Clinical effectiveness in nursing最新文献

Objectives

To examine the use of knowledge, and in particular, of evidence derived from research, in interactions between community midwives or health visitors and their clients around the topic of breastfeeding.

Design

A qualitative study involving observation of practice (n = 158) and in-depth interviews with women (n = 22), midwives (n = 9) and health visitors (n = 9). This paper draws primarily on interviews with health professionals.

Setting

Inner city, suburban and rural areas of a northern city in England.

Findings

A range of different sources of knowledge were used, including: clinical experience; training courses; reading journals; research, policies and guidelines; watching or speaking to colleagues; and personal experience. Practitioners considered each woman’s individual circumstances, drew on their knowledge of what had worked with other women and used knowledge from formal and informal sources, in an ongoing process of feedback. This accumulation of previous experiences acted as a reference point to test out new information including research findings. The process of building knowledge over time from different sources, formal and informal, seemed to lead to practices that generally concurred with current research evidence. The potential strengths and weaknesses of this approach are discussed, and implications for practice and research are described.

Delirium is a severe organic dysfunction of the brain with a decline in attention and cognition. It is characterized by an acute onset with a tendency to fluctuate and impaired consciousness with reduced clarity of awareness. Furthermore it is designated by a reduced ability to focus, sustain, or shift attention and a change in cognition or a perceptual disturbance with hallucinations.

Up to 20% of hospitalized patients older than 65 years are affected, in an intensive care setting reports go up to 80%. Once delirium developed, it is associated with poor cognitive outcome, dementia and increased costs. Delirium is an independent predictor of mortality and prolonged stay in the intensive care unit (ICU) and hospital.

For early diagnosis of delirium, monitoring is required in daily routine. Symptoms of and reasons for delirium are very variable. The application of special scales to assess delirium should be performed. The “Delirium Detection Scale” (DDS) and the “Confusion Assessment Method” (CAM-ICU) are both validated and reliable measurements for delirium in ICU patients. Any possible general medical condition must be excluded.

This overview article is to demonstrate the importance of a tight monitoring to enable optimal treatment and to save patients from associated complications like prolonged stay in ICU and hospital, increased mortality, poor cognitive outcome and increased costs.

Objectives

The principle aim of this paper is to explore the available evidence based literature examining the significance of symptom interpretation as an influencing factor in malignant melanoma presentation delay.

Method

A comprehensive review of the literature relating to presentation delay in melanoma was undertaken. A search strategy using the key words; malignant melanoma, cancer, presentation, delay, symptom interpretation, signs, symptoms and help seeking was devised to interrogate electronic medical, nursing and psychological databases. Twelve original English language papers that met the inclusion criteria were included.

Results

A number of influencing factors associated with symptom interpretation in malignant melanoma were identified. These included knowledge and awareness, the nature of the symptoms and previous experience of benign diagnosis.

Conclusions

Delay was associated with incorrect interpretation of symptoms, minimisation of significance of signs of malignant melanoma, and outcomes from previous help seeking behaviour. Only limited evidence was available and further research needs to be targeted on further examination of presentation journeys and possible benefits of the internet and other media for enhancing knowledge and encouraging translation to aid interpretation and initiate self referral to specialist services.

Introduction

Psychosocial interventions are recognised as important treatments for people with dementia. Attention is now focusing on the appropriateness of such interventions for people in different stages of the illness. Two recent systematic reviews have focused on psychosocial interventions for people with a milder dementia. This systematic review investigates the effectiveness of such interventions for people with moderate to severe dementia.

Methods

A comprehensive search was undertaken using all the major health care databases, as well as various grey literature sources. For studies to be included in the review, they must have investigated the effect of one or more psychosocial intervention on people with moderate to severe dementia, employing a controlled trial design and examining outcomes such as cognitive ability, communication, functional performance, well-being, physical performance, mobility, and disruptive behaviour. Identified studies were critically appraised, and where suitable for inclusion, data were extracted.

Results

Six studies met the final inclusion criteria for the review. The included studies covered five psychosocial interventions; multi-sensory stimulation, group exercise, reality orientation, combined walking and talking, and reminiscence therapy. No evidence was found for the effectiveness of reminiscence therapy and multi-sensory stimulation. The review provides some evidence for the effectiveness of exercise in increasing muscle strength; walking and talking, in slowing the decline in mobility; and reality orientation in improving cognitive ability in the short-term.

Conclusions

This review has revealed relatively few well-designed studies focusing on the effectiveness of psychosocial interventions for people with moderate and severe dementia. This highlights the need therefore for further multi-centre randomised controlled trials to be undertaken on these interventions, together with well-designed comparative and combined studies.

Objective

This paper presents a study exploring women’s experiences of making choices for maternity care in early pregnancy. The content will provide clinically useful information to midwives and health care professionals involved in caring for pregnant women.

Background

Choice has been high on the maternity care agenda since 1993. Policies promoting choice were in part a response to critiques of the biomedical model, but also in recognition that an increased sense of control and quality of experience can have both physical and psychological benefits. Choice however may not be as straightforward as policy makers suggest and to date women’s own experiences of choice remain relatively silent in the debate.

Methodology

10 women took part in in-depth narrative interviews in early pregnancy, between 12 and 16 weeks gestation, in order to explore their choices for care, the rationale for those choices and their experiences and feelings at that point in their pregnancies.

Findings

Three key themes emerged with regard to choice and revealed how women following a positive pregnancy test adopt a pregnant woman identity. This new identity invests them with both ownership of the pregnancy and a responsibility to the fetus to make the right decisions with regard to choices for care. Responsible choices are defined by both explicit and implicit influences and discourses, which fundamentally facilitate or inhibit choice.

Conclusion

Over a decade after choice was hailed as essential to ensuring a positive maternity experience for women, there remains a lack of evidence to suggest that choice is a reality for many women accessing maternity care.

Postnatal depression currently represents the most frequent post-delivery pathology in Western countries. Early screening strategies constitute epidemiological challenges. Non-psychiatric staff must be offered adequate training on why, where, when and what kind of screenings must be established in order to obtain an effective reduction of postnatal depression. Perinatal psychiatrists should be encouraged to be meticulous about evaluation and availability of such screenings.

This paper reviews the main strategies for screening and assessing the needs of the diverse range of socially excluded clients who come into contact with statutory and non-statutory agencies. A high level aim of contemporary UK health and social policy is to engage with those who are hard to reach with traditional health service provision. The initial contact and screening processes, therefore, are central to developing a relationship with the client and engaging him/her with the main stream community services. Many homeless and socially excluded people have multiple and complex needs but seeking accommodation provides a good opportunity to begin to engage the client with support services. Although substance misuse and mental health problems might not be immediately apparent, screening and subsequent assessment of these aspects of dual diagnosis should be provided in order for appropriate help to be made available. Ongoing monitoring of the client’s progress will provide an insight into the cues which indicate relapse. However, an important aspect of inclusion often involves gaining access to meaningful work. The neurocognitive ability of the client to undertake work and become socially integrated may be limited by problems in decision making and other cognitive skills. Appropriate support, in these cases, might involve an evaluation of neurocognitive deficits and the guidance to appropriate employment tasks. The encouragement of positive health behaviours, including improvements in nutritional status will all add to the increased possibility of coming in from the cold.

Objectives

To describe the Alcohol Health Work intervention, by setting the scene with a brief overview of the impact of alcohol-related health problems at accident & emergency, then describing the Paddington Alcohol Test and other alcohol screening tools, and the concomitant impact on the rest of the hospital. Finally, there will be a case study illustration of the use of PAT and the AHW intervention.

Setting

St Mary’s A&E department, at a busy central London hospital, where the PAT process has been developed over the past decade as a response to the perceived effects of alcohol misuse.

Determinants of pediatric health care use extend beyond the health status of the child and economic and access considerations. Parental factors, particularly those associated with the mother, are critical. The common sense model of health and illness behaviors, which was developed to account for adult health care use, may constitute a framework to study the role of mothers in determining pediatric health care use. In the common sense model, the person’s cognitive representations of and affective reactions to bodily states influence health care decision-making. There is a growing literature that points to the importance of maternal psychopathology (reflecting the affective component of the common sense model) and maternal parenting self-efficacy (reflecting the cognitive component of the model) as important contributors to pediatric health care use. The implications of this conceptualization for future research and clinical practice are discussed.

Objectives

To explore the views and experiences of nursing staff and patients about using hip protectors in in-patient clinical wards.

Design and method

Qualitative, cross-sectional study. Semi-structured interviews and focus groups were carried out with nurses and patients. All data were analysed using the ‘Framework’ method.

Setting

Two dementia and two enduring mental health problem wards within an NHS Trust.

Sample

Nurses (n = 22) and patients (n = 16).

Findings

Patients and staff supported the use of hip protectors, because they: (1) were perceived to reduce falls-related injuries, (2) lessen anxiety around falls, and (3) provide patients with confidence to mobilise unaided. However, there was concern that hip protectors can reduce patients’ ability to dress and use the toilet unaided. Some patients find protectors uncomfortable and hot, particularly in bed. Nurses in dementia wards reported that patients forget they are wearing the intervention, and that patients remove the protector once it is in position.

Conclusions

The successful utilisation of hip protectors is dependent on: (1) the degree to which patients accept the purpose of the protector and any resultant discomfort and adverse impact on their independence; and (2) the ability of nursing staff to explain the benefits of the intervention, and to monitor its correct usage.