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PubMed1989

New developments in international nursing ethics.

This article has described numerous activities in nursing ethics at international levels. It acknowledges the larger context within which nurses practice by focusing on selected issues involved in resource allocation and death and dying, cross-culturally. The questions raised about universally shared moral principles reflects the larger questions of cultural and ethical relativism. The discussions of new developments in international nursing ethics focuses on international conferences, the teaching of nursing ethics, national nursing associations, and other professional groups that are actively involved in health care or nursing ethics. Finally, the development of international nursing ethics research studies is providing new knowledge about the scope of ethics within nursing and the nature of nursing care worldwide. Nurses are involved in some aspects of these new developments in nursing ethics in all countries. As they examine and reflect on ethical principles, virtues, and on an ethics of caring, they bring a new dimension to their work as nurses. This new dimension stands as one of the oldest and most central foundations in professional nursing.

Advisory Committees↗
PubMed2001

Hospice care and patients' pain: communication between patients, relatives, nurses and doctors.

This article describes a study that sought to assess how patients, relatives, doctors and nurses in a palliative care unit viewed pain and pain management, and how standards and expectations for pain relief can be raised by upholding statements of care and agreed partnership values. The results showed that research-based pain management enables the provision of pain control that is acceptable to patients, relatives, doctors and nurses. By valuing patient-centred care, where assessment tools assist communication and information sharing, a partnership of care is established in which patient and professional autonomy are recognized and respected, international recommendations for pain relief are practised and professional codes of conduct upheld. Good pain management requires accurate assessment that is best achieved by open and honest discussion in a supportive environment. Hospices provide specialist symptom control aimed at improving quality of life for patients with advanced disease. They are not only an ideal setting to provide evidence for practice, but also a learning environment for specialist understanding of symptom control and a resource base for other professionals.

Attitude of Health Personnel↗
PubMed1990

Nursing research in the United States: the protection of human subjects.

In the United States the protection of the rights of human subjects in experimentation has evolved at three levels: professional, public, and private. At the professional level, codes, guidelines and the Patient's Bill of Rights address the issues of protecting the dignity, privacy and autonomy of individuals who serve as research subjects. At the public level, regulations promulgated by the Food and Drug Administration and the Department of Health and Human Services have become the standard for protecting human subjects. At the private level, United States common law regulates the conduct of individual researchers by requiring them to act in a manner consistent with generally accepted standards of care. As professionals, nurses must be actively involved in the formation of public policy regarding the conduct of research and strive to formulate a research agenda that will ensure that the ethics of research in nursing is above question.

Codes of Ethics↗
PubMedDate not supplied

Applying technology today. A computerized nursing recruitment database.

This article describes the development and implementation of a computerized nursing recruitment program. This system offers a fast, efficient, individualized, item-selectable mechanism for tracking and monitoring recruiting activities. Included in this system are easily accessible functions that provide precise information regarding the activities and costs relating to recruitment transactions. It is user-focused and coded for accurate storage and retrieval of information. This program has multiple implications for improving or revising recruitment activities. Nursing administrators can obtain detailed reports of the operations of the recruiting office, and internal audits can be easily generated to identify areas of efficiency as well as areas needing revision. It is written to be integrated with other management systems, thus providing a rapid and comprehensive network of communication that is cost-effective and precise.

Humans↗
PubMed2005

Changes in the utilization of diagnostic codes in neonatology following the introduction of activity-based financing.

Activity-based financing was introduced in public hospitals in Norway in 1997. Following this, hospitals have been financed in part by block grants, in part by grants based on productivity as measured through weighted diagnosis-related groups (DRGs). Insufficient national data were available to allow for proper calculation of DRG weights for neonatology. Thus, data from other countries were used to estimate weights. It seemed of interest to examine whether the use of diagnostic codes in neonatal medicine was changed following the introduction of activity-based financing and DRGs. Data from 1994, 1996, 1998, and 2000 were obtained from the proprietary database of the NICU at Rikshospitalet, University of Oslo, as well as from the hospital Patient Information Management System. Diagnoses were organized into 39 categories, counted for each of the 4 years, and analyzed by non-parametric ANOVA. There were significant changes in the use of diagnostic categories during the 1994-2000 time period. Some diagnoses which previously have been only rarely used, became more frequent. The use of other diagnoses varied in ways that could only be understood in terms of tactical usage. It is concluded that the use of DRGs as a basis for activity-based financing may result in changes in the use of certain diagnostic categories which are not related to biological changes in the patient population. This may complicate epidemiological research. On the other hand, activity-based financing may result in increased attention to the diagnostic process, leading to increased use of secondary diagnoses and thus more complete diagnostic coding.

Diagnosis-Related Groups↗
PubMed1993

[Use of psychotropic drugs in a group of nursing home patients with dementia: many users, long-term use but low dosages].

Of 890 nursing home patients with dementia, admitted between 1980 en 1989 to Dutch nursing home 'Joachim en Anna' in Nijmegen, each episode of psychotropic drug use was retrospectively registered. Drugs were coded by means of the Anatomical Therapeutic Chemical (ATC)-classification system and the daily dose was expressed as the ratio of the prescribed daily dose and the internationally agreed defined daily dose. Side effects were analysed as were changes in prescription patterns throughout the years of patient admittance. A total of 3090 episodes were registered. Neuroleptics, benzodiazepines and antidepressants accounted for 58, 32 and 9% of the prescriptions. In almost every drug-prescription the prescribed daily dose was lower than the defined daily dose. More than 75% of the patients had at least one prescription for a psychotropic drug during institutionalization. Half of those patients who used a neuroleptic showed one or more side effects. Neither the total amount of patients with psychotropics nor the duration of usage changed throughout the years of patient admittance. It is concluded that a majority of these nursing home patients got at least one prescription of a psychotropic drug during institutionalization. Psychotropics were prescribed for long-term usage, but in low doses. Side effects were frequently observed in determining the right dose.

Aged↗
PubMed2004

Benzodiazepine use and hip fractures in the elderly: who is at greatest risk?

BACKGROUND: It remains unclear whether benzodiazepine use increases hip fracture incidence. We studied this relationship in a large cohort, controlling for multiple potential confounders. METHODS: We analyzed 42 months of New Jersey Medicaid health care claims data for all enrollees. Each eligible person-day was assigned to categories of benzodiazepine exposure and categories of other predictors, based on prior and current medication dispensing and diagnosis information. Hip fractures were identified based on hospital claims with primary discharge diagnosis International Classification of Diseases, Ninth Revision (ICD-9) codes 820.xx. RESULTS: Cohort members (n = 125 203) contributed 194 071 person-years and had 2312 eligible hip fractures. After adjustment for age, sex, race, Medicaid nursing home residence, exposure to other psychoactive medications, including antiparkinsonian medications, diagnoses of epilepsy and dementia, and hospitalization in the previous 6 months, the incidence rate of hip fracture was significantly higher compared with no benzodiazepine use for exposure to any benzodiazepine (incidence rate ratio [IRR], 1.24; 95% confidence interval [CI], 1.06-1.44), to a short half-life, high-potency benzodiazepine (IRR, 1.27; 95% CI, 1.01-1.59), during the first 2 weeks after starting a benzodiazepine (IRR, 2.05; 95% CI, 1.28-3.28), during the second 2 weeks after starting a benzodiazepine (IRR, 1.88; 95% CI, 1.15-3.07), and for continued use (IRR, 1.18; 95% CI, 1.03-1.35). CONCLUSIONS: The incidence of hip fracture appears to be associated with benzodiazepine use. Contrary to several previous studies, short half-life benzodiazepines are not safer than long half-life benzodiazepines. Hip fracture risk is highest during the first 2 weeks after starting a benzodiazepine and declines thereafter.

Aged↗
PubMed1992

[The research process in grounded theory: some examples of nursing education and nursing practice research].

The purpose of this paper is to describe the grounded theory method; especially of the research process in studies using the method. The article is based on the examples of authors' studies of nursing education and nursing practice. The grounded theory method is qualitative and inductive, analyzing data from the empirical world, from which categories and concepts are emerged. Analysis is made by coding and memorizing. The emerging categories will be structured, restructured and developed continually during the research process. In the final theory the concepts, the relationships between them and their internal and external differences are defined in the social process. The meaning of a good description of the research process is emphasized, because the evaluation of the research studies using grounded theory method are based on well documented research process.

Models, Nursing↗
PubMed2001

[Evaluation and improvement of medical and nursing service and caregiving for the elderly using MDS. 3. Revised recording system of diagnoses and symptoms suitable for use in Japan].

Diagnoses and symptoms are recorded by physicians in the chapter E of the Minimum Data Set (MDS), if they are relevant to disabilities of activities of daily living, cognition, behavior, medical treatments or risk of death. We improved the chapter so that it is suited to disease patterns in Japan in a format useful not only for nursing and ADL care but for medical treatment in our practice. In E1, diseases directly underlying the current disability states were recorded in the international classification of Disease, 9th Revision (ICD9). In 24, 670, 195, and 45 patients respectively, there were 0, 1, 2, and 3 separate recorded diseases. A Total of 63 ICD9 codes were observed, but only four codes; 290, 332, 431, and 434, were underlying diseases for 3% or more patients. These codes included mostly ischemic and degenerative disease of the brain.

Aged↗
PubMed1999

A discussion of the legal aspects of female genital mutilation.

The purpose of this paper is to examine the position of the nurse/midwife in the United Kingdom when involved with the care of a woman or female child who has suffered genital mutilation, which is an illegal practice in this country and most other areas of the world. The types of circumcision commonly practised are introduced, the prevalent reasons for the continuation of the practice among certain ethnic groups are presented, and the range of issues to be considered by the nurse is examined. These include international and national legal aspects which do not exist in isolation and are considered in context with cultural, medical, human rights and gender issues. Nursing legal issues include child protection, consent, advocacy and confidentiality, which invoke the Code Of Professional Conduct of the United Kingdom Central Council for Nursing Midwifery & Health Visiting. Midwives and nurses working in the field of gynaecology have raised questions regarding possible courses of action to take when presented with this issue. Increased knowledge can help to inform those decisions. Therefore, implications for future practice are addressed, together with recommendations to assist nurses with decision making when faced with this scenario in the future.

Adolescent↗
PubMed1997

In defence of patient/person human rights within national health care provision: implications for British nursing.

One cannot fail to be aware of the 'human rights' that are vividly thrust into our living rooms by the world's media; but, what are human rights and are they of relevance to British nursing practice? In a democratic state such as the UK, human rights infringements or violations are not typified as occurring in a health care system outwardly appearing to safeguard the interests of the patient/person. This paper examines some of the issues and concludes that the notion of human rights remains inconspicuous and peripheral to the 'real world' of clinical nursing practice. It challenges British nurses to reflect on their practice and outwardly demonstrate that nursing's contemporary language of human rights does not remain simply rhetorical in nature.

Dissent and Disputes↗
PubMed2004

The Acute Stroke Unit at Middlemore Hospital: an evaluation in its first year of operation.

AIM: Despite strong evidence of benefit, few stroke units exist in New Zealand. In this paper, we describe the process and outcome for the country's first, comprehensive Acute Stroke Unit (ASU), established at Middlemore Hospital in 2001. METHODS: The evaluation comprised: (a) two independent 'before and after' audits of medical records of a random selection of patients (2 x n=100) identified from Diagnostic Related Group (DRG) discharge codes for stroke in 1999 (12 months) and 2001-02 (9 months); (b) a review of all DRG stroke outcome data and internal cost analyses for the study periods; and (c) a 'time-in-motion' study of nursing care requirements. RESULTS: The DRG data showed an increase in separations (538 vs 613); stable re-admissions (8% vs 7%); and declines in average length of stay (6.1 vs 5.4 days), deaths (14.0% vs 8.8%), and referrals for rehabilitation (127 vs 67); while the audit indicated shorter times from admission to brain imaging, and swallow and allied health assessments, for stroke f rom 1999 to 2001-02. A 1:4 nurse:patient ratio seems to provide an optimum level of care for costs. CONCLUSIONS: The introduction of the ASU has been associated with improvements in several key indicators of quality of care for patients with stroke.

Adult↗
PubMed2003

The classification systems of nursing practice--the historical and practical perspective.

The contribution into activities connected with the development of the quality of nursing care is closely combined with the process of systematic recording of accumulated data, of undertaken activities and achieved results. This in turn constitutes the essence of the 31st Aim of WHO which speaks not only about the need to continue the rational contribution towards the increase in the nursing care quality but also the application of adequate computer technologies to improve this quality. The aim of this work is to demonstrate the scope and character of the activities that have been over years undertaken by the nursing community towards the development of the classification systems which are comparable with those used in medicine. The focus has been specifically put on the taxonomy of diagnosis used by the North American Nursing Diagnosis Association (NANDA) and the European International Classification of Nursing Practice (ICNP). The analysis of the reference sources constitutes the methodological foundation applied in this work. It has allowed to show the pioneering contribution of the American Nursing Association (ANA) into the process of recording and coding of the data that are essential in care delivery as well as their value for the development of ICNP. The latter one is a systematic and multi-axial structure which uses unified terminology and numeric codes for the three categories of variables: the recognized conditions, the undertaken activities and the achieved results.

Classification↗