Verpleegkunde最新文献

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.

In the Netherlands, experiments are taking place in which nurses work in general practice with physicians. In the United Kingdom, so-called practice nurses have been working in general practice since the 1960's. In this article, the experiences in the United Kingdom with the practice nurse are outlined. The focus is on the lessons that can be learned from these experiences. In the United Kingdom, the majority of practice nurses are employed by general practitioners. The most important reason for introducing nurses into the general practice setting was to decrease the physicians' workload. The practice nurse in the United Kingdom has evolved from a 'cheap, task-oriented practice assistant' to a more or less autonomous colleague of the general practitioner. The practice nurses' activities vary greatly. Problems encountered in the United Kingdom primarily concern the lack of training, the absence of a clear definition of the function and responsibilities and the problems associated with working conditions which result from the employment contract with a specific general practitioner. The previously mentioned Dutch experiments show a great deal of variation in terms of the nurses' activities and their position within general practice. Consequently, the development of a clear definition of the function and an adequate training programme are also difficult in the Dutch situation. An additional point of consideration for the Dutch situation is the difference in tasks and responsibilities between the practice nurse and other nurses employed in primary care settings.

The aim of this investigation was to determine which positions were associated with the lowest pressures to the skin in persons lying in bed. The pressure was recorded in ten different lying positions on two mattresses in 26 healthy volunteers. The semi Fowler position and the prone position were associated with a very low pressure. The 30 degrees laterally inclined position had significantly lower pressure than the classical 90 degrees side lying position. The highest pressure was measured in the 90 degrees side lying position and thus it should be avoided. A polyethylene-urethane mattress reduced pressure by 20 to 30% in comparison to a standard hospital mattress.

In home care nursing work is redesigned by differentiated practice (= skill mix) and specialization. The aim of this redesign is efficient use of staff, and maintenance or improvement of quality of care. In this article the effects of differentiated practice and specialization are studied in respect of quality of care. The perspective of the client was taken as the starting point. Quality of care was defined as the discrepancy between clients' expectations and perceptions of several aspects of care. The effects of work redesign were determined on the basis of a comparison between an experimental (n = 103) and a control group (n = 108). Data-analysis showed hardly any differences. Possible explanations are the premature status of the projects and the fact that clients are usually (very) satisfied. The margin in which differences between the experimental and the control group should occur is therefore very small. However, by means of this approach a detailed picture can be obtained of the subjective standard clients use to judge the quality of care.

This paper reports on the results of a study conducted in 1994. The aim of the study was to gain insight into nurses' perceptions of ethical dilemmas concerning informational privacy of patients with hiv/aids. The chosen research method was descriptive, from a qualitative research perspective (Grounded Theory). The purposive sample consisted of seven nurses working in a university hospital. Data were collected by means of in-depth interviews and the critical incidents method. The description of the dilemmas led to a central theme: the nurses' choice whether or not to give information revealing the diagnosis seropositivity or aids to patient's relatives or partner. The core categories were derived from analysis of the descriptions given by the nurses. They are split up into experiences of the nurses and the way nurses cope with these dilemmas. Recommendations are given for promotion of expertise and education.

This study with a quasi-experimental design was conducted into the effects of an aggression management training on the perception of safety and self-confidence of the participants. Also it was studied whether the participants of the training were less likely to be involved in aggressive incidents. It was found that the perception of safety of the participants had significantly increased compared to the control subjects. No significant differences in perceived self-confidence were found between the two groups. In both the experimental and the control group the frequency of aggressive incidents was lower during the posttest period. This reduction had taken place regardless of the aggression management training. Possibly, the systematic registration of aggression by means of the Staff Observation Aggression Scale (SOAS) initiates a learning process in the staff.

Within the context of the desired unambiguousness in definitions and classifications of the nursing terminology, this literature research attempts to inventory the divergent meanings in recent professional nursing literature of the concept 'patient outcome', as well as the classifications used. Data analysis and interpretation was carried out by means of analytic induction. The results clearly show the ambiguousness of the concept. Nursing literature appears to pay little attention to the study of the structure of (the) patient outcome(s). Then, the context in which the patient outcome has to be situated appears to be described in many divergent ways. Finally, classifications of patient outcomes are found in many variants. This report concludes with suggestions for an unequivocal definition of patient outcome, as well as for the construction of (a) classification(s) of patient outcomes.

This article reports on a literature review into the publications on the practise of seclusion. Attention will be paid to the moral debate on seclusion. The major part of the publications consider seclusion as a necessary intervention to manage problem behaviour. The first part of the article will consider definitional aspects and will result in concept clarification. The review shows differences at definitional aspects, motives for seclusion and patient characteristics. Data on frequencies, incidence and duration appear to be different. The experience of patients who are secluded are mostly negative, but positive reactions are also reported. Publications on the influence of the hospital characteristics to the use of seclusion seem to increase during time. Finally it is concluded that seclusion is an effective way to manage (potential) dangerous behaviour and that seclusion is an intervention which may create therapeutic conditions.