To generate a substantive grounded theory of relatives' pattern of behaviour in older patients' fast-track treatment programmes during total hip or knee replacement.Background
Fast-track treatment programmes are designed to make total hip and knee replacements more efficient through recovery improvements. The support of relatives during older patients' trajectory is important. However, knowledge is needed on the relatives' pattern of behaviour to strengthen their involvement in fast-track treatment programmes.Design
We used a Glaserian grounded theory approach based on a systematic generation of theory from data to explain the latent pattern of behaviour of relatives.Methods
Data were collected from 2010–2011 in orthopaedic wards at two Danish university hospitals and consisted of 14 non-participant observations, 14 postobservational interviews and five interviews. Seven relatives of patients over 70 years of age participated. The constant comparative method was the guiding principle for simultaneous data collection, data analysis and coding, while theoretically sampling and writing memos.Findings
Maintaining Unity emerged as the relatives' pattern of behaviour through which they resolved their main concern: preventing the patients from feeling alone. The relatives resolved their main concern through three interchangeable behavioural modes: Protecting Mode, by providing loving and respectful support; Substituting Mode, with practical and cognitive support; and an Adapting Mode, by trying to fit in with the patients' and health professionals' requirements.Conclusion
The substantive theory of Maintaining Unity offers knowledge of relatives' strong desire to provide compassionate and loving support for the older patients during fast-track treatment programmes.
This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework.Background
Recent work to develop and validate a new evidence-based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research. The foundation for the risk assessment component incorporated a systematic review and a consensus study that highlighted the need to propose a new conceptual framework.Design
Discussion Paper.Data Sources
The new conceptual framework links evidence from biomechanical, physiological and epidemiological evidence, through use of data from a systematic review (search conducted March 2010), a consensus study (conducted December 2010–2011) and an international expert group meeting (conducted December 2011).Implications for Nursing
A new pressure ulcer conceptual framework incorporating key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds is proposed. Direct and key indirect causal factors suggested in a theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. The new proposed conceptual framework provides the basis for understanding the critical determinants of pressure ulcer development and has the potential to influence risk assessment guidance and practice. It could also be used to underpin future research to explore the role of individual risk factors conceptually and operationally.Conclusion
By integrating existing knowledge from epidemiological, physiological and biomechanical evidence, a theoretical causal pathway and new conceptual framework are proposed with potential implications for practice and research.
The study protocol is designed to evaluate the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care.Background
Recent (temporarily) enacted legislation in Dutch health care authorizes nurse practitioners and physician assistants to indicate and perform specified medical procedures, i.e. catheterization, cardioversion, defibrillation, endoscopy, injection, puncture, prescribing and simple surgical procedures, independently. Formerly, these procedures were exclusively reserved to physicians, dentists and midwives.Design
A triangulation mixed method design is used to collect quantitative (surveys) and qualitative (interviews) data.Methods
Outcomes are selected from evidence-based frameworks and models for assessing the impact of advanced nursing on quality of health care. Data are collected in various manners. Surveys are structured around the domains: (i) quality of care; (ii) costs; (iii) healthcare resource use; and (iv) patient centredness. Focus group and expert interviews aim to ascertain facilitators and barriers to the implementation process. Data are collected before the amendment of the law, 1 and 2·5 years thereafter.
Groups of patients, nurse practitioners, physician assistants, supervising physicians and policy makers all participate in this national study. The study is supported by a grant from the Dutch Ministry of Health, Welfare and Sport in March 2011. Research Ethics Committee approval was obtained in July 2011.Conclusion
This study will provide information about the effects of granting independent authorization for medical procedures to nurse practitioners and physician assistants on processes and outcomes of health care. Study findings aim to support policy makers and other stakeholders in making related decisions. The study design enables a cross-national comparative analysis.
This multi-centre prospective field study evaluated whether peripheral venous catheter site of insertion influences the risk of catheter-related phlebitis. Potential predictors of phlebitis were also investigated.Background
Millions of patients worldwide use peripheral venous catheters, which frequently cause local complications including phlebitis, infection and obstruction. Although phlebitis predictors have been broadly investigated, uncertainties remain on the potential effect of cannulation anatomical site, duration and the appropriate time for catheter removal.Design
A prospective cohort design was carried out from January–June 2012.Methods
The clinical course of each patient who received a new peripheral venous catheter for any cause in five Italian hospitals was followed by trained nurses until catheter removal. The presence of phlebitis was assessed every 24 hours using the Visual Infusion Phlebitis score. Analyses were based upon multilevel mixed-effects regression.Results
The final sample consisted of 1498 patients. The average time for catheters in situ was 65·6 hours and 23·6% of the catheters were in place beyond 96 hours. Overall phlebitis incidence was 15·4%, 94·4% of which were grade 1. The likelihood of phlebitis independently increased with increasing catheter duration, being highest after 96 hours. Compared with patients with catheter placed in the dorsum of the hand (22·8% of the sample), those with the catheter located in the antecubital fossa (34·1%) or forearm were less likely to have a phlebitis of any grade.Conclusions
Antecubital fossa and forearm veins may be preferential sites for peripheral venous cannulation. Our results support Centers for Disease Control and Prevention recommendations to replace catheters in adults no later than 96 hours. A relevant proportion of healthcare personnel did not adhere to such guidelines – more attention to this issue is required.
To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness.Background
Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care.Design
Pragmatic randomized controlled trial at one site with 260 participants.Methods
This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours.Discussion
Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce.
To provide an original perspective on front-line nurses' perception of senior managers who are not nurses.Background
A key element of new public management had been the drive for ‘hands-on’ professional management within the UK National Health Service, meaning the employment of mangers with managerial experience but little or no healthcare experience.Design
An interpretive qualitative study, based on a single case study design with semi-structured interviews.Methods
Semi-structured interviews were carried out with 31 front-line Scottish National Health Service nurses exploring their perceptions of the role of managers between July–September 2010.Results/Findings
Nursing staff were often unsure of the responsibilities of managers and perceived that there were an unnecessarily high number of managers within the National Health Service. Nursing staff raised concerns over the non-clinical background of managers, including their ability to understand the pressures faced at the front line.Conclusions
The main reason for conflict between managers and nursing staff was their differing foci. Managers were seen to concentrate on decisions surrounding targets, audits and budgets with little consideration given to the impact of these decisions on patient care.
To develop and examine the effectiveness of a home-based self-help psychoeducation programme on health-related quality of life, stress level, anxiety and depression symptoms, self-efficacy, cardiac risk factors and health service use of outpatients with coronary heart disease.Background
Hospital-based cardiac rehabilitation programmes have been shown to improve, effectively, the quality of life of patients with coronary heart disease. However, a majority of these patients do not participate in these programmes, while those who do enrol in these programmes fail to complete the programmes.Design
Randomized controlled trial with repeated measures.Methods
This study was approved and received the grant in July 2013. A convenience sample of 128 coronary heart disease outpatients will be recruited from a tertiary hospital in Singapore. Participants are randomly assigned to the 4-week experimental group and will participate in the programme or the control group who will not participate in the programme. The outcome measures include the: 12-item Short Form Health Survey, Perceived Stress Scale, Hospital Anxiety and Depression Scale and General Self-Efficacy Scale. Data will be collected at baseline, then 4 and 16 weeks from baseline. At the end, a process evaluation will be conducted to assess the acceptability, strengths and weaknesses of our programme based on the participants' perspectives.Discussion
Our programme offers coronary heart disease patients an additional option to the existing cardiac rehabilitative services in Singapore hospitals. It aims to help them manage their disease effectively by reducing cardiac risk factors and improve their health-related quality of life and psychological well-being.
Scales and instruments play an important role in health research and practice. It is important that studies that report on their psychometric properties do so in a way such that readers can understand what was done and what was found. This paper is a guide to writing articles about the development and assessment of these tools. It covers what should be in the abstract and how key words should be chosen. The article then discusses what should be in the main parts of the paper: the introduction, methods, results and discussion. In each of these parts, it suggests the statistical tests that should be used and how to report them. The emphasis throughout the paper is that reliability and validity are not fixed properties of a scale, but depend on an interaction among it, the population being evaluated and the circumstances under which the instrument is administered.
A discussion exploring the ways disabled students are managed in practice settings. It proposes and argues for morally and legally viable principles to guide risk assessment and inclusive decision-making in practice.Background
Equality law means that universities are bound not to discriminate against students on the basis, amongst other things, of disability. As a consequence in the UK, there is a perceived increase in numbers of disabled people applying for and succeeding as health professionals. Whilst placement providers are equally obliged by the law to have inclusive policies, competing needs including patient safety, public confidence and professional regulations mean that adjustments that can be made in an educational environment to appropriately support student learning may prove to be more difficult in placements that provide direct care to the public.Data Sources
This discussion is an outcome of recommendations from published research by the authors and their research partners. It is supported by related literature, critical debate amongst academics, disabled students and disabled and non-disabled practitioners.Implications for Nursing
Ensuring a nursing workforce that mirrors the diversity of the population it serves is of universal importance. Effective management of disabled students can contribute to achieving this goal and to promoting a positive view of disabled practitioners.Conclusion
Legislation is necessary to protect disabled people from discrimination. To respect this legislation, when preparing nurses and other health professions, a clear understanding of the law and a principles-based approach to guiding risk is important.
To report from a study aimed at illuminating how French Registered Nurses experience and engage in nursing research in clinical practice.Background
Nursing research in France is mainly conducted by nurses working at clinical research units rather than by dedicated nurse researchers. Education, i.e. advanced degrees, in the field of nursing research is still in its infancy and not yet consistent with the international context. Outside France, the general perception is that nursing research is a unified part of professional nursing. Consequently, in-depth knowledge about how nurses in a French clinical context might experience and engage in nursing research is still lacking.Design
The design of this study was influenced by an ethnographic approach as described by the French anthropologists Beaud and Weber.Method
Data, participatory observations, field notes and interviews (n = 6) were collected in a teaching hospital between April–August 2012. The field consisted of a wound-care unit and clinical research units. Collected data were analysed based on Beaud and Weber's description of analysis.Results
Three beliefs were identified: being a unified part of a research team, being an integral part of ‘crosswise – across’ activities and being part of research activities.Conclusion/Implication for research
Commitment to nursing research was strengthened by patient-related issues. Based on this context, nursing research would likely benefit from the support of a naturalized reciprocity between clinical practice and research.
To examine the effects of individual video-feedback on the generic communication skills, clinical competence (i.e. adherence to practice guidelines) and motivational interviewing skills of experienced practice nurses working in primary care.Background
Continuing professional education may be necessary to refresh and reflect on the communication and motivational interviewing skills of experienced primary care practice nurses. A video-feedback method was designed to improve these skills.Design
Pre-test/posttest control group design.Methods
Seventeen Dutch practice nurses and 325 patients participated between June 2010–June 2011. Nurse–patient consultations were videotaped at two moments (T0 and T1), with an interval of 3–6 months. The videotaped consultations were rated using two protocols: the Maastrichtse Anamnese en Advies Scorelijst met globale items (MAAS-global) and the Behaviour Change Counselling Index. Before the recordings, nurses were allocated to a control or video-feedback group. Nurses allocated to the video-feedback group received video-feedback between T0 and T1. Data were analysed using multilevel linear or logistic regression.Results
Nurses who received video-feedback appeared to pay significantly more attention to patients’ request for help, their physical examination and gave significantly more understandable information. With respect to motivational interviewing, nurses who received video-feedback appeared to pay more attention to ‘agenda setting and permission seeking’ during their consultations.Conclusion
Video-feedback is a potentially effective method to improve practice nurses’ generic communication skills. Although a single video-feedback session does not seem sufficient to increase all motivational interviewing skills, significant improvement in some specific skills was found. Nurses’ clinical competences were not altered after feedback due to already high standards.
To explore the challenges faced by community nurses when providing home health care to ethnic minority patients.Background
Norway has a growing number of immigrants, including older immigrant patients. Community nurses who provide home care encounter considerable challenges when delivering services to an increasingly diverse patient population.Design
A qualitative study based on a hermeneutics approach.Methods
A qualitative study was conducted involving 19 nurses in Norwegian home health care districts, which had high proportions of minority patients. Data were collected in 2008.Findings
We identified three critical aspects of the encounters between community nurses and minority patients. The first was intimate care. Nurses perceived the fear of mistakes and crossing boundaries related to the cultural and religious practices of minority patients as particularly stressful. The second was rehabilitation after stroke. The beliefs of nurses in the benefits of rapid rehabilitation conflicted with those of the minority patients and their relatives who favoured extended rest during recovery. Third, the commitment of community nurses to transparency in the care of dying patients was tested severely when they met relatives who believed in religious explanations for the destinies of patients and who wanted to conceal the true diagnosis from terminally ill patients.Conclusion
Community nurses encountered various challenges due to a lack of experience with highly diverse patient populations. This situation will continue to create difficulties for nurses and minority patients if management support and appropriate training measures are not provided.
To explore factors at the family caregiver and nursing home administrative levels that may affect participation in a clinical trial to determine the efficacy of hand feeding vs. percutaneous gastrostomy tube feeding in persons with late-stage dementia.Background
Decision-making regarding use of tube feeding vs. hand feeding for persons with late-stage dementia is fraught with practical, emotional and ethical issues and is not informed by high levels of evidence.Design
Qualitative case study.Methods
Transcripts of focus groups with family caregivers were reviewed for themes guided by behavioural theory. Analyses of notes from contacts with nursing home administrators and staff were reviewed for themes guided by an organizational readiness model. Data were collected between the years 2009–2012.Results
Factors related to caregiver willingness to participate included understanding of the prognosis of dementia, perceptions of feeding needs and clarity about research protocols. Nursing home willingness to participate was influenced by corporate approval, concerns about legal and regulatory issues, and prior relationships with investigators.Conclusion
Participation in rigorous trials requires lengthy navigation of complex corporate requirements and training competent study staff. Objective deliberation by caregivers will depend on appropriate recruitment timing, design of recruitment materials and understanding of study requirements. The clinical standards and policy environment and the secular trends there-in have relevance to the responses of people at all levels.
To explore how Registered Nurses address psychosocial issues for patients and their families living with chronic kidney disease.Background
It is in the scope of registered nursing practice to address the emotional, psychological and relational implications of living with chronic disease through psychosocial and family interventions. Patients living with chronic kidney disease frequently report poor quality of life and numerous psychosocial issues; however, they do not find that these issues are always adequately addressed.Design
This research was hermeneutic inquiry as guided by Gadamer's philosophy of understanding.Methods
Family/psychosocial nursing practices are examined from the perspective of self-reports of Registered Nurses working in acute care nephrology units. Interviews with nurses were conducted throughout 2012.Results
Nurses attribute, or explain, patient and family member behaviour in a variety of ways. These explanations may or may not align with actual patient/family reasons for behaviour. Nurses' explanations influence subsequent nursing practice. While there is some evidence of practices that overcome biased attributions of patient behaviour, the cognitive processes by which nurses develop these explanations are more complex than previously reported in nursing literature.Conclusion
Clinical reasoning and subsequent nursing practice are influenced by how nurses explain patients'/families' behaviour. Exploration of this issue with the support of social cognition literature suggests a need for further research with significant implications for nursing education and practice to improve family/psychosocial interventions.
To explore the nursing role in the use of insulin coma therapy for schizophrenia in Britain, 1936–1965.Background
The only history of mental health nursing in Britain published to date gives a minor role to insulin coma therapy and emphasizes nursing opposition to it.Design
An historical study using documentary and oral history sources obtained in 2003–2008 and supplemented by material drawn from interviews in 2010.Method
Historical method was used involving the collection and analysis of primary documentary and oral history material, together with relevant secondary sources.Findings
A range of contemporary sources suggest that nurses in Britain were generally supportive of this treatment regime. The scope for using physical nursing skills was particularly attractive, while the emphasis on close interaction with patients also laid the foundation for later developments in social therapy. The debates surrounding its evidence base are also examined. Faced with a lack of rigorous research findings, clinicians preferred to rely on their clinical judgement. The issue of whether the treatment was abandoned as worthless or merely superseded by still more effective regimes is also explored.Conclusion
A nuanced account of the rise and fall of insulin coma therapy provides a lens through which to examine the development of mental health nursing and a case study of the challenges involved in implementing care based on the best evidence.
To explore how men with penile cancer construct humour in relation to their diagnosis and treatment.Background
Functionalist, relief and incongruity theories attempt to account for humour, but there is a dearth of empirical evidence in nursing care. This is particularly so in relation to a condition like penile cancer where some nurses think that humour in their interactions with patients would be inappropriate.Design
The study employed a participative, mixed-qualitative-methods design.Method
Focus groups and patient-conducted interviews were both used during a one-day ‘pilot workshop’ in March 2011. The data were initially analysed using framework analysis. This paper explores the theme of humour in depth.Findings
Humour helped participants make light of their condition, which meant that they could laugh about the consequences of treatment (‘laughing about urination’) and build rapport with health professionals (‘humour with health professionals’). Nevertheless, the use of humour was less important than the treatment of their cancer (‘humour discounted’) and there was a fear that they would be subject to ridicule because of their condition (‘fear of ridicule’).Conclusion
The findings suggest a combination of functionalist, relief and incongruity theories of humour; the emotions these men experience are contained (functionalist) and released (relief) through humorous interaction, and the potential for comedy lies in an incongruity between what is expected socially and the experiences of these men, for example, around expectations that men use urinals in public toilets. Nurses should continue to use humour to build rapport with patients, should they judge this to be appropriate, although they may want to avoid jokes about sexual and urinary functioning until after treatment.
To examine gender differences in the medication adherence of patients with hypertension by applying a longitudinal follow-up.Background
Patient views of illness affect their adherence to therapeutic regimens. However, few studies have explored these issues by using a longitudinal design or from a gender perspective.Design
This study used a longitudinal, correlational design.Methods
A purposive sampling of 118 patients were recruited from cardiovascular clinics of a teaching hospital in Central Taiwan in 2007–2009. Data were collected using the Chinese Illness Perception Questionnaire-Revised and the Medication Adherence Inventory at three time points: at the first clinic visit, 6 and 12 months after the initial survey. Generalized estimating equations were calculated using the STATA software for data analysis.Results
The findings revealed that male patients adhere more effectively to medications than female patients do. The interaction between systolic blood pressure and gender emerged as a significant predictor of adherence. Factors associated with adherence in male patients included less causal attribution to culture, more attribution to risk factors, fewer symptoms and uncertain symptoms related to high blood pressure, lower scores for timeline-cyclical and higher scores for illness consequences and coherence. Medication adherence for female patients was significantly related to more causal attribution to balance and risk factors, less personal control and enhanced illness coherence.Conclusion
Factors associated with adherence to antihypertensive medication were relatively gender-specific. Awareness of the differences is crucial for health professionals to provide appropriate advice for patients to cope effectively with their health threat.
This article described a research protocol for a study exploring the lived experiences of patients with operable lung cancer in daily life at ‘Four Critical Moments’ during the disease and treatment trajectory.Background
Patients with lung cancer may experience complex problems during the disease and treatment trajectory, and studies conclude this population to be at higher risk in developing emotional distress than other cancer populations. It is required to explore the supportive needs of patients with lung cancer through the treatment trajectory.Design
A longitudinal design with a method of multiple data collection. The study is performed at four time points ‘Four Critical Moments’.Methods
The study contained three samples. Sample I and sample II explored the expected four critical moments for patients with operable lung cancer within the first 4 months following diagnosis and surgery. Sample III explored the patients' participation and the feasibility of an exercise intervention targeting patients with operable lung cancer. For all three samples, interviews will be performed: (1) 5 days following diagnosis; (2) the day after surgery; (3) 7 weeks; and (4) 4 months following surgery. Data from questionnaires for all three samples will be collected at baseline and 4 months following surgery.Discussion
The study will add new perspectives on the lived experiences of patients with lung cancer along the treatment trajectory based on empirical and theoretical findings for both the general lung cancer population and patients participating in an exercise intervention. This will provide a basis for optimizing and developing interventions for patients with lung cancer starting in the surgical context.
To investigate the extent to which perceived support from healthcare professionals and shock anxiety is related to device acceptance among implantable cardioverter defibrillator recipients.Background
Device acceptance can be influenced by several factors, one of which is shock anxiety associated with poor device acceptance. Reduced shock anxiety, as well as increased device acceptance, has been reported after psycho-educational programmes. As healthcare professionals appear to play a significant role in providing support and education during regular follow-up visits, they may constitute an important social support system that could be another factor influencing device acceptance. However, little is known about the relationship between perceived support from healthcare professionals and device acceptance among recipients.Design
A cross-sectional survey design.Methods
A sample comprising implantable cardioverter defibrillator recipients completed questionnaires assessing perceived support from healthcare professionals, shock anxiety and device acceptance. Demographic and clinical data were collected by self-report and from medical records in September–October 2010.Results
The descriptive results indicated that approximately 85% of the recipients experienced high device acceptance. Regression analysis demonstrated that constructive support from healthcare professionals was positively associated with device acceptance and moderated the negative relationship between shock anxiety and device acceptance. Non-constructive support and shock anxiety had a negative statistical association with device acceptance.Conclusions
Healthcare professionals may represent a valuable constructive support system that can enhance device acceptance among implantable cardioverter defibrillator recipients, partly by preventing shock anxiety from leading to poor device acceptance. Non-constructive communication on the part of healthcare professionals could hinder device acceptance.
To identify and discuss the competencies required by learning disability nurses to work effectively with people with an offending background in low, medium, high secure and community settings.Background
Research into the competencies required by nurses working with individuals with an offending background, particularly those with a learning disability, is limited. There is some uncertainty as to whether there should be differentiation according to specific setting.Design
A qualitative study addressing the perceptions of nurses on the knowledge, skills and competencies required to effectively work with people with learning disabilities and an offending background in different settings.Methods
Seven focus groups were conducted across the four settings to inform the construction of the semi-structured interview schedule. Thirty-nine interviews were subsequently undertaken with nurses across settings to develop a fuller understanding of the competencies and ascertain if these were influenced by the specific setting where the nurses worked. Data were collected over 1-year in 2010 and analysed using a structured thematic analysis supported by the software package MAXqda.Findings
The thematic analysis produced four over-arching competencies: knowledge assimilation and application; team working; communication skills; and decision-making. A further competency around personal attributes constitutes the basis of a future paper.Conclusion
The first three competencies combine well to inform the work of nurses and appear transferable across settings, but the fourth appears more complicated, specifically in terms of the role of risk in supporting or detracting from decision-making capacity.