Clinical effectiveness in nursing最新文献

Introduction:

To review the evolution of critical appraisal skills training alongside the results from a long-term evaluation of a series of research utilisation workshops.

Critical appraisal skills training and evidence based health care:

The evolution of critical appraisal skills (CAS) training across health care professions is described, showing the centrality of this to evidence based health care and thus clinical effectiveness. The evidence for the effectiveness of CAS training is reviewed.

The long-term evaluation of the Foundation of Nursing Studies’ workshops:

A postal questionnaire and qualitative interview study of participants and managers were used to evaluate the workshops. These findings were then contextualised through a consultation exercise with senior nurses, practice developers and nurse educators in health care trusts and academic units across the UK.

Discussion:

The effectiveness of CAS training, its focus and structure is revisited with reference to the literature and the long-term evaluation. Questions concerning the way forward are proposed.

Objectives

To assess surgical patient education interventions and to explore the outcomes of experimental and quasiexperimental studies from 1990 to 2003.

Design

Systematic literature review.

Material and methods

Database searches were carried out in May and September 2003 on Medline and Cochrane Library files from 1990 to 2003, using the inclusion criteria of adult surgical patients, patient education in experimental and quasiexperimental studies, English language and nursing. Data analysis in September–October 2003 focused on assessing the interventions and the outcomes of the studies.

Main results

The database search yielded 32 articles involving 2723 participants. Most of the interventions concerned preoperative surgical patient education and focused on cardiological patients. The most common outcome measures were experiential related (87.5%) and cognitive related (59%). None of the studies measured social or ethical aspects of patient education. Half of the studies (50%) reported both statistically significant and non-significant outcomes. There were also a number of studies (41%) which reported no statistically significant findings.

Conclusions

Educational interventions may have many positive effects, but it is difficult unequivocally to demonstrate those effects. This review did produce some evidence on the effectiveness of patient education, but more rigorous research with strict intervention designs and measures is still needed.

The role of perceived authority on the clinical behaviour and decision-making of midwives has received little research attention, largely due to the unavailability of a midwifery-specific measure of conformity. The current study investigated the factor structure of the social influence scale for midwifery (SIS-M), a recently developed measure of conformity designed specifically for use within midwifery practice. Confirmatory factor analysis revealed that a four-factor model of conformity, comprising distinct dimensions of conformity, client control, personal control and non-conformity offered an excellent fit to the data. It is concluded that, though the SIS-M was developed as a unitary measure of conformity, there is also compelling evidence that the SIS-M could be developed as a multi-dimensional measure of distinct, but related, conformity dimensions. The SIS-M therefore offers considerable potential as a research tool to gain novel insights into the conformity behaviour of midwives in the practice environment and the relationship of such behaviour to maternal and neonatal outcomes.

Objectives: To identify barriers and facilitators to research utilisation as perceived by breast care nurses (BCNs) and to identify BCNs' preferred methods of receiving research based information.

The sample: 263 BCNs in the UK and represented a 76.2% response rate.

Data collection: Conducted by postal survey and consisted of a demographic questionnaire, the Barriers to Research Utilisation Scale [BARRIERS: The Barriers to Research Utilization Scale, 1987] and questions on preferred methods of dissemination.

Results: The most frequently identified barriers were associated with communication and organisational issues, e.g. `statistical analyses not understandable', `insufficient time on the job to implement new ideas', `facilities inadequate for implementation', `research not reported clearly and readably' and `no time to read research'. Facilitators included working within a motivated, supportive, research oriented team and time to read and discuss practical implications within specialist networks. BCNs perceived meeting experts, specialist conferences and discussion groups/workshop as the preferred methods for keeping up to date.

Conclusions: BCNs want and need research reports to be understandable, readily available and clearly presented but must improve their research appraisal skills. Relevant organisational barriers should be confronted with support from managers and the multidisciplinary team e.g. time, development and training.

The purpose of this study was to examine the level of adherence to medical recommendations and health advice among post-myocardial infarction patients and determine the factors that may influence adherence. This study took a quantitative approach and structured questionnaires were used with a convenience sample of 52 patients. All patients reported that they were taking medication as directed all the time. Most patients were adhering well with a health diet (80.8% “often” or “all the time”), but lower levels of adherence were observed with regards to adherence with weight loss (25%), physical activity (65.4%), social activity (44.2%), smoking cessation (28.8%) and alcohol use (19.2%). Key predictors of adherence were found to be the extent family members encourage patients to follow health advice in relation to following a healthy diet, health locus of control (powerful other) in relation to adherence with weight loss, past medical history, anxiety and internal health locus of control in relation to adherence with physical activity, and finally depression, gender and internal locus of control in relation to adherence with social activities advice. Families should also be part of cardiac rehabilitation programmes as they can influence adherence, and beliefs or personality characteristics that influence adherence should be assessed in post-myocardial infarction patients in order to identify who is more likely to be nonadherent and thus provide more individualised support.

Introduction: Constipation presents as a perpetual problem in health-care with painful and debilitating consequences, however it is frequently preventable. A prerequisite to prevention is assessment of risk of a condition occurring so that interventions can be individualised in an attempt to prevent it. On analysis of published literature no objective comprehensive risk assessment tools for constipation were found.

Study purpose: The purpose of this literature review was to identify and analyse risk factors for constipation recognised by previous empirical research. This enabled subsequent work to be performed to develop a risk assessment tool for constipation that could be used in clinical practice.

Literature review: The literature search identified potential risk factors for constipation. These risk factors were systematically analysed and justification was provided for the risk factors' inclusion to or exclusion from the risk assessment instrument that was subsequently developed.

Conclusion: The study appears to be the first within health-related literature that has extracted the risk factors for constipation from previous empirical research. This groundwork led the way for the subsequent development of a comprehensive objective tool to assess risk for constipation.

The United Kingdom (UK) National Health Service (NHS) has experienced a rapid expansion in the number of clinical nurse specialist (CNS) posts in the last two decades. Despite this, there is limited robust evidence that evaluates the role and impact that the CNS makes. Furthermore there is reportedly considerable confusion and inconsistency surrounding the titles, descriptions, qualifications and grading of CNS posts. It is against this background the findings from this multi-centre descriptive survey are presented which explored final year `soon to be qualified' student nurses' perceptions of the CNS role and the impact they had on care delivery and other members of the nursing team.

A specially designed self report instrument was distributed to 269 student nurses undertaking pre-registration adult branch nurse education at three higher education institutions in England and Scotland. A response rate of 82% (n=220) was obtained. The instrument contained a combination of open and closed questions. Quantitative data were analysed using SPSS (v 11.0) and a thematic approach as described by Miles and Huberman (1994) was used to categorise responses to the open ended items.

The results indicate that the students had encountered clinical nurse specialists during their education. The students ranked CNS' in the fields of diabetes, palliative care and acute pain as the most frequent recipient of patient referrals. The students recognised the added value brought to patient care by involvement of a CNS in care delivery and valued the CNS as a source of knowledge and support to both themselves and other staff. Students also identified a number of disadvantages associated with the CNS role. These included role conflict and potential for deskilling nurses fulfilling a generalist role. This paper will discuss the findings and offer possible explanations for the results.