Clinical effectiveness in nursing最新文献

Introduction

Cancer and its treatment place significant demands on the nutritional status of patients. This can be exacerbated by admission to hospital.

Study purpose

The study aimed to identify factors that are barriers and facilitators to oncology in-patients receiving adequate nutrition in an acute cancer unit.

Methods

Qualitative non-participant observational techniques were used to explore practice relating to nutrition. The study was carried out on two 30 bedded wards in a UK cancer centre. Five observations, each lasting three hours, were conducted on each of the wards.

Data analysis

Framework analysis techniques were used to analyse the data.

Results

Nutrition was influenced by a complex interaction of factors relating to both the physical and social environment. Characteristics of each of these were identified.

Conclusion

In the hospital setting nutrition takes place in a context that balances the needs of the individual patient with the needs of the organisation, the busyness of the ward and staff schedules. The ongoing formal and informal assessment of the range of barriers and facilitators to nutrition may influence nutritional intake. A positive and proactive culture around food may also be important.

This paper presents qualitative findings from a three year study which set out to develop and test a nurse-led strategy for improving the management of the conclusion of patients’ participation in early cancer clinical trials. Most previous research has concentrated on recruitment, obtaining informed consent, and ensuring participation in trials. This study focused on the management of trial conclusion, a neglected area. The strategy (trial exit interviews, written information and telephone follow-up) was evaluated through a randomised controlled trial that assessed its impact on, and effectiveness in improving, the trial conclusion experience. Outcome measures were patient perceptions of trial participation and conclusion, patients’ knowledge and understanding, psychological distress, satisfaction with the intervention and adjustment to no longer being in a trial. Data were collected through questionnaires, standardised psychosocial and patient-satisfaction measures, and in-depth interviews.

The findings reported in this paper relate to the data collected through in-depth interviews. The interview data showed that patients in the intervention group expressed fewer fears of abandonment at the conclusion of the trial, they appreciated being given feedback about the trial in which they had participated, expressed satisfaction with the exit interview, and derived a feeling of support from the follow-up telephone call. These findings support and illuminate other quantitative findings that we have reported elsewhere (Cox et al., 2005) and demonstrate that low cost, simple interventions can be effectively incorporated into practice.

The 2001 UK research assessment exercise (RAE) was explored for units of assessment (UoA) 10 (Nursing) and 11 (Other Studies and Professions Allied to Medicine). In nursing funding was the best predictor of high RAE ratings. Other factors that appear relevant are numbers of doctorates awarded and publications in prestigious journals and in those with high impact factors (IF). UoA 11 showed similar but not identical trends. Specific funding sources were more important than overall funds in UoA 11, and the journals with high ratings in UoA 10 did not necessarily score highly in UoA 11. Further the diversity of journals was higher in UoA 11.

Background

The benefits accruing from the provision of ongoing care and support for children with complex health needs in the community are well established with Diana Nursing Teams contributing to and filling gaps in existing service provision.

Methodology

The study aimed to explore the children’s/siblings’ perceptions of the (Salford) Diana Team. It drew upon participant inquiry and involved participant observation of the children’s activities. Data were generated by the children through informal peer interviews, photographs, and the development of scrapbooks containing poems, stories, drawings and other materials.

Results

Five families (ten children, aged 2–13 years old) participated in the study. Three key findings were constructed from the data relating to technical competence with the ‘sick’ child, the qualities and attributes that Diana nurses should (and should not) have, and the difference the Team made to the children and their parents.

Conclusions

The sick child’s siblings highlighted that attention to their needs was important. This study shows the value of including children within research about children’s services. It also highlights that children use parents as their gold standard for care and they are clear about the skills and attributes they value about ‘outsiders’ who provide care to their family.

Objectives

The aims of this study were to describe the characteristics of institutionalized older patients with delirium and to explore whether the factors associated with delirium differed according to the severity of the prior cognitive impairment of newly admitted older patients.

Methods

This is a secondary analysis study (cross-sectional) of institutionalized older patients newly admitted to an acute care hospital (n = 104). We screened patients for delirium upon their admission, using the Confusion Assessment Method.

Results

Of the 104 cognitively impaired older patients included in the study, 68% had delirium. We identified the following as characteristic of older patients with delirium: male sex (p = 0.0259), being admitted from a nursing home (p = 0.0269), lower MMSE score at admission (p = 0.0001), severe illness (p = 0.0001), lower functional autonomy (BI: p = 0.0001; IADL: p = 0.0089), bladder (p = 0.0018) and bowel (p = 0.0276) incontinence, and physical restraints (p = 0.0003). Apart from hearing impairment, we found that remaining factors were similarly distributed among older patients with mild, moderate and severe prior cognitive impairment.

Conclusion(s)

The severity of prior cognitive impairment does not appear to influence the distribution of the factors associated with delirium. Hence patients with severe prior cognitive impairment at admission to an acute-care hospital would not require preventive nursing interventions different from those for older patients with mild or moderate impairment.

Introduction

Constipation can be a predominant problem within health care. Within health-related literature there is no comprehensive tool for assessing risk of constipation.

Study purpose

Previous review of the literature had identified risk factors for constipation. The purpose of this paper is to report the development of a constipation risk assessment scale.

Tool development

Review of previous work demonstrates that there are various methods that can be adopted to enable development of an instrument. [DeVellis, R.F., 1991. Scale development. Theory and applications. Sage Publications, London] outlines a framework of tool development and this structure was followed in this study.

Scoring the risk factors

The research-validated independent variables for constipation were allocated a score that reflected their relative contribution to the development of constipation. The risk factors were then organised to produce a user-friendly comprehensive tool.

Content and face validity analysis

Following development of the tool, it was subjected to content and face validity analysis and the instrument modified accordingly.

Conclusion

This work appears to be the first within health-related literature that has extracted, organised and scored the risk factors for constipation in accordance with previous empirical research. Subsequent research is now required to assess reliability and further validity of this tool.