Clinical effectiveness in nursing最新文献

Background

There are few collations of outcome measures used to evaluate UK nursing and midwifery practice. This paper makes a clear contribution to our existing knowledge by exposing the range and robustness of outcome measure available in the evaluation of nursing and midwifery practice. The review questions answered in this paper are:

• 1)

  what patient outcome measures have been used in studies of nursing and midwifery practice in the UK within the last decade?

• 2)

  to what extent have the instruments been tested in the UK for validity and reliability with the respective patient populations?

The review was conducted in 2002/3.

Methods

Conventional methods for systematic reviews guided this work. These included: 1) defining terms to be used in the review, 2) searching for published and grey literature relevant to the two review questions, 3) selecting studies from this literature that would help to answer the review questions, 4) appraising studies to further determine their rigor and appropriateness in answering the review questions and 5) synthesising the findings to enable a comprehensive view of outcome measures used to evaluate nursing and midwifery to be formed.

Results and Conclusions

This systematic review identified numerous patient outcome measures, across a range of specialisms, available for the assessment of nursing and midwifery practice in the UK. The review also highlighted the extent to which the instruments have been tested in the UK for validity and reliability and showed the need for further testing of new instruments. The development of qualitative tools, which may also be suited to the evaluation of nursing and midwifery practice both within the UK and the wider international arena, was identified as an area for future work.

Objectives

To investigate everyday memory processes in teenagers who drink excessive amounts of alcohol (drinking above the 14/21 units-per-week recommended for females/males respectively), compared with low-dose controls. To consider what implications putative deficits might have upon prevention and potential treatment issue relating to alcohol misuse in teenagers.

Design

Existing groups.

Setting

Testing took place in quiet rooms in colleges in North-East of England.

Participants

86 teenagers studying at colleges in the North-East of England were tested, 55 of whom were excessive drinkers and 31 drank below the ‘safe limits’.

Main Outcome Measures

Self-report measures; Prospective Memory Questionnaire and UEL Drug-Use Questionnaire.

Results

After controlling for tobacco and strategy use (no other between-group differences were found on the non-memory measures), the excessive alcohol group reported more lapses in memory in their long-term and short-term everyday prospective memory functioning, than the low-dose control group.

Conclusions

The findings suggest that teenagers who use excessive amounts of alcohol have selective deficits in their ability to engage in day-to-day activities that rely on memory. Identifying such deficits may help in prevention campaigns and the development of strategies to combat these difficulties may be a useful addition to the knowledge and skills in nurse training.

Objective

The objective of this study was to examine evidence of the effectiveness of interventions, particularly by midwives, to prevent postnatal depression, or by Health Visitors to treat postnatal depression.

Methods

A literature search from 1966 to July 2005 covered health databases MEDLINE, CINAHL, EMBASE, and PsycINFO, and Evidence-Based databases in The Cochrane Library, covering the Cochrane Database of Systematic Reviews and the Cochrane Controlled Trials Register. Studies that evaluated maternal mood up to one year after delivery were reviewed.

Results

From the 37 published studies that involved an intervention to prevent postnatal depression, there was little evidence of effectiveness. Of 20 reviewed trials aiming to treat PND, there were encouraging outcomes, but many of the studies had methodological or reporting limitations. Of all the trials reviewed, The PoNDER Trial, a pragmatic cluster randomised trial (commissioned and funded by the NHS R&D Health Technology Assessment programme) was the largest, with the longest follow-up (to 18 months). This trial reported the cost-effectiveness of Health Visitors’ role in the detection of PND and offering a psychological intervention.

Conclusion

Among all the trials reviewed here, The PoNDER Trial has provided evidence of the cost-effectiveness of the HVs role in detecting PND and offering a psychological intervention.

Alcohol consumption in the United Kingdom has risen dramatically over the last fifty years and there has been an associated increase in cirrhosis secondary to alcohol. In western society the most common cause of cirrhosis is secondary to alcohol. Alcoholic liver disease has become an increasing financial burden upon the NHS. Ten percent of hospital admissions are thought to relate in part to alcohol. This review examines the pathogenesis of alcoholic liver disease and the three stages of fatty liver, alcoholic hepatitis and cirrhosis. The clinical presentations of alcoholic liver disease and management will be discussed in detail. Evidence based treatments available for patients with alcoholic liver disease and their clinical effectiveness are also summarized. The systemic complications of alcoholic liver disease primarily malnutrition, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, hepatorenal syndrome and oesophageal varices will be discussed, as well as new approaches to management of these complications.

Addiction affects all aspects of a person’s life, and addiction also impacts upon all aspects of health care. The emergency department (ED) is a frequent provider of services to those addicted to alcohol or drugs. The central role of the ED as the last common pathway in acute crisis management in healthcare means that all staff working in health services or in addiction care should be aware of what the ED can provide acutely. It is also important to understand which specialist services the ED needs to be able to access in order to provide a safe and high quality service to addicts in their care. These aspects, among others, will be covered in this review.

Objectives

As the number of community-dwelling older adults increases, assisting them to maintain health is an optimal goal of care. Adherence to treatment plans, medical follow-up, and the participation in preventive health maintenance activities (PHMA) are primary approaches to health maintenance. But the impetus for this group to request or assent to PHMA remains unclear. Thus, the purpose of this study was to determine whether satisfaction with healthcare providers influenced community-dwelling older adults’ participation in PHMA.

Design

A descriptive design was used to investigate whether healthcare satisfaction influenced participation in PHMA in a population of community-dwelling older adults.

Sample, Setting, Measures

Thirty-nine community-dwelling older adults completed two questionnaires, participation in PHMA and the patient satisfaction in healthcare providers scale.

Results

The majority of participants were satisfied with their healthcare providers but that finding had little influence on PHMA participation.

Conclusions

Healthcare provider satisfaction may play a limited part in influencing whether older adults participate in PHMA. The onus remains on the geriatric healthcare provider to educate, encourage, schedule, refer, and follow-up on the completion of PHMA to help safeguard the health of community-dwelling older adults.

This account demonstrates areas previously neglected in the cross-cultural research literature. The aim is to examine challenges which researchers may encounter when planning cross-cultural projects. Methodological issues arising while preparing a qualitative research project are compared with the literature. The research project, planned in Scotland, was undertaken in three industrial cities in China. Semi-structured interviews were planned with three groups of informants in each city. The informants were (1) women who had given birth by caesarean one week or one year previously (2) health care workers and (3) community members. The Scotland-based researchers kept notes of their experiences of preparing and beginning this project.

It was found that cultural issues should be recognised and addressed during planning. These affect various aspects of the project, including recruitment and fieldwork. Additionally, other influences, not only the indigenous culture, are identified in the ‘host’ setting. Further, challenges presented by linguistic issues should not be underestimated. The rapidity of change in countries like China has implications for researchers. It is concluded that difficulties may be encountered in planning cross-cultural research. Some may be anticipated and precautions taken to minimise their effects. The research literature may not keep abreast of change in rapidly-developing areas.

Eclampsia is responsible for more than 50,000 maternal deaths a year worldwide. The strong correlations between standard of living and prevalence of eclampsia (and severe pre-eclampsia) suggest the importance of nutritional factors in the genesis of this disease. Yet most studies are conducted in developed countries. They investigate mild forms of the disease and ignore nutritional factors (apart from a small number of studies investigating the effects of micronutrients). They cannot help moderating the rates of maternal deaths and infant morbidity. They have not lead to significant advances in our understanding of the pathophysiological processes. This is why there is an urgent need for studies of nutrition in pregnancy among at-risk populations with low standards of living.

The current project is to evaluate the effects of supplements of tinned sardines, given as early as possible in pregnancy, on birth outcomes in a low-income population in the peripheral part of Rio de Janeiro, Brazil. This trial, conducted by two Brazilian nurse-midwives, will take place at the Alexander Fleming hospital (and in the attached birthing centre founded by nurse-midwives), in a poor district of the city. In that hospital, where the number of births a year is around 5,600, eclampsia is still common (about four cases a month).

Women in the study group will be offered a sardine sandwich once a week. This will be eaten in the meeting room of the hospital. Women in the control group will be offered a mussarella cheese sandwich once a week. One of the objectives is to test the hypothesis that eclampsia is the expression of a conflict between mother and fetus, assuming that meeting the specific nutritional needs of the fetal developing brain is a priority among humans. Sardines provide a good balance of all the nutrients that meet the needs of human brain. The rates of pre-eclampsia are exceptionally low in populations with high sea fish consumption.

Brazil, characterized by a low per capita fish consumption (6.5 kg yearly), is an appropriate place for such a study.

This project might inspire similar projects among other at-risk populations.