Clinical effectiveness in nursing最新文献

Alcohol consumption has increased in England over the last forty years and this has been associated with a rise in alcohol related health and social problems. Excessive alcohol consumption has an important effect on individuals and society, in addition is leading to a huge financial burden upon the National Health Service. This review looks at the need for accurate diagnosis of individuals as risk of developing alcohol related disease due to excess alcohol consumption. The biochemical markers currently available to health care professionals will be discussed and future markers currently being tested experimentally will also be highlighted upon. In current practice blood alcohol, mean corpuscular cell volume, gamma-glutamyl transferase, serum aminotransferases and carbohydrate deficient transferrin are used. In addition the combined use of clinical questionnaires and biochemical markers are discussed. Currently there are no perfect clinical markers available to diagnose excess alcohol consumption; however, further markers are being evaluated.

Objective

Critically ill patients are exposed to a high degree of clinical risk and adverse events due to a number of factors including complex clinical interventions, polypharmacy, acuity and severity of illness, and a high level of physical dependency. The incidence of adverse events has been investigated as an indicator of quality of care and clinical risk. The purpose of this evaluation was to explore the nature of untoward clinical events (UCE) experienced by adult patients admitted to a high dependency unit in order to introduce an appropriate education and training programme.

Method

Twenty discrete assessments were carried out involving adult patients admitted to a high dependency unit. A systematic, in-depth assessment of each patient was undertaken by a critical care nurse consultant in order to identify UCE. Quantitative clinical data and descriptive data of diagnosis, clinical interventions, treatment and nursing care were collected. Quantitative data were analysed using SPSS version 11.5 for windows and descriptive data describing the nature and type of untoward clinical events were content analysed and coded into categories.

Results

Twenty-eight UCE were detected involving ten patients. Four categories of UCE were identified as deviation from treatment plans, hospital standards and guidelines; inaccurate information recorded/communicated influencing a patient’s treatment/care; service/resource shortfalls; and inadequate treatment plans.

Conclusions

All the events were seemingly preventable and mainly attributable to nursing practice although there were possibly a number of reasons why they occurred. Further research is needed to investigate the correlation of adverse events with organisational factors, nurse staffing and patient dependency.

In this paper some of the limitations of grounded theory are demonstrated by examining the application of categories that arose in an empirical study of sexuality in special hospital settings (high security psychiatric hospitals). By looking in more depth at the ways in which the categories are applied and the meanings given to them by informants it is shown that grounded theory relies on a reconstructed logic. This logic is at once plausible but it requires a great deal of accommodative work if the meaningful behaviour of informants is not simply to be taken on ‘trust of interpretation’. In facing these limitations during the study the author was drawn to ethnomethodology and, in particular, membership category analysis (MCA) as an additional approach. By working through a case example it is shown how the values of informants and their meaningful behaviour can be reached through MCA analysis.

The aim of this paper was to present a comprehensive picture of characteristics within a maternity hospital which promote obedient behaviour from midwives. The overall objective was to assess midwives’ views about their own acquiescent behaviour. A sensitive qualitative analysis appraised midwives’ views gained from semi-structured interviews conducted within the seven maternity units of North Yorkshire in the UK. Participants included a stratified sample of 20 (7E, 7F, 6G grade) practicing midwives aged between 21–60 years. Taking a post-positivist approach, inductive thematic analysis was used to interpret the data. Two themes of “situational factors that promote obedient behaviour” were derived; “an obligation to follow hospital policies” and “fear of consequences from challenging senior staff”. The key conclusion is that midwives are frequently placed in unenviable positions of relative powerlessness. It was clear that some actions and strategies that midwives use serve to reinforce the fundamental power structures and “status quo”. Quite clearly, midwives are sometimes presented with conflict between a drive to agree with authority and supporting the safe, evidence-based choices of childbearing women in their care. Raising awareness of the processes involved in obedient behaviour and exercising sharing of power may be helpful to midwives in asserting not only their own professional capacity to influence, but also the autonomy of the women they seek to empower.

Most institutes who entered the Research Assessment Exercise (RAE) Unit of Assessment (UoA) 10 put forward several papers that are clearly not nursing in any meaningful way. 6.1% of all papers are neither papers about nursing, relevant to nursing, or in nursing journals. Non-nursing papers are associated with similar RAE scores as nursing papers. Those institutes that enter many non-nursing papers do not focus on one other area, but enter papers from several.

If the 2007/8 RAE were to be similar to the 2001 RAE then there is scope to place academics from other disciplines to increase funding for nursing, even if the rating is not improved. It would probably be sensible to enter academics from clinical or social science areas that could be construed as relevant to nursing.

The purpose of this article is to describe the barriers to creating breastfeeding friendly culture and strategies used to overcome these barriers by a tertiary level Health Centre and a Capital District Health Authority (CDHA) Public Health Services, with which the authors were affiliated. Lessons learned from this process may be a useful resource for other organizations embarking on this difficult, yet exciting journey.

Objectives

To examine one aspect of a larger study evaluating the modern matron role, comparing trust nursing directors’ perceived outcomes of introducing matrons to the NHS with actual evidence of such outcomes gathered in ten subsequent case studies.

Design, methods and outcomes

In a national survey, nursing directors stated their perceived outcomes arising from introduction of matrons; these outcomes were compared with case study findings.

Participants and settings:

Survey

Questionnaire to Directors of Nursing in all 545 NHS trusts in England in 2003.

Case Studies

Ten NHS trusts purposively selected to include different types in varied settings. Data collection involved interviews and questionnaires to matrons, other relevant staff and some patients, and use of routinely collected data.

Results

Sixty percent of 414 survey respondents reported positive outcomes such as improvements in staff management, leadership, patient environment and standards of care, whereas only 36% reported negative outcomes such as role ambiguity and role overload for matrons. Most of the reported positive outcomes were recognised in subsequent case studies.

Conclusions

Positive outcomes attributed by directors of nursing to matron appointments appeared to outweigh negative outcomes. There was evidence of these positive outcomes in subsequent case studies.

Objectives

To review the psychiatric and obstetric complications of pregnancy in women with psychotic disorders and discuss implications for prevention and treatment of these conditions.

Design

Narrative review.

Results

Many women with psychotic disorders have children but their pregnancies are at an increased risk of obstetric complications, stillbirths and neonatal deaths, and psychiatric complications. Women with a history of mood disorders (affective psychoses) are at high risk of postpartum relapse. A significant proportion of mothers with psychotic disorders have parenting difficulties and lose custody of their infant.

Conclusions

Close liaison between all health professionals during pregnancy and postpartum is essential for optimal management of these high-risk pregnancies.