Nursing staffing, nursing workload, the work environment and patient outcomes

Nurse staffing (fewer RNs), increased workload, and unstable nursing unit environments were linked to negative patient outcomes including falls and medication errors on medical/surgical units in a mixed method study combining longitudinal data (5 years) and primary data collection.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Compassion fatigue in nurses

Compassion fatigue, trigger situations, and coping strategies were investigated in hospital and home care nurses. The Professional Quality of Life Scale measured compassion fatigue, compassion satisfaction, and burnout. Narrative questions elicited trigger situations and coping strategies. Compassion fatigue scores were significantly different between nurses who worked 8- or 12-hour shifts. Fifteen percent of the participants had scores indicating risk of the compassion fatigue. There were significant differences in compassion satisfaction, depending on the unit worked and time as a nurse. The most common category of trigger situations was caring for the patient. Work-related and personal coping strategies were identified.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Posttraumatic stress among mothers of very low birthweight infants at 6 months after discharge from the neonatal intensive care unit

This correlational study examined how mother's posttraumatic stress disorder (PTSD) symptoms are related to characteristics of the mother and her infant, as well as to mother-infant interaction and infant development, in 21 mothers of very low birthweight infants. Twenty-three percent of mothers scored in the clinical range on a measure of PTSD. How ill the infant was during the NICU hospitalization was related to mothers' PTSD symptoms. Mothers with greater PTSD symptoms were less sensitive and effective at structuring interaction with their infant. © 2011.

Website: https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

The “Big 5” and beyond: Nurses, paid carers, and adults with developmental disability discuss communication needs in hospital

Adults with developmental disability and little or no speech need to communicate with nurses in hospital to (a) express physical needs, (b) discuss health, (c) convey intelligence and emotions, (d) connect socially, and (e) control the environment. All stakeholders need access to a variety of communication strategies to support communication of these needs.

Website:https://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/ 

Availability of Obstetric And Neonatale Mergency Cares (Emonc) In Benin

Itis a descriptive, analytical and transversal study such as SARA (Service Availability and

ReadinessAssessment) which took place from January 1 to August 31, 2013. The sample consisted of health facilities in public and private sectors located in both urban and rural areas.

Results: The delivery services were available in 82% of health facilities (97.7% of hospitals, 92.2% of Health Centers (HC), 40.5% of Primary Care Centers (PCC), 86.1% of public’s health facilities have and 75.7% of private).Qualified personnel was available in 88.4% of health-centers. Parenteral administration of antibiotics, oxytocic and anticonvulsants were available respectively 94.2%, 94.2% and 76.1%. The assisted vaginal delivery, the manual removal of placenta and uterine evacuation maneuvers were respectively found in 42.6%, 88.4% and 54.8% of health facilities which practice birth. Neonatal resuscitation was available in 83.9% of facilities including all hospitals, 83% of HC and 47% of PCC. Only a quarter of institutions offering delivery (25.8%) were real BEmONC centers.Cesarean section was available in all hospitals and 3.2% HC. Blood transfusion was available in 25.8% of health facilities surveyed. Actual CEmONC health facilities represent 18.1% of all health facilities offering delivery services.

Conclusion: Efforts are still needed to ensure better availability of all EmONC functions to achieve the MDGs.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-gynecology/

Smoking cessation strategies may increase quit rates among adults of low socioeconomic status

·         Interactive technology can be used to engage low socioeconomic smokers in effective tobacco treatment outside of the traditional clinical setting.

·         Nurses should encourage all smokers to use evidence-based cessation strategies, including telephone-based counselling and pharmacotherapy.

·         More research is needed to address social and contextual factors impacting tobacco use.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Nurses experience feelings of disempowerment when caring for patients in severe pain

·         Protocols are required to enhance nurses’ lines of power when caring for patients in pain. This includes triggering a critical incidence when nurses struggle to control a patient's pain, thus mobilising senior medical staff and pain specialists to the patient's bedside.

·         Whether triggering a critical incidence in this context results in better pain care needs further evaluation.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Parents are psychologically affected by their experiences when their child is in hospital because of uncertainty about prognosis and anxiety at the time of admission

Post-traumatic stress symptoms are experienced by parents after a child's hospitalisation, even where the child's medical condition is not life-threatening.

Screening parents during admission for risk factors, such as anxiety and single parent status, may facilitate more appropriate targeting of support.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Goals of care are important for older adults with severe illness and their families, and are infrequently addressed by health professionals

Patients and families identify goals of care discussions as being essential and include preferences for care at the end-of-life, eliciting patient's values, disclosing prognosis, allowing expression of fears or concerns and questions about goals of care.

Healthcare providers often do not address guideline recommended elements of goals of care discussion, but when undertaken, patient satisfaction can improve.

Future research should examine the benefits of automatic triggers, variations of timing along the disease trajectory and interventions …

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Ateplase for ischaemic stroke: increased risk of intracranial haemorrhage is balanced by improved stroke outcomes, particularly if treated within 3–4.5 h of onset

Thrombolysis given to appropriate patients within 4.5 h of the onset of stroke symptoms increases the chance of a good outcome. The earlier it is given, the more likely it is to be effective.

Thrombolysis increases the risk of early death, but by 3–6 months mortality is equivalent in treated and untreated patients.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Heel stick test for obtaining blood samples in neonates: both swaddling and heel warming may help, but heel warming appears to provide greater pain reduction

Heel warming and swaddling are found to effectively reduce infant pain during heel stick tests for obtaining blood samples and can be used as pain interventions in routine neonatal practice.

The efficacy of swaddling and heel warming on neonatal pain can be added to the health professionals’ armoury for pain management in infants, especially in the intensive care environment.

The underpinning mechanisms of pain reduction by heel warming and swaddling may be different and need to be investigated in future studies.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Behavioural counselling improves physiological outcomes in those with cardiovascular risk factors

Clinicians need to engage community-based public health and other partners to deliver the intensity of diet and physical activity needed to have a positive impact on cardiovascular disease (CVD) risk.

More research is needed to identify the most efficient (cost and time) means of intervention delivery to achieve positive short-term and long-term impacts.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Clinically significant pain is experienced by just over a third of all hospitalised patients, affecting around a half of surgical and a quarter of medical admissions

Greater attention should be placed on assessing pain independently of vital signs, when there is evidence of pain that needs to be relieved.

Future research needs to examine the development and implementation of minimum standards for clinicians assessing and responding to pain in hospitalised patients.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

A nurse-facilitated cognitive behavioural self-management programme for heart failure is no more cost effective than usual CBT care

Using nurses to facilitate a cognitive behavioural therapy (CBT) based self-management intervention for heart failure patients is no more cost-effective than a CBT manual alone.

CBT self-management for heart failure patients may be more effectively delivered as part of collaborative care but this needs to be confirmed in future trials.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

A psychological intervention for family carers of people with dementia is clinically and cost effective at reducing carer depression and anxiety levels over 2 years of follow-up

The START (STrAtegies for RelaTives) intervention is easy to administrate, cost-effective and likely to enhance psychological well-being of family carers of people with dementia.

Training and monitoring of START therapists will be important when implemented by local mental health services.

Future research should evaluate carers’ increased positive behaviours as well as a reduction of psychological symptoms.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

The role of nursing unit culture in shaping research utilization behaviors

A hierarchical structure of authority, routinized and technology-driven work at the bedside, a workplace ethos that discouraged innovation, and an emphasis on clinical experience acted together to teach nurses both that they were to do as they were told and that they were not expected to use research. Nurses perceived that the behaviors expected of them were arbitrarily determined by physicians and managers in charge. Consequently, they were reluctant to step outside of routine and physician-ordered nursing care. This left little opportunity for research utilization.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Using saliva to measure endogenous cortisol in nursing home residents with advanced dementia

Two research teams determined the feasibility of saliva collection for cortisol measurement in nursing home residents with advanced dementia. Study aims were to:

(a) determine if sufficient saliva could be obtained for assay and

(b) examine whether cortisol values exhibited range and variability for meaningful interpretation. Useable samples were consistent across sites, suggesting that saliva collection for cortisol assay is a viable method in this setting. Cortisol values showed range and variability. More than half of the residents showed the normal adult pattern of high morning levels decreasing throughout the day. A third of the participants demonstrated an increase in the evening cortisol levels, while the remaining profiles were flat, suggesting hypothalamic-pituitary-adrenal (HPA) dysregulation in this population.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Home healthcare practice environment: predictors of RN satisfaction

Home healthcare nurses reported slightly lower satisfaction than hospital nurses and were approximately 50% less satisfied than they were in 2000. Satisfaction had a negative relationship with years worked as a home healthcare nurse (r= -.25, p< .01). Controlling for years of home healthcare experience, control over practice decisions and practice setting decisions were significant predictors of satisfaction. With the demand for home healthcare nurses expected to increase 109% by 2020, development of a National Database of Nursing Quality Indicators for home healthcare that includes satisfaction as a nurse-sensitive outcome might be helpful.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

The relationship of nursing staff to the hospitalization of nursing home residents

Although most nursing home admissions are from hospitals, their studies involved residents who probably were not admitted from hospitals. In this study I examined data on 6,623 discharges of nursing home residents admitted or not admitted from a hospital. For patients with longer stays (>30 days), higher RN staffing levels in nursing homes reduced hospitalizations only for residents admitted from hospitals. Higher RN levels reduced hospitalizations more than higher licensed nurse levels or skill mix. Only among longer-stay residents not admitted from hospitals was RN staffing unrelated to hospitalizations.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/

Metaphors in qualitative research: Shedding light or casting shadows?

Metaphors can be used to provide structure to the data; to understand a familiar process in a new light; to identify situation-specific interventions; and to evoke emotion. Misuse of metaphors may detract from the intended research message. Mixing metaphors, failing to follow through with metaphors, and using metaphors that do not fit the data can misrepresent the data. The choice to use metaphors should not become a self-serving attempt at creativity that supersedes subject and substance. At their best, metaphors illuminate the meanings of experiences; at their worst, metaphors distort or obscure the essences of them.

Website: http://www.arjonline.org/medicine-and-health-care/american-research-journal-of-nursing/