Clinical effectiveness in nursing最新文献

Assisted reproductive intervention is an increasingly popular choice following a diagnosis of infertility and has inspired researchers to consider the implications of successful treatment on families, both in the short and long term. A well functioning health care system will meet the global needs of the society it resources, including its relatively healthy population utilizing health care to improve the quality of their life through fertility treatment. This review addresses the welfare and needs identified in studies of parents and children following assisted reproductive intervention, in an attempt to determine if these are supported by the health or social care systems. The literature was searched using electronic databases and book searches. Few significant differences have been found between Assisted Reproductive Treatment (ART) families and naturally conceiving families and when differences were found they were generally within the normal range. Studies tended to be cross sectional rather than longitudinal, and evaluations of cultural differences are not reported. In general, research findings are reassuring to ART parents, their offspring, those considering assisted reproductive treatment and health care professionals. What is lacking is research into the functioning of couples giving up unsuccessfully.

Research across a number of disease-states has shown there is some discrepancy between how clinicians and “patients” rate their life situation. Thus it is important to assess the subjective views of the “patient”/client when evaluating the clinical effectiveness. There is now a body of work that attempts to do this under the heading of Quality of Life/Health-Related Quality of Life. In the field of alcohol dependency these types of study are in their comparative infancy. Quality of life (QoL) can be measured using condition-specific or generic tools (which can be used across different disease states). An attempt has been made to design an alcohol-specific QoL (Al-Qol-9) measure but it still needs a great deal of work before it can adequately capture the QoL of alcohol dependent individuals. This paper provides some pointers to the issues future QoL studies need to address. It concludes by suggesting how QoL measurement can be integrated into nursing research and clinical practice.

Background

There is clear evidence for the effectiveness of specific interventions for common mental health problems in primary care. A major challenge is the inflexibility of traditional approaches to respond to the sheer volume of need. Evidence for brief cognitive behavioural therapy (CBT) based guided self-help interventions is emergent and may offer a way forward in responding to the issues of volume and accessibility. We present, an evaluation of a training course designed to equip non CBT trained workers to deliver such interventions.

Process

Seventeen primary care mental health workers participated in a 10-day training course focussed on CBT based facilitated self-help approaches. Evaluation focussed on knowledge of CBT; acceptability/usefulness of the training; self perceived incorporation into participants’ clinical practice and perceived barriers to the use of the knowledge and skills acquired. Measures were administered pre and post training and 6 months later.

Results

Positive changes were recorded in knowledge, self rating of use of CBT techniques, usefulness of training which largly maintained 6 months after the course concluded. Perceived barriers to implementation of the intervention were noted particularly in the institutional domain and remained up to 6 months post the course.

Discussion

In this group of staff the training outlined was able to produce desired changes that were maintained. The degree to which these changes were responsible for improved access or effectiveness is beyond the scope of this paper. Further research is recommended in relation to the optimum level of training required to deliver effective brief interventions as part of a stepped system of mental health care.

Objectives

To evaluate the use of a combined strategy (a nurse opinion-leader; evidence-based guidelines; a staff education programme and a new recording system) for the implementation of multidisciplinary stroke assessment in an acute hospital setting as measured by the compliance of different professional groups.

Design

A quasi-experimental study design utilising a pre-test/post-test group.

Setting

Nine medical wards in a 600 bedded outer London Acute NHS Trust (without a stroke unit).

Participants

190 stroke patients (n = 98 pre-test vs n = 92 post-test).

Main outcome measures

Professional compliance with assessment guidelines documented in the new recording system.

Results

Pre-test compliance with guidelines (n40) ranged from 0% to 100% and post-test ranged from 23–100%. Significant improvements (p < .05) in compliance were found in relation to 25 guidelines and a significant decline was documented in four others. Comparison of pre vs post-test values demonstrated variable changes in compliance with guidelines across professional groups: medical (range −64–+23%); nursing (range +2–+74%); physiotherapy (range −15–+69%); occupational therapy (range 0–+34%).

Conclusion

The combined use of an opinion leader, guidelines, education and a recording system had a variable affect on compliance with guidelines; opinion-leadership appeared to have the most influence over compliance. The study design, and guideline specific features may have constrained changes in practice.

Few Quality of Life (QoL) instruments in use today were originally developed for older populations (75+). Information on their validity and reliability in this age group is sparse. The current study investigated the psychometric properties of the Life Quality Gerontological Centre Scale (LGC), a general QoL instrument designed for use among older people. A further aim was to describe and compare QoL with gender and in people needing help with Activities of Daily Living and those not needing such help. A postal questionnaire surveyed 1093 people (mean age 82.7, SD 5.3). Principal component analysis revealed that LGC was reasonably stable as the construct-and cross validation more or less replicated the suggested QoL factors. The instrument differentiated between needing help and not and between men and women. LGC needs further development with respect to reliability, face and content validity but is potentially useful as a diagnostic or an outcome assessment after interventions among older people. Individuals in need of help and women had lower scores in several QoL areas and in total QoL scores compared to those not needing help and men. Older people’s QoL may be improved by interventions directed to areas beyond health and physical functioning. Men and women might also benefit from different interventions directed towards QoL.

Objectives

Changes in cancer services to out-patient care have resulted in patients spending limited time in hospital. The use of IT within healthcare has seen the development of innovative ways to support patients in the community. This study aimed to test the procedures and technical systems involved in using an advanced symptom management system (ASyMS) in the home monitoring and symptom management of patients receiving chemotherapy.

Patients and methods

Ten patients were recruited from two centres in Scotland. Patients in the intervention group used the mobile phone to record and send their symptom reports to their hospital and receive self-care advice, while the control group received standard care. A risk model was developed which alerted health professionals of symptoms that were severe or life threatening. Patient and professional perceptions were evaluated throughout.

Main results

Patients believed that the ASyMS system improved the management of their symptoms and felt reassured they were being monitored at home. Health professionals also found the system beneficial in the management of symptoms and the promotion of timely interventions. The full randomised controlled trial is now underway.

Conclusion

The ASyMS system has the potential to improve the management of symptoms in patients with cancer receiving chemotherapy.

Background

The paediatric oncology community is focused on providing appropriate care to survivors of childhood cancer, given that despite increases in survival rates it is estimated that 60% will have one or more problems related to their disease or treatment. Agreement and consistency in how follow-up for this group of young people should be designed and delivered has not yet been reached and rarely have young people been asked to contribute to this discussion.

Methodology

The study aimed to find out what young people who are receiving long-term follow-up for childhood cancer would like from their follow-up service. It aimed to illuminate the dimensions of care valued by young people as well as make explicit to professionals health care needs that must be met to provide optimum care into their adult life. The emphasis was on qualitative, participatory methods using reflexive and responsive approaches to give primacy to the voice of participants. Data were generated through a series of workshops, interviews and questionnaires.

Findings

Forty young people (12 male: 30% and 28 female: 70%), participated in the study. Preliminary analysis yielded a descriptive typology that could serve as a basis for classifying and clarifying health care needs: defined as what the young people in this study wanted from a follow-up service. Five categories of health care need were identified: (i) need for a positive relationship with health care professionals; (ii) need for information; (iii) need for communication; (iv) need for parents to be supported; (v) need for health care professionals to have appropriate knowledge.

Conclusions and relevance to practice

Young people in this study were clear about the structure and process of a service that would meet their needs. Assembling data into a typology of health care need presents those delivering and commissioning services a tangible indicator of outcome that can be confidently described as what young people want from any current or future model of follow-up service.