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PubMed1998

Racism and its implications in ethical-moral reasoning in nursing practice: a tentative approach to a largely unexplored topic.

Nursing as a profession seems to avoid considering the problem of racism. There is, however, a need to address this topic and to evaluate its implications for nursing practice. This article attempts to establish a rationale for nursing to address racism and introduce it into academic discourse. The results of a small-scale study by the author are analysed and the implications for ethical-moral reasoning in nursing practice are discussed in relation to professional codes of conduct developed by nurses' professional organizations in the UK and elsewhere.

Conflict, Psychological↗
PubMed1998

Factors affecting practice nurse involvement in follow-up care of patients following myocardial infarction.

BACKGROUND: Preventive care can reduce the morbidity and mortality of patients following myocardial infarction. Recent evidence has shown that such care is not being provided effectively. The involvement of practice nurses has been proposed as a means of improving the completeness of follow-up and the quality of preventive care. OBJECTIVES: We aimed to determine the extent to which follow-up care for people discharged from hospital after a myocardial infarction is currently being undertaken by practice nurses and to assess the factors influencing the provision of such care and the nurses' attitudes towards this extended role. METHOD: Postal questionnaires were sent to 183 practice nurses working in general practices in the Southampton and South-West Hampshire Health District; 121 nurses responded (66%), representing 58 out of 64 practices surveyed (91%). RESULTS: The majority of responding practice nurses (55%, 95% CI 47-64%) had hospital experience of caring for patients with ischaemic heart disease, and most (83%, 95% CI 76-89%) believed that they played a key role in follow-up care of patients following myocardial infarction. In the absence of external support from a cardiac liaison nurse, few nurses (26%, 95% CI 16-41%) provide such care at present and only 21% work in practices with a register of myocardial infarction patients. Factors predicting the provision of follow-up care are having adequate time (odds ratio 4.59, 95% CI 1.66-12.7), the support of a cardiac liaison nurse (odds ratio 3.07, 95% CI 1.28-7.34) and GP colleagues (odds ratio 3.38, 95% CI 1.38-8.23), training in consultation skills (odds ratio 7.25, 95% CI 2.08-25.3), fundholding (odds ratio 3.11, 95% CI 1.26-7.69) and the confidence and knowledge of the practice nurse (odds ratios and 95% CIs respectively: 2.84, 1.18-6.83 and 2.80, 1.13-6.89). CONCLUSION: Most practice nurses are enthusiastic and have some of the necessary experience to provide follow-up care for patients who have experienced a myocardial infarction. Yet few currently provide it. The most important organizational incentives for providing such care are further training and the support of GPs and the cardiac liaison nurse.

Adult↗
PubMed2000

Congruence of terms between lists of problems and the ICNP--Alpha Version. International Classification for Nursing Practice.

The International Classification for Nursing Practice (ICNP)--Alpha Version, is the first rendition of the International Council of Nurses (ICN) efforts to develop a standardized international nursing language system. This system has three principal components: nursing phenomena; nursing actions; and nursing outcomes. This article describes a study of agreements between terms used by nurses of the intensive care unit at the Hospital of the University of Sao Paulo, to designate patients' nursing problems and the terms proposed by the ICNP--Alpha Version. The records of 59 interned patients, admitted to the intensive therapy unit, were analysed for nursing problems. Of 336 problem categories listed by the nurses, 153 (45.5%) corresponded to the ICNP terms. The 183 categories of problems that did not correspond to the ICNP terms were categorized by the authors as the following: medical diagnoses (37.2%); signs (28.4%); interventions (26.2%); and historical data (8.2%). These results show that there may be no agreement between the concept of nursing phenomena for the ICNP and of nursing problems for the nurses whose records were analysed. Considering that medical diagnoses, intervention and historical data could not be accepted as nursing phenomena for the ICNP, the agreement is potentially higher than 45.5%.

Humans↗
PubMed1995

Advanced nursing practice: legal concerns.

Empowerment of nurses in advanced nursing practice begins with an understanding of the current legal status of the advanced nurse practitioner. True empowerment will not occur until the reform regulations needed to expand the role of the advanced nurse practitioner is understood by nurses and measures are taken to begin such reform. In this article, the author reviews the current legal status of advanced nurse practitioners, while projecting the needed reforms that must occur across the country. The aim is to help advanced nurse practitioners undertake measures to ensure that legal empowerment for themselves becomes a reality.

Health Care Reform↗
PubMedDate not supplied

Investigation: basis for nursing practice.

The term evidence based nursing signifies a systematic process of search, assessment and application of the most up-to-date investigation for decision taking. In practice the process can be applied in four steps: formulation of the question, a search of the bibliography, a critical analysis of the validity of the results, and putting the obtained findings into practice. Nursing practise must be based on the best available scientific results. Professional nurses are more accustomed to acting according to tradition with scarce scientific rigour. It is necessary to introduce investigation as an instrument to allow resolution of problems with practice and to offer the best possible care alternative. The evidence contributed by investigation is evaluated according to criteria of validity and utility. There are several scales to assess the methodological rigour of investigation studies as well as to recommend a practice or technique as appropriate, or not, according to the scientific evidence available.

Databases, Bibliographic↗
PubMed1994

'It's the little things that count': the hidden complexity of everyday clinical nursing practice.

This article reports on one aspect of a phenomenological study of everyday experience in nursing and how it contributes to the development of nursing expertise. The study was carried out with 10 'excellent, experienced' surgical ward sisters in two Scottish teaching hospitals. The ward sisters were found to help individual patients towards recovery by making the ward work for all. When moment-by-moment nursing practice, the context of nursing experience, is examined, it is found to be patient-centred and complex, geared towards multilayered goals. Three distinct yet inextricably intertwined processes--noticing, understanding and acting--characterize how nurses practise nursing. The quality of these processes contributes to the effectiveness of nurses' caring practices. The 'little things' of nursing practice make a difference to patients because they are imbued with nursing knowledge and skill.

Humans↗
PubMed1988

The norms and values held by three groups of nurses concerning psychosocial nursing practice.

Research findings indicate that nurses often fail to provide patients with supportive psychosocial nursing care. The reasons for this and the norms and values on which nursing practice is predicated are unknown. The norms and values of three similar groups of nurses concerning psychosocial nursing care were inferred from observation and analysis of the nurses' interactions with each other, with other hospital personnel and with patients. Each group was observed for 5-7 weeks while working on one of three selected medical floors in the same hospital. Each group of nurses had norms and values which were discernable in typical behavior patterns, characteristics, explicit and implicit expectations, orientations, beliefs and attitudes. Two head nurses greatly influenced selection and enforcement of their groups' norms and values. The third group had not developed work-oriented norms and values. Nurses did not usually collaborate with other health-care professionals in the interests of their patients. The head nurses performed this function for each group. All nurses demonstrated knowledge of psychosocial nursing concepts but patient care was usually limited to physical nursing care, giving medications and meeting patients' verbally expressed requests for assistance. Nurses did not respond to or seem to notice patients' non-verbal or incoherent distress. They referred patients who exhibited disruptive behavior to other health professionals without delay. Patients who did not require physical nursing care had little opportunity for interaction with nurses. All three groups had work schedules which facilitated the typical style of nurse-patient interaction on each unit. These interactions were: cool, efficient and rushed on one unit; casual, warm and somewhat superficial on the second unit; brusque and business-like on the third unit. Nurses used social/moral assessment of patients which was facilitated by nurses telling each other anecdotes concerning patients. These anecdotes facilitated one group's typical humane, and two groups' typical dehumanizing nurse-patient interactions. The researcher concluded that group dynamics require consideration when planning nursing care delivery systems and that nurses need to develop pragmatic, supportive, psychosocial nursing interventions.

Adult↗
PubMed2006

Hospital demand for licensed practical nurses.

Despite evidence that hospital use of licensed practical nurses (LPNs) declined in the 1990s, the current registered nurse (RN) shortage has prompted interest in LPNs as substitutes for RNs. Hospitals, being the dominant employer of RNs, have an economic incentive to use less expensive LPNs as substitutes. Beside wages, there are several forces underlying hospital demand for LPNs. In this article, the authors model and estimate hospital demand for LPNs as a function of nurse wages and hospital, market, and patient characteristics using a longitudinal data set of short-term general hospitals in the United States. The authors find evidence that higher RN wages increase hospital demand for LPNs, both in levels and relative to RNs, suggesting that hospitals at least partially substitute RNs with LPNs.

Employment↗
PubMed1995

Communication standards: impact on nursing practice.

1. BACKGROUND INFORMATION. In order to meet the demands of processing large amounts of data, hospitals must look to innovative methods of information handling. One new method currently in use is the computerized patient record (CPR) (Dick & Steen, 1991). To successfully implement the CPR, many factors must be considered, including: (a) the fact that the database is dependent upon several different departments and resources for information; (b) the information needs of each department differs, making selection of a single information system that encompasses all users' needs difficult; and (c) operating systems may be incompatible, hampering the process of networking and exchanging, processing, and retrieving data in an integrated manner. Yet the integration of systems is central to the successful development of the CPR. 2. PURPOSE. Establishment of communication standards for health care promotes the effective integration of patient information across various computer systems (McDonald, 1990). To achieve this level of automation, standard organizations must unite in the development and implementation of communication standards for health care. This poster will explore: (a) data on communication standards; (b) the process of reaching standards; (c) established communication standards; and (d) the impact of communication standards on nursing practice. In addition, we will present a model for an integrated patient focused system of the future. Today, communication standards continue to evolve in health care. Many professional organizations share the goal of developing communication standards between clinical systems (McDonald, 1990). Standards to be explored in this poster include: the American Society for Testing and Materials (ASTM), the Medical Data Interchange Standard (MEDIX), the Medical Information Bus (MIB), and Health Level (HL7). Evolving standards will define protocols and procedures for the effective exchange of easy integration of information systems. Once standards are established for health care, society will benefit from the ability to: (a) compare health care costs; (b) measure the effectiveness of treatment; and (c) provide clinicians with comprehensive patient information (Rishel, 1992). 3. IMPLICATIONS. There is very little in existing literature and research studies on the impact of communication standards on nursing practice. Nurse researchers willing to assume the challenge of conducting studies on the impact of communication standards on nursing practice will forge new territory. Implications for nursing from the development of communication standards include: (a) increased productivity, (b) definition of a clinical data set, (c) improved quality patient care, and (d) easier system implementations.

Humans↗
PubMedDate not supplied

The context & clinical evidence for common nursing practices during labor.

The purpose of this article is to review the context and current evidence for common nursing care practices during labor and birth. Although many nursing interventions during labor and birth are based on physician orders, there are a number of care processes that are mainly within the realm of nursing practice. In many cases, particularly in community hospitals, routine physician orders for intrapartum care provide wide latitude for nurses in how they ultimately carry out those orders. An important consideration of common nursing practices during labor is the context or practice model in which those practices occur. Nursing practice is not the same in all clinical environments. Intrapartum nursing practice consists of an assortment of different roles depending on the circumstances, hospital setting, and context in which it takes place. A variety of intrapartum nursing practice models have evolved as a result and in response to the range of sizes, locations, and provider practice styles found in hospitals providing obstetric services. A summary of intrapartum nursing models is presented. The evidence is reviewed for the three most common clinical practices for which nurses have primary responsibility in most settings and that comprise the majority of their time in caring for women during labor: (1) maternal-fetal assessment, (2) management of oxytocin infusions, and (3) second-stage care. Evidence exists for these nursing interventions that can be used to promote maternal-fetal well-being, minimize risk, and enhance patient safety.

Clinical Nursing Research↗
PubMed2004

A pocket full of knowing--enhancing nursing practice with handheld computers.

PERIOPERATIVE NURSES are using high-tech, pocket-sized, handheld computers to perform a variety of functions and enhance nursing practice. THIS ARTICLE GIVES an introduction to handheld technology and provides feature and cost comparisons. NURSES CAN USE built-in programs to keep procedure notes, pertinent telephone numbers, and a calendar. Optional reference programs of interest to health care workers number in the hundreds.

Computer Security↗
PubMed2000

Comparing the effects of stress and relationship style on student and practicing nurse anesthetists.

Stress in the workplace can be extremely detrimental. It has been estimated that stress-related outcomes cost organizations $50 billion to $75 billion per year. These costs are realized in the form of decreased productivity, increased absenteeism, and increased job turnover. Excessive stress in the healthcare professional can lead to burnout. A purpose of the present study was to compare and contrast stress levels between practicing nurse anesthetists and those in training. The study also sought to determine if communication was adversely affected by stress and by the style nurse anesthetists chose in relating to others. Style can be defined as any identifiable pattern of relating to others one follows to reach one's goals. Sixty-six student nurse anesthetists and 15 practicing nurse anesthetists participated in the study for a total of 81 participants. All participants were administered the Occupational Stress Inventory, the Strength Deployment Inventory, and the Interpersonal Communication Inventory. Significant findings included: (1) second-year students experienced the greatest amount of stress, (2) practicing nurse anesthetists have more coping resources than student nurse anesthetists, (3) of the 4 relationship styles available, the altruistic/nurturing and the analytic/autonomizing are the styles of relating to others used most often by student and practicing nurse anesthetists, (4) nurse anesthetists with high stress levels communicated less effectively than nurse anesthetists with low stress levels, and (5) nurse anesthetists communicated less effectively when using the altruistic/nurturing style compared with the analytic/autonomizing style.

Adaptation, Psychological↗
PubMedDate not supplied

Nursing diagnosis in the International Classification for Nursing Practice (ICNP).

TOPIC: International Classification for Nursing Practice (ICNP) Classification of Nursing Phenomena. PURPOSE: Provide a historical review of nursing diagnosis in the developing ICNP. SOURCES: Literature, meeting notes, and experience. CONCLUSION: The development of the ICNP has benefited from contributions of many. Continued refinement depends on participation of nurses globally.

Congresses as Topic↗
PubMed2000

Ethics of case management: implications for advanced practice nursing.

The healthcare system is under pressure to provide quality care with less money for a growing and aging populace, and the resulting changes in the system could pose ethical problems for advanced practice nurses. Expanding healthcare needs, the increased use of technology, and dwindling resources all place burdens on advanced practice nurses, who have taken on the role of case manager in an attempt to reduce costs, meet patient outcomes, and provide improved, personalized, high-quality care. This paper explores the ethical concerns that can arise from managed care delivery systems and discusses the role of advanced practice nurses as case managers and the possible implications for nursing practice and research.

Case Management↗
PubMedDate not supplied

What are the factors that influence learning in relation to nursing practice?

Although ongoing education is an expectation of all nurses in today's climate of increasing technology and patient acuity, little is known about the attitudes, beliefs, and values of the general staff nurse toward on-the-job learning. The authors detail the factors that influence the learning ability of nurses on general medical-surgical units in a teaching hospital in relation to their nursing practice. Findings of what promotes learning, what interferes with learning, and how learning is integrated into nursing practice are outlined. Implications for the future are discussed.

Education, Nursing, Continuing↗
PubMedDate not supplied

Developing advanced nursing practice roles in cancer care.

Nurses in cancer care have been at the forefront of developing advanced nursing practice, however there has not been national agreement in relation to the education and clinical skills required for this practice. Work is under way by the NMC to develop a regulated framework for the standard for post-registration nursing.

Clinical Competence↗
PubMed1996

Information system support of changes in health care and nursing practice.

The practice of nursing is changing in response to changes in health care. An effective information system can support nursing's need to streamline the process of documentation, move to standards-based practice, access standards and other reference material, and access data and information to make clinical and management decisions. Nurses will increasingly rely on information systems to provide them with the critical data and information they need to make decisions about patient care, management of the care team, efficient resource utilization, and best practice standards.

Decision Support Techniques↗