Clinical effectiveness in nursing最新文献

Objectives

The purpose of the study was to refine and validate the self-medication risk assessment instrument for use as a reliable screening method to identify people who may have difficulty managing their medication safely. Specific objectives of the study were to demonstrate the reliability of the instrument.

Design

The study, using a correlational design, was designed to test inter- and intra-rater reliability of the instrument using a sample of 45 patients and 45 pairs of assessors. Each pair of assessors assessed the same patient on the same day and one of the original assessors returned to reassess the patient approximately one week later.

Setting

The data collection took place in Acute medical and Community Rehabilitation settings and via Community Nursing, Pharmacy and Social Care staff in Hull and the East Riding of Yorkshire.

Participants

45 patients and 45 pairs of assessors from Nursing, Pharmacy and Social Care backgrounds.

Main Outcome measures

Reliability of the instrument when used by different and same assessors and identification of key risk factors related to self-medication risk assessment.

Results

The instrument has demonstrated strong inter- and intra-rater reliability for both outcome of assessment findings and risk category. Three key elements of the assessment criteria, mental state, attitude and knowledge about medications and severe visual impairment demonstrated a high level of criterion validity.

Conclusion

The self-medication assessment instrument shows promise in terms of reliability but further testing is required to demonstrate its validity and the possible weighting of individual items in the instrument.

Objective.

The relationship of self-esteem to other indicators of psychological distress such as anxiety and depression has seldom been explored in relation to antenatal care. However, there is increasing evidence that low self-esteem has a significant negative impact on a variety of health outcomes during pregnancy and following delivery. The current study investigated the predictive ability of self-esteem, assessed by self-report questionnaire, in predicting the psychological status of women early in pregnancy.

Design.

A cross-sectional study design was used with all observations taken on one occasion.

Setting.

Participants were recruited from two hospital antenatal clinics and a community antenatal clinic.

Participants.

A convenience sample of 129 women recruited consecutively from the above settings at 14 weeks gestation.

Main outcome measures.

The adult version of the Culture-Free Self-Esteem Inventory version 2 (CFSEI-2) and self-report measures of anxiety and depression.

Results.

Personal self-esteem was found to be a significant predictor of psychological status in terms of both anxiety and depression.

Conclusions.

It is concluded that self-esteem is an easily assessed, but clinically useful psychological domain that health professionals should consider during their encounters with this clinical group.

A mental health needs assessment scale (MHNAS) was designed for use in prisons.

The new tool was based on the Camberwell Assessment of Need (CAN) with many items considered irrelevant removed, the coding simplified, and open responses added.

The new tool was more acceptable to prisoners and mental health staff. The tool had high internal reliability and showed face, content and convergent validity. A factor analysis suggested two dimensions, substance abuse and other mental health symptoms.

Objective

Screening for psychological disturbance during pregnancy is clinically desirable, however the current battery of brief screening instruments have limited utility in this group. A short-version of the General Health Questionnaire (GHQ), the GHQ-8 comprising two sub-scales has recently been developed. The current investigation sought to determine if common covariates (age and level of education) impacted on item responsiveness within the two GHQ-8 sub-scales.

Design

A cross sectional design was used with GHQ-8 item scores, age and level of education as dependent variables evaluated within a structural equation model.

Setting

Women in the third trimester of pregnancy recruited from one obstetric out-patient clinic of a public teaching hospital in Hong Kong.

Main outcome measure

The 8-item GHQ-8 [Kalliath, T.J., O’Driscoll, M.P., Brough, P., 2004. A confirmatory factor analysis of the General Health Questionnaire-12. Stress and Health 20, 11–20].

Results

The GHQ-8 was shown to have good factorial validity, however, one of the GHQ-8 items in the social dysfunction sub-scale was found to be differentially influenced by age.

Conclusions

The GHQ-8 may have to be revised, or age-normed cut-off scores developed, in order to prevent screening accuracy of a clinically-applied version of the instrument being compromised by the age of the individual being screened.

Objective

Metabolic control is believed to be central to positive clinical outcome in patients with diabetes. Empowerment has been linked to improved metabolic control in this clinical group, though such a relationship remains equivocal. The current study sought to determine if patient empowerment predicted metabolic control.

Design

A cross-sectional study design was used with all observations taken on one occasion.

Setting

Participants were assessed at a diabetes specialist out-patient clinic.

Participants

189 patients participated in the study. The majority of patients had type 2 diabetes mellitus (N = 158, 84%).

Main outcome measures

Empowerment was assessed using the Chinese Diabetes Empowerment Scale. Metabolic control was assessed by reference to blood HbA1c levels.

Results

C-DES sub-scale scores explained little variation in HbA1c levels.

Conclusions

There appears to be no relationship between patient empowerment and metabolic control in this clinical group. Nurses working within an empowerment model with patients with diabetes should be aware of a possibility of a non linear relationship and the complexity involved in maintaining good metabolic control.

Objective

This study explored older non-English speaking German clients perceptions of the care they received from nurses during time spent in an acute hospital.

Methodology

The study used a phenomenological approach to interview six participants who had spent time in a hospital in the last five years.

Setting

The participants in the study were German-speaking people residing in the New South Wales Southern Highlands, Australia.

Main outcomes

The theme ‘Nursing for the Masses’ which emerged from the analysis is the focus of this paper. Nursing care was portrayed by the participants as a broad, distant and generalised approach to client care. The perceptions of care of Non-English Speaking Background (NESB) German patients were highlighted thus enabling nurses to better assess their own care delivery and its effectiveness.

The objective of this literature review is to explore the use and effectiveness of touch as a distinct aspect of nurse patient communication. Nurses’ use of touch, the impact of touch and the experiences of touch are explored. Touching is a regarded as a special type of non-verbal communication. It is an intimate action that implies an invasion of the individuals’ personal and private space. The practice of nursing involves a high level of human contact encompassing many activities such as bathing a patient, that require a physical aspect in their operation. Touch has been muted as a valuable channel of non-verbal communication in nursing and students are advised of its potential theoretical benefits to clients. Touch has been linked to the phenomenon of caring [Clifford, C., 1995. Caring: fitting the concept to nursing practice. Journal of Advanced Nursing (4), 37–41; Chang, S.O., 2001. The conceptual structure of physical touch in caring. Journal of Advanced Nursing 33(6), 820–827; Bassett, C., 2002. Nurses’ perceptions of care and caring. International Journal of Nursing Practice 8, 8–15] and is suggested to enhance the nurse patient relationship [Arnold, E., Underman Boggs, K., 1999. Interpersonal Relationships. Professional Communication Skills for Nurses. third ed. W.B. Saunders Company, London]. However, the evidence base for this practice is less convincing. The objective of this review is to explore the evidence base that underpins the use of touch in nursing practice and use this knowledge to inform practice. The main objective of the review is to examine the use and clinical effectiveness of touch as a nursing intervention. Little empirical evidence exists that supports the use of touch as a nursing intervention per se, and ambiguity exists with regard to its perception by both patients and nurses. Widespread adoption of touch as a caring intervention is discouraged in the absence of research evidence and clear guidelines for practice.

Hollins Martin [Social influence effects on midwives’ practice. Presentation at the British Psychological Society Social Psychology Section Annual Conference, 10th–12th September, 2003: London] developed the Social Influence Scale for Midwifery (SIS-M) to measure social influence of a senior midwife on a junior midwife’s decisions. First, midwives were asked to answer SIS-M questions in a postal survey. Second, in interviews, a senior midwife attempted to influence SIS-M responses in a conformist direction. The results of the Hollins Martin (2003) study showed that a senior midwife was able to significantly influence change to many midwives decisions, F(1,57) = 249.62, p = 0.001. The present study aims to ascertain whether decision changes were caused by social components of the relationship between interviewer and interviewee, or education shared during discussion. This is achieved by removing social influence of the senior midwife at interview. For this purpose, a workbook was devised that replicated the exact content of interview. This workbook was posted to a differing group of 60 midwives, who had also previously completed a private postal SIS-M. Overall, analysis of variance (ANOVA) showed no significant difference between the postal workbook scores and the private SIS-M scores, (F(1,57) = 0.31, p = 0.58). In other words, participants gave similar responses to the SIS-M questions in the workbook as the private postal condition. Results exclude possibility that education during the Hollins Martin (2003) interviews adjusted participants’ schema in relation to decisions made. Furthermore, this indicates that the social relationship, in part, caused the large social influence effect during interviews. The implications for practice are: first, that a senior midwife is profoundly capable of influencing decisions that junior midwives make; second, educational content plays little part in this process. Moreover, many of the SIS-M decisions should not be the choice of a senior midwife, but the preference of the childbearing women.