days) than that of the private sector. For individual hospitals, relative length-of-stay efficiency typically varied by condition. Among 14 hospitals in the VA's midwest region, none were high risk-adjusted length-of-stay outliers in all conditions studied, and four were high outliers for some conditions and low outliers for others. CONCLUSIONS: Controlling for differences in patient demographic and clinical factors, Veterans Affairs medical centers consumed significantly more days of care than private sector hospitals. Veterans Affairs medical centers will be able to improve efficiency by identifying specific subgroups of patients whose clinical treatment should be examined.
Comorbidity↗
Dientes! Community dental clinic: dental care for low-income residents of Santa Cruz County.
Dientes! is a private nonprofit community dental clinic that was established in 1994 to provide dental care for low-income residents of Santa Cruz County. Its founders were successful in securing support from a diverse group of community agencies, including city and county governments, philanthropic foundations, the dental community, and corporate and individual donors. Dientes! provides approximately 250 visits per month in a three-chair clinic in Santa Cruz; a school-based program in Watsonville began March 1998. The major challenge facing Dientes! is to establish a reliable financial base that will allow the program to better meet the needs of low-income county residents over the long term.
California↗
The formulation of recombinant factor IX: stability, robustness, and convenience.
A lyophilized recombinant factor IX (rFIX) formulation has been developed that is stable and contains no preservatives. No blood or plasma products are used in the production or formulation of rFIX. The formulation contains 10 mmol/L histidine, 0.26 mol/L glycine, 1% sucrose, and 0.005% polysorbate-80 (pH 6.8). Polysorbate-80 acts as a protectant for the protein from freezing-induced damage (eg, aggregation). Sucrose provides protection to the protein in the freeze-dried state. Glycine provides for a high-quality cake morphology. Histidine provides optimal buffering stability at the desired pH and minimizes aggregate formation upon storage in the lyophilized state. This optimized combination of excipients provides a high degree of long-term stability, as demonstrated by a variety of analytical methods, including clotting assays, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE), isoelectric focusing (IEF), size-exclusion chromatography (SEC), peptide mapping, oligosaccharide fingerprinting, and reverse-phase high-performance liquid chromatography (HPLC). The rFIX product is easy to reconstitute and demonstrates excellent stability in solution after reconstitution.
Chemistry, Pharmaceutical↗
Tripartite involvement in health care clinical education.
This paper discusses the importance of an appropriate student-clinical educator-university lecturer (tripartite) relationship in clinical education and substantiates this importance with the experiences of the dynamics of such relationship in a physiotherapy course.
Faculty↗
Building a relationship: communications and relationships between staff and stroke patients on a rehabilitation ward.
Communications among staff and patients on a stroke rehabilitation ward form the focus of this article, which reports on some aspects of a larger study using a grounded theory approach. Tape-recorded interviews were transcribed and analysed concurrently according to recommendations for the approach. A main theme entitled building a relationship was identified, and this process was found to occur in a context varying from participative at one end of a continuum to hierarchical at the other. Building a relationship was found to be influenced by role, personal qualities and organizational context. Appropriate relationships between role-holders were subject to negotiation, leading to a resulting congruence or incongruence between participants' expectations of each other and their roles. Personal qualities were brought into play in the process, with patients' views of staff and staff views of patients both being influential. Some of these views seemed to parallel what has been described in earlier literature as 'the sick role' and the labelling of patients as 'good' or 'bad'. Responses to personal qualities led to nurses ascribing meaning to patients' behaviour in terms of adjustment to their stroke, giving time to them to help them to adjust, and withdrawal and handing over to other staff if this strategy failed. Organizational context also had an influence on building a relationship, with time constraints being identified particularly by nurses, and the need to fit in the most essential aspects of care. Place was also important, in that nurses were confined to the ward as a work location, whereas other therapists and doctors worked in other places and sometimes had the facility to take patients off the ward to concentrate on therapy. The findings are discussed against the background of related literature and the conclusion is drawn that the crucial role of nurses in rehabilitation is not recognized and valued, and that shortages of resources-especially suitably qualified and trained nursing staff-are a negative influence on building the relationships which are vital to successful rehabilitation.
Cerebrovascular Disorders↗
Women's experiences of non-invasive breast cancer: literature review and study report.
A review of the post-1990 literature on breast cancer has identified a large body of psychosocial research focusing on coping styles, quality of life and women's participation in choice of treatment. However, numerous methodological problems were found, including a variety of different diagnoses included in samples both within studies and between studies, making comparisons difficult. In particular, no article was traced which focused on non-invasive breast cancer, or ductal carcinoma in situ (DCIS). Therefore a small exploratory study was conducted using qualitative methods to explore women's experience of DCIS, in an attempt to begin exploration of possible similarities or differences in the way women experience invasive and non-invasive breast cancer. A convenience sample of 10 women treated at two hospitals in an Australian state capital city was interviewed, and three themes which emerged from these interviews are discussed in this article. These are discovering the problem, reaction to the diagnosis, and information. Most women unexpectedly reacted in a calm and accepting way to receiving the diagnosis of DCIS, and this may be because they had had no signs of disease but been recalled for further tests after routine screening. They felt well and had no cause to assume a poor prognosis. It is possible also that their reactions were affected by a television health education campaign at the time, which gave a very optimistic picture of the benefits of early detection of breast cancer. Information-giving, as reported by the women, seemed deficient. None of them knew that they had had a non-invasive condition, one thought her disease had been benign, and another that hers was "evasive'. Findings are discussed in relation to the literature on information-giving and on the role of the nurse in this area, and suggestions are made for further research to systematically compare women's reactions to having invasive and non-invasive breast cancer in order that nurses may be aware of their possibly different needs and respond to them appropriately.
Adaptation, Psychological↗
Evaluating the introduction of primary nursing: the use of a care plan audit.
A care plan audit was carried out as part of an action research project involving the introduction of primary nursing. The audit tool was based on the Roper, Logan and Tierney Activities of Living model and the nursing process. The audit showed that few changes in documentation had taken place as a result of the introduction of primary nursing. The volume of communications had increased but much of this was not documented on care plans. Other positive changes as a result of introducing primary nursing were found, and both patients and nurses were aware of these.
Activities of Daily Living↗
Treatment of traumagenic beliefs among sexually abused girls and their mothers: an evaluation study.
The objective of this study was to evaluate and compare the efficacy of two short-term individual therapy interventions for sexually abused girls and their nonoffending female caretakers. Thirty-two girls, ages 8 to 13, and their caretakers from primarily low-income, African-American families were randomly assigned to a theoretically based, structured experimental treatment program or to a relatively unstructured comparison intervention. Measures of child outcome were completed before and after the treatment program by each parent and child, and by a clinician blind to treatment condition. Pre- and postmeasures of maternal outcome were completed by the caretaker and a clinician not involved in the treatment. Both treatment programs yielded decreases in children's posttraumatic stress disorder symptoms and traumagenic beliefs reflecting self-blame and powerlessness, and increases in children's overall psychosocial functioning. The experimental intervention was more effective than the comparison program in increasing abuse-related caretaker support of the child and in decreasing caretaker self-blame and expectations of undue negative impact of the abuse on the child. Clinical implications of these findings include the development of interventions targeting sexually abused children's traumagenic beliefs and nonoffending parents' support of their victimized children.
Adolescent↗
Training to do women's work in a man's world.
Many student nurses also carry the responsibilities of parenthood, and government has encouraged the recruitment of more mature students to nursing. The majority of nursing recruits continue to be women, but career models are more appropriate to those who do not bear the principal responsibility for childcare, namely men. After reviewing the literature relating to these issues in the National Health Service, the article discusses discrimination against nurses who are parents. An empirical study of a group of mature nursing students on Project 2000 courses is reported, showing that they encounter problems with childcare, support, study, family relationships and inflexibility within nursing education. The article concludes by suggesting a number of points which nurse educators should bear in mind when planning and delivering courses to ensure that the needs of student parents are met.
Career Mobility↗
Caring, curing, coping: towards an integrated model.
There is an extensive literature discussing the "care:cure dilemma'. This usually puts forward the position that it is doctors who do the curing and nurses who do the caring. Patients are rarely included in the discussion. This paper considers some of this literature and examines whether this separation of functions is a valid one, the part of lay carers in the process, and the perspective of patients. It focuses particularly on cancer because this is an area where the issues seem particularly pertinent. The paper concludes by proposing an alternative and integrated conception which includes patients, nurses and doctors in a cognitive-phenomenological model of coping. It is suggested that this model moves forward from the previous limitations of the care:cure approach and enables more fruitful research and education of practitioners to be undertaken.
Adaptation, Psychological↗
The biomedical construction of ageing: implications for nursing care of older people.
This paper reports on an existential phenomenological study carried out in a care of elderly people setting in a 1000-bed hospital in the United Kingdom. Fourteen participants were interviewed, each on several occasions. Two themes derived from these narratives are discussed, revealing negative experiences which are related to feelings of powerlessness. These two themes, routine geriatric style and segregation, are shown to arise from the history and culture of the wards and are shown to result in care deprivation and depersonalization. Patients' individual needs are ignored as they become the objects of inflexible routines within health care practice. In order to understand the situation, the history of care of older people and the biomedical construction of ageing are examined. It is concluded that what is needed is a wider social and political movement which opposes ageism and challenges ageist stereotypes. In addition, in health care there is a need for a review of the routine geriatric style of care and of segregation based on age and a social gerontology programme for nurse education.
Activities of Daily Living↗
Age and recovery from brain injury: clinical opinions and experimental evidence.
For many years the notion that brain damage causes less impairment in children than in adults (sometimes known as the 'Kennard Principle') has enjoyed widespread support among scientists and clinicians. More recently neuroscientists have questioned the Principle, most now taking an opposing view that damage to the rapidly developing brain can be more harmful than equivalent damage in adulthood. Many clinicians, however, appear reluctant to reject the Kennard Principle. This study investigates the extent to which the Kennard Principle still guides the judgement of different groups of health-care professionals (neurosurgeons, neurologists, neuropsychologists, general practitioners, nurses, physiotherapists, occupational therapists, and speech therapists). Subjects were asked to estimate the extent of recovery in clinically based but fictitious case studies which differed only in the reported age of the patient. The professions differed in their levels of optimism regarding the extent of recovery to be expected, but all predicted better recovery in younger patients (under 10) than in adults with otherwise similar brain injuries. The results are discussed in terms of their implications for the treatment of brain injuries in the young.
Adult↗
Assessing patient satisfaction. Part 2. Findings: nursing, the hospital and patients' concerns.
Part 1 of this article discussed the process of evaluating patient satisfaction by means of unstructured, in-depth interviews. In this part, the content of interviews will be presented and the analytic domains derived from the research will be described. These are 'nursing', 'the hospital' and 'patients' concerns', and the categories which make up these domains will be discussed.
Hospitals↗
Introducing primary nursing: nurses' opinions.
This article reports on one aspect of a research project carried out to monitor and evaluate the introduction of primary nursing on four demonstration wards in one health authority. Nursing staff working on the wards were interviewed to identify how the changes were affecting them and their work. Stress questionnaires were also completed by a sample of nurses on the wards. Responsibility and communication--key concepts emerging from the data--are discussed and related to the literature on primary nursing.
Attitude of Health Personnel↗
Family burden of schizophrenia and bipolar disorder: perceptions of relatives and professionals.
OBJECTIVE: The study compared the burden that specific problem behaviors of patients with schizophrenia or bipolar disorder placed on relatives and evaluated the accuracy of mental health professionals' judgment of the burden. METHODS: A questionnaire was developed to assess the burden of 20 common problem behaviors associated with manic, positive, and negative symptoms. The questionnaire was given to 48 relatives of patients with schizophrenia or bipolar disorder. In addition, 39 mental health professionals completed separate questionnaires indicating the amount of burden they believed relatives experienced due to these behaviors. RESULTS: Relatives of patients with bipolar disorder rated manic symptoms as more burdensome than did relatives of patients with schizophrenia, but relatives of patients in the two groups did not differ in their ratings of burden associated with positive or negative symptoms. Professionals' perceptions of the burden associated with manic symptoms were relatively accurate, but they tended to underestimate the burden of positive and negative symptoms experienced by relative of patients with bipolar disorder. CONCLUSIONS: Psychiatric diagnosis may be of limited value in understanding the burden relatives experience due to specific psychiatric symptoms. Professionals are encouraged to assess the burden that is associated with specific problem behaviors regardless of psychiatric diagnosis.
Activities of Daily Living↗
The post-registration bachelor in nursing programme at the Chinese University of Hong Kong.
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Education, Nursing, Baccalaureate↗