Biomedical subjects
Publications and source records attributed to M McSweeney.
Clinical practice guidelines are valuable, clinical decision-making aids for preventive, diagnostic, therapeutic, and palliative patient care. This article identifies ways to access clinical practice guidelines and discusses evaluative criteria for identifying gold-standard evidence-based practice guidelines. Finally, clinicians are reminded of crucial questions to ask before applying any guidelines to patient care.
The efficacy of telemedicine technology was tested for equivalence of nursing assessment with chronic congestive heart failure (CHF) home care patients (N = 28). The equivalence of nurses' physical assessment findings was estimated using an innovative two-way, telemedicine audiovisual system. Nurses were randomly assigned to a method of client assessment: on-site (real time) or telemedicine (monitor time). Each assessment was performed within 10 minutes of each other. Assessment variables compared were auscultation of lung sounds, heart sounds, rate and rhythm, blood pressure, weight, edema, respiratory effort, and client's face, lip, and nail color. Eighteen physiological parameters were analyzed, using either the Wilcoxon signed ranks test or the McNemar test. Results indicate few significant differences between the assessments of the real time and monitor time nurses. The monitor nurse was more likely to claim abnormality than the real nurse was when assessing the color of nails (p = .048). The real nurse picked up ankle edema (p = .024), pedal edema (p = .099), and inspiratory wheeze (p = .01) more frequently than did the monitor nurse. Kappa coefficients to determine the extent of agreement between nurse's assessments were significant. Nurses' comments were favorable, but they recommended altering the interview to elicit symptoms not easily observed by the monitor nurse such as diaphoresis. Exit interviews of the elderly patients revealed a favorable reaction to using the telemedicine monitor, citing a quick connection to a nurse and response to their concerns and questions. Both nurses and patients reported the need to have real nurse home visits along with telemedicine visits.
PURPOSE/OBJECTIVES: To evaluate the quality of existing instruments measuring cancer-related fatigue (CRF). DATA SOURCES: Nursing and medical literature. DATA SYNTHESIS: Although fatigue is highly prevalent among patients with cancer and adversely affects their quality of life, CRF often is unrecognized and untreated. The instruments available to measure CRF have numerous limitations. Many have been generated from investigators' observations, not actual experiences described by patients. Others operationalize different definitions of fatigue or differ in dimensionality, which leads to limited reliability and validity testing. CONCLUSIONS: All of the instruments in this review need further study of their psychometric properties. Qualitative studies of CRF from the patients' perspective are needed to develop better instruments. IMPLICATIONS FOR NURSING PRACTICE: Nurses need to increase their knowledge of assessing CRF to intervene and improve the quality of life for patients with cancer.
The purpose of this study was to analyze written communications among nurses providing care to battered women and their children in a community shelter setting over a 1-year period of time. Interviews were conducted with the nurses to study the perceived effectiveness of the manual used to update daily shelter health operations, clients of concern, follow-up recommendations, or other ongoing issues. The unit of analysis was each entry recorded in the manual. The Communications Process Model guided the study (Budd, Thorp, & Donohew, 1967). Communications were transcribed and analyzed for categories of meaning from the data utilizing the Ethnograph software (Seidel & Clark, 1983). When content analysis was applied, 10 distinct categories emerged: (a) injury assessment, (b) acute condition assessment, (c) chronic condition assessment, (d) pregnancy assessment, (e) emergency assessment, (f) nursing care and procedures, (g) teaching and counseling, (h) community referrals and resources, (i) housekeeping, and (j) health program issues. From the categories, 3 primary themes were identified: nursing assessments, nursing interventions, and health program operations. The nurses were positive about using the manual for various communications. Nurses who consider working in shelter settings may find descriptions of the realities of practice and application of a working tool for communications useful. Shelter administrators and board members need to recognize the importance of having nurses on staff to address inevitable injuries and health concerns of battered women and their children. Researchers are encouraged to develop models that relate to care of clients and caregivers in this challenging practice setting.
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Insight is a complex phenomenon which has been conceptualized variously as a symptom of schizophrenia and as awareness of illness, making comparisons of studies measuring insight difficult. Furthermore, attempts to establish a correlation between insight and successful treatment outcomes are fraught with methodological problems. Specifically, categorical judgments fail to capture important information about the quality of insight; inappropriate inferential statistics have been used; and validity of instruments to measure insight has not been established. In future research, the concept of insight needs to be clarified. Nonparametric statistical analysis should be considered for small, nonnormally distributed samples. Qualitative exploratory research is needed.
BACKGROUND: Poor morale and high levels of stress among general practitioners (GPs) are causing concern. Little research has previously been carried out to study possible differences in morale and stress between GPs working in two different but geographically similar health care systems. AIM: To compare perceived levels of stress and morale between GPs working in two different health care systems--one having a state monopoly (Northern Ireland) and the other having mixed private and state funding (Republic of Ireland)--and to look for factors that might help explain any differences in stress levels and morale between the two systems. METHOD: Anonymous and confidential questionnaires were sent to all 986 National Health Service (NHS) GPs in Northern Ireland (NI) and a random sample of 900 GPs in the Republic of Ireland (ROI). A common set of core questions on demographic details, partners and work patterns, perceived levels of stress and morale, safety, violence, and complaints were asked. RESULTS: Response rates were high in both areas: 91% in NI and 78% in the ROI. GPs in NI had significantly higher stress levels and significantly lower levels of morale than GPs in the ROI. The NI sample expect matters to get worse over the following year. Doctors in the ROI were more likely to be single handed and to work from two sites. Also, more GPs in ROI had fears for their safety and had been the subject of physical violence, but fewer had received complaints and medico-legal actions than in NI. CONCLUSIONS: A significant proportion of both groups of doctors report feeling highly stressed but GPs in NI appear more unhappy and have a poorer outlook for the future. It is suggested that the structure, management, and expectations of the NHS have taken a severe toll on its GPs, whereas a system in which doctors have less practice support but more control is good for morale.
For the purpose of defining the specialty of vascular nursing, a survey was sent to the nursing membership of the Society for Vascular Nursing. Nurses in all geographic locations were included, and the survey was accompanied by a self-addressed, stamped return envelope. A total of 873 nurses were surveyed. Respondents were encouraged to give the survey to other vascular nurses who were not members of the Society for Vascular Nursing. The initial mailing resulted in 276 responses. A second mailing provided an additional 224 responses for a total response of 500. Fifty-six of the 500 respondents (11.2%) were nonmembers. Response rate of members was 50.9% (444 of 873). Demographic information was obtained regarding age, years in nursing and vascular nursing, sex, employment type, and location. In addition to demographic information, the survey asked the respondent to identify a definition or definitions of vascular nursing. There was no restriction on space or content. In a small pilot study, "defining the specialty" was the only question asked. However, on the basis of responses to the pilot, the form was refined to request a description of the skills necessary to be a vascular nurse. A total of 73 definitions were identified on the basis of coded responses. The range in number of definitions given on any survey was 0 to 13. Essential skills listed by any one respondent ranged in number from 0 to 14. A total of 90 skills were identified. The purpose of this study is to identify the definitions of vascular nursing given by vascular nurses. In addition, the skills identified as necessary will be elaborated on.(ABSTRACT TRUNCATED AT 250 WORDS)
Although nurses may have the necessary skills to plan care of clients in a variety of settings, experience and research demonstrate that nursing interventions with women victims of violence have been consistently inadequate. Of the 243 nursing students included in this study, 8% reported experiencing physical abuse, and 18.9% reported experiencing nonphysical abuse. Difficulties with depression for 26.1% of the students and some level of clinical stress were reported in over half of the group. Specific needs to combat violence and abuse against nurses and nursing students include providing better information on such behavior by incorporating family-violence education into nursing-school curricula, and using this proactively in confronting domestic violence in home and work settings.
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Data from a 1989 survey using the condom attitude and belief instrument with 310 clients from two sexually transmitted disease clinics identified significant social referents who influence condom-use intentions. They are sexual partner, father and friends. The present study found that communication with these referents had a positive net effect on beliefs about and intentions to use condoms. Implications applicable for intervention programmes to increase condom use are to promote talking about condoms between the sexual partners and important social referents and to develop such communication skills.
Factors that foster sibling involvement with the newborn and the early stages of the attachment process were cited by key experts: Brazelton and Kennell viewed organization as an essential component of any successful sibling involvement program; Rait and Barnard saw recognition of siblings' needs as vital in any effort to help them process the entire experience; and Consolvo recognized attitudinal issues as playing a key role in implementing and accepting sibling involvement. The interviews with the head nurses identified some common themes within their unique programs that centered around families, the NICU atmosphere, and the promotion of sibling activities. A liberal visiting policy was recognized in all the units, promoting the concept of family-centered care and allowing parents, siblings, and grandparents the opportunity to be supportive together. The flip side of having such a liberal visitation program was the sibling's exposure to a noisy, hurried atmosphere and parents' high anxiety level and the staff's concern about the preterm infant being subjected to a noisier, brighter, more stressful environment and possible exposure to infectious disease. The promotion of sibling activities was a recurring theme in all the head nurse interviews. Examples varied from unit to unit, but the implementation of growth and development principles, along with creativity and innovation, indicated that the overall efforts of these units in promoting sibling involvement was commendable.
1. A group of psychiatric inpatients followed plans to participate in leisure activities after discharge at significantly higher levels when treated with classes and written contracts; or classes, written contracts, and musical entertainment; rather than with classes alone. 2. Inpatient classes for psychiatric patients should be coupled with other interventions, such as contracts or musical entertainment, to assist patients to attain therapeutic goals after discharge. 3. The utilization of written goal-setting contracts seems to have merit as a routine nursing intervention with psychiatric inpatients. 4. The use of a written contract left with the patient may promote or enhance a nurse/patient transaction.
Three methods of recording mother-child interaction were compared in a sample of 136 adolescent mothers with children ranging in age from 8 to 27 months. Mother-child interaction was rated during in-home observations using Barnard's Teaching Scale, Schaefer's Attachment Inventory, and Clarke-Stewart's Rating Scales. The results indicate that each measure complements the other two, and that their interrelationships support the validity of the dimensions each describes. Yet, analyses indicate that they do not share common underlying factors. The findings suggest that each measure contributes to a more complete description of mother-child interaction.
An analysis of patient records in four different DRG categories estimated direct nursing care requirements. The evaluation of these results showed a great range in direct hours of nursing care, as well as resultant cost of nursing care within and among the DRG categories. Nursing resource use is widely fluctuating based on acuity levels, length of stay, and DRG category. Thus, it was concluded the variables inherent in a model to predict cost rely on determinants of the functional needs of the individual patient.
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