Nursing administrative process. A patient tool in the therapeutic community.
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Humans↗
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Can we solve current problems with nursing information systems?
Dutch nurses are confronted with health care information systems quite often. However, they do not take full advantage of electronic support for their care activities and professional development. The nursing process is often considered the core of nursing care delivery and guides the documentation of care. Currently, this process can be supported electronically. However, the actual use of nursing information systems (NISs) in the Netherlands is limited to a few sites. Therefore, it is timely to analyse the problems that exist in the development and use of NISs and to look for solutions to solve them. This paper proposes both the nursing information reference model (NIRM), and structured discussions for a proper course of action in the development and use of NISs.
Database Management Systems↗
Am I still ethical? The socially-mediated process of nurses' moral identity.
In a recent, currently unpublished, research project that sought to examine the meaning and enactment of ethical nursing practice across a variety of clinical settings, the significance of moral identity was highlighted. This article describes the findings and illuminates how the moral identities of the nurse participants arose and evolved as they navigated their way through the contextual and systemic forces that shaped the moral situations of their practice. The study revealed the socially-mediated process of identity development and the narrative, dialogical, relational and contextual nature of nurses' moral identities.
Attitude of Health Personnel↗
Towards basic nursing information in patient records.
Four key concepts for good nursing care and a list of key words for nursing documentation in patient records were established and to some extent tried in clinical practice in Sweden. The method consisted of the following steps: extensive literature review, review of nursing records, development of a list of key words on two levels, a first level corresponding to the nursing process, and a second level consisting of subdivisions for possible use in practice, use and assessment in clinical practice by nurses and students, expert panel judgement and refinement of the key words including an examination of semantic accuracy of the Swedish key words by an expert in Nordic languages. The proposed key words are presented both in English and Swedish and explanations, comments and references are given. The version of key words presented here is subject to further testing for possible modifications.
Documentation↗
The value of clinical pathways in home care.
Providing cost-effective, high-quality care can pose a challenge in this era of managed care. One agency successfully established and implemented multidisciplinary teams to organize and optimize care. Two case studies compare the nursing process of traditional versus well-managed care and show that clinical pathways can be effective tools to enhance the nursing process in home care.
Cost-Benefit Analysis↗
An integrative review of ambulatory postanesthesia nursing patient outcome research: 1982 to 1993.
Specialty nursing practice tends to define itself by a set of competencies believed to be essential by the practitioner. A specialty practice is rarely the result of patient outcome research. Although nurses have been caring for postoperative patients since the early 1900s, a review of published ambulatory postanesthesia patient outcome nursing research has not been reported. As part of a larger study, an integrative review of ambulatory postanesthesia research was conducted to investigate adherence to the scientific method and to examine whether reported research findings link nursing process with patient outcome. Data were collected from identified ambulatory postanesthesia research studies published between 1982 and 1993. The tables of contents from 16 nursing journals were examined to identify published studies. The sample for the integrative review consisted of 28 studies meeting inclusion criteria. Data from the 28 studies were collected independently by two researchers on Ambulatory Post Anesthesia Research Literature Instrument (APARLI) coding sheets developed for the review. Findings indicated that the scientific method was used with varied levels of sophistication. The linkage of nursing process with patient outcome did not appear explicitly in the research studies reviewed.
Ambulatory Surgical Procedures↗
Telephone follow-up of ambulatory surgery patients following discharge is a nursing responsibility.
The ambulatory surgery nurse manages care for a diverse population of patients who may or may not be ideal candidates for early discharge after surgery. Integral to the nursing care is the postdischarge follow-up contact, which allows the nurse to assess the patient's level of recuperation and evaluate the care provided. A number of reasons, besides completion of the nursing process, indicate that this contact is a nursing obligation. These include compliance with national standards of care, improvement of quality of care, and reduction of the facility's liability exposure. These calls also show a sense of caring about patients and help to market the ambulatory surgery program in the community. The nurse develops a true sense of professionalism and often benefits by increased job satisfaction.
Ambulatory Surgical Procedures↗
Preventing back injuries: an application of the nursing research process.
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Back Injuries↗
[Humanistic approach to nursing communication: the case of a hospitalized adolescent female].
Nursing is a profession committed to the promotion of human beings. It takes into consideration their freedom, uniqueness and dignity. Therefore, communication plays an important role within the nursing process and its results, and it is also a fundamental component of the treatment. However, in the context of Brazilian hospitals, communication between nurses and patients is limited to the performance of these professionals' technical role. The purpose of this study is to analyse the case of a hospitalized female adolescent, focusing on the communication that happens between her and the nursing professionals who provide her assistance. This analysis was based on Bales' categories. Through the technique of direct observation, the behavior resultant from the interaction between nurses and the adolescent was analysed on a total of 30 hours during five days. The observation showed 428 units of interaction which were classified, by qualified professionals, in positive, negative and neutral socio-emotional areas. Considering the high incidence of interactions in the neutral area (89.2%), authors recommend a humanistic correction in the communication during the nursing process. This change in communication can qualify patient's care as well as generate satisfaction at work through empathy and solidarity.
Adolescent↗
A transactional perspective on critical thinking.
The quality of thinking has received much attention within the last decade. The scientific inquiry models introduced by Dewey, Dressel and Mayhew, and Watson-Glaser have been expanded to incorporate such aspects as reflection, development, attitude, skill, and knowledge domain. Dichotomies between critical and creative thinking have been eased. While this scholarship on thinking has been impressive, current pedagogy remains focused on scientific inquiry and on received knowledge. In nursing the learning paradigm has been similarly focused for the past 3 decades on a scientific inquiry model and received knowledge. The major cognitive approach to education and practice has been the nursing process, a linear problem-solving paradigm equivalent to the scientific method. This linear approach does not fully account for how nurses think and make judgments in clinical practice. The Transactional Model of Critical Thinking presented in this paper addresses the complexity of critical thinking in nursing. The model provides an educative and novel vision of thinking based on a transactional view of the individual, personal attributes, and the environment. Components and elements of the model are described and suggestions made for teaching-learning and for evaluation of critical thinking in nursing.
Adult↗
[Resident-oriented nursing care in nursing homes. Testing of a measuring tool].
The findings of an investigation of a patient oriented nursing system in nursing homes are reported in this article. The direct translation of the Dutch word for this type of nursing system is 'Integrated Nursing'. Central to this study are the two premises of Integrated Nursing, namely patient allocation and working in a systemical manner, which is similar to the nursing process. The aim of this study was to determine the validity and reliability of an instrument which was developed to measure the degree of Integrated Nursing in nursing homes. For this purpose, an existing instrument designed for use in general hospitals was modified for use with nursing homes. The modified instrument was tested in two nursing homes: one with a task-oriented nursing system and the other with Integrated Nursing. The instrument was used in the form of both questions and observations. It was concluded that the modified instrument which consists of a Patient Allocation SubScale and a Nursing Process SubScale was reliable and valid.
Aged↗
[Group process in nursing: possibilities and limits].
This work shows studies and reflections about the utilisation of groups in nursing assistance. As an aim sought to identify, through nurses perspective, aspects about their motivations to work with groups, their source of knowledge and relevant points of their experience with groups. The results demonstrates that nurses recognise the therapeutic value of groups in assistance and provide suitable conditions to its development. However, difficulties to handling groupal situations are limiting elements to develop this activity that reveal the human sentiment meander, indicating that nurse group co-ordinator needs, beyond theoretical establishment, to practice by their self-knowledge to provide an ambient and a interpersonal relationship able to obtain the real significance of this activity.
Attitude of Health Personnel↗
[Family members in intensive care units--possibilities and boundaries of integration of family networks into the nursing care process].
Patients' family members are often regarded rather as a burden in intensive care, but they need personalised contact, information and support as much as the patients themselves. The concept of "family nursing" tries to integrate positive social mechanisms of support family members try to provide. For a short term nursing staff has to do some extra work, but seen from a wider angle this can become an important contribution to successful care. This approach can only be realised by an interdisciplinary collaboration of the professional team.
Adaptation, Psychological↗
A study of nurses' attitudes and quality of documents in computer care planning.
This article describes the introduction and development of a computerised care planning system at the Royal Hampshire County Hospital, Winchester - the first to be installed in a UK hospital. The research examined ward nurses' attitudes to the nursing process and the new care planning system before it was implemented, after three months and after one year. The quality of manual and computer care planning was also compared. Results showed that the majority of nurses were ambivalent about the nursing process and the proposed computer care plans. Three months after the new system was introduced, most nurses held negative attitudes, but after a year, attitudes, although still negative, showed a significant shift towards positive. The quality of care planning also improved significantly on the wards for which comparisons were possible.
Attitude to Computers↗
The accuracy of patient records in Swedish nursing homes: congruence of record content and nurses' and patients' descriptions.
The accuracy of patient records in Swedish nursing homes: congruence of record content and nurses' and patients' descriptions. Data from patient records will increasingly be used for care planning, quality assessment, research, health planning and allocation of resources. Knowledge about the accuracy of such secondary data, however, is limited and only a few studies have been conducted on the accuracy of nursing recording. The aim of this study was to analyse the concordance between the nursing documentation in nursing homes and descriptions of some specific problems of nurses and patients. Comparisons were made between wards where nurses had received training in structured recording based on the nursing process (study group) and wards where no intervention had taken place (reference group). Data were collected from the patient records of randomly selected nursing home residents (n=85). The methods used were audits of patient records and structured interviews with residents and nurses. The study revealed considerable deficiencies in the accuracy of the patient records when the records were compared with the reports from nurses and residents. The overall agreement between the interview data from nurses and from the patient records was low. Concordance was better in the study group as compared with the reference group in which the recorded data were structured only following chronological order. The study unequivocally demonstrates that there are major limitations in using records as a data source for the evaluation, planning and development of care.
Aged↗
Comparing patient and nurse perceptions of perioperative care quality.
This study compared surgical patients' (n = 874) and perioperative nurses' (n = 143) perceptions of the quality of perioperative nursing care. The data were collected with a structured questionnaire in five hospital operating departments in Finland. The questionnaire items were divided into five main categories (staff characteristics, nursing activities, preconditions, progress of nursing process and environment); some of these categories were further divided into subcategories. Overall, patients tended to give significantly higher (P <.001) ratings than nurses, but for some items the patients had more critical perceptions. The results provide important clues for improving the quality of patient care so that staff activities better serve the needs of patients.
Adolescent↗
Nursing documentation practice on 153 hospital wards in Sweden as described by nurses.
According to Swedish laws and regulations, registered nurses are required to document nursing care in the patient's record. In this exploratory study, nurses were asked to describe how they made their nursing records. The nursing process model was used as a framework. The findings show that a system for admission assessment was fairly common, regarding objectives and a nursing care plan together with a nursing discharge note; more than half of the wards studied recorded these aspects at least occasionally. Nursing diagnoses were seldom recorded in practice. The results reveal serious limitations and deficiencies in the practice of nursing documentation and the implementation of current laws and regulations. This underlines the importance of emphasizing nursing knowledge and nursing documentation in nursing training and practice.
Humans↗
Turning clinical problems into research.
The nursing process is well known by practicing nurses. The model for approaching the development of nursing research using this process has been presented. The clinical arena is rich in data and problems worthy of detailed research work. The models provide structure and methods that are familiar to practicing nurses so that they may begin to work with colleagues and other researchers in the clinical setting. A nurse who wants to use this model to begin research efforts needs interested colleagues in nursing, friends with patient ears, superiors who value this type of work, and affable determination.
Data Collection↗