Diminished hyperaemic response of the hepatic artery to portal venous occlusion (the buffer response) in Asian hybrid minipigs: a comparison of the response to that observed in dogs

This study is part of a larger study of the effect of integrity-promoting care in a Swedish nursing home ward. Compared with assessments on a control ward, improvements were found in the patients' behaviour and in the quality of care after a three-month intervention period. This paper reports on parts of a questionnaire survey on the nursing staff's opinions of their working conditions and demented patients. Most staff members on both the intervention ward and the control ward found their jobs meaningful, engaging and stimulating, but they also felt that they had a heavy work-load. Most of the staff members experienced mental strain because of the patients' disturbed behaviour. Many did not think that the care on their ward would have been good enough for their own close relatives, if they had been suffering from dementia. Only slight changes were found in the staff members opinions after the intervention.     

Expression of IGFs and their receptors is a potential marker for embryo quality

This paper is based on a one-year ethnographic study that focused on nurse-patient relationships on a ward where therapeutic nursing and professional autonomy were explicit nursing goals. Through participant observation and semi-structured interviews, it was found that nurses, as a team, adopted a highly relaxed form of posture. Their informal and open stance served to emphasize their 'closeness' with patients, supporting nurses' claim of a special role in the healthcare team, and making flesh some of the differences between nursing and medical roles. The interpretation of nurses' bodily practice rested in part on the meanings given to the ward space patients felt the ward to be a private domain in which nurses' informality endorsed their sense of being cared for as if by family, while for medical staff the ward remained a public space in which female nurses tacitly challenged their authority as men through the adoption of a masculine bodily praxis. The paper thus looks at links between the gendered body, the gendered professions of medicine and nursing, and the gendered nature of space. It argues that work on occupational closure has previously privileged the discursive, and suggests that understanding how nurses arbitrate professional boundaries in everyday practice will benefit from consideration of the nurse's body as a point of political resistance.     

Dying and death in an acute-care medical hospital

Nowadays, more people seem to die in hospitals or other establishments than in their own homes. The following paper reports on 50 consecutive cases of death that occurred in a clinic of internal medicine. The analysis concentrated on the circumstances, the symptoms and the treatment of the patients during the 12 h. preceding and immediately before death as well as on the opinion of the relatives and the attending staff. A questionnaire registered the different opinions. Nearly a third of these deaths occurred after a fairly short hospitalization time. Death was not always the result of a long illness and it involved also young people. Most of the patients died in their hospital room, in the presence of their relatives and/or of the attending staff. They were mostly unconscious during the moments preceding their death. Terminal symptoms such as pain, anxiety, shortness of breath or thirst were largely kept under control. The relatives and concerned people were, as far as possible, informed about the grievance and the fatal issue of the patient's illness. Their reactions were diverse. Most relatives were satisfied with the treatment and care given to the hospitalized patient. The doctors and nursing staff considered their working together as being better than usually expected. Clear therapeutical concepts, appropriate palliative care as much as optimal communication are important requirements for a good treatment of the dying. The following results allow us to question many a prejudice concerning death in a hospital surrounding, but also show us possibilities of improvement. So we should sometimes question ourselves about the sense and the need of certain nursing interventions. We should spend more time during our medical training on the question of palliative care and on the problem of the relationship of doctors to death and to the dying. We feel that establishing a "science of death" or a segregation of the dying in specialized institutions makes no sense.     

Failure of pain relief after surgery. Attitudes of ward staff and patients to postoperative analgesia

Three surveys of postoperative patients and surgical ward staff were conducted in an 840-bed university hospital to ascertain the severity of pain after surgery and the reasons why patients in pain do not receive more of the analgesia prescribed for them. In the first survey, 206 inpatients were questioned within 24 h following operation, and 25.2% of patients experienced moderate pain whilst 9.2% experienced severe pain but received only 36% of their prescribed analgesics. In the second survey, 176 staff reported that the commonest reasons why patients in pain did not receive analgesics were that they did not request analgesia, were too sleepy or refused the dose. In the final survey, of 200 inpatients questioned, 88% had experienced pain since operation, 97% had been offered analgesics, 14% refused a dose. Twenty-nine percent were moderately or very concerned about injections. The beliefs of both ward staff and patients could have contributed to this failure of pain relief.     

Re-examination of topographic distribution of thalamic neurons projecting to the caudate nucleus. A retrograde labeling study in the cat

This article aims to identify and describe the ethical dilemmas that are involved in the care of patients with incurable cancer. The data were collected in semistructured focused interviews with 32 patients, 13 nurses and 13 doctors from two central hospitals and four community health centres. The interviews were tape-recorded and transcribed verbatim. Interpretation was based on the method of content analysis. Ethical dilemmas occurred at the time of diagnosis, in connection with telling the truth, in providing information, in the treatment of pain, and in decision-making situations concerning active treatment. Dilemmas of active treatment concerned chemotherapy, intravenous infusions, blood transfusions and antibiotics. There were also problems in relationships between nursing staff and next of kin, as well as a lack of co-operation between nurses and doctors.     

A quality review of high-dependency patient care

In order to develop strategies to improve high-dependency (HD) patient care, a continuous quality improvement (CQI) study was initiated in August 1994. It sought to establish a system for the collection and evaluation of relevant information concerning medical and nursing management of HD patients. This CQI study followed a high-dependency areas needs analysis undertaken in January, 1994. Conducted over a 12-week period (August-October, 1994) the CQI study involved 92 HD patients who required cardiac and/or respiratory monitoring. The study revealed a low HD bed occupancy rate, inadequate documentation by medical staff of the need for monitoring, and insufficient numbers of nursing personnel specifically educated to care for HD patients. Recommendations include increased consultants surveillance, immediate assessment of HD patients by a medical officer on the ward, a documented plan for monitoring, avoidance of after-hours discharge from operating theatres or intensive care, and the implementation of an education program for HD area nurses.     

The observers and the observed: The effects of doing ratings on staff-patient contact patterns.

On a research ward where nursing personnel have both research and clinical responsibilities, the effect of staff's rating of patients' behavior on frequency of contacts was assessed. Percentages of staff's contacts with patients and with other staff were compared on days when the staff was doing the ratings with days when it was not. There were no differences in the percentage of interactions with patients on rating and nonrating days. There were more interactions with staff on rating days. This finding suggests that although doing rating did not interfere with patient-staff relations, the increase in staff-staff contacts might be due to rating staff obtaining more information upon which to base their ratings by talking to other staff members. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

General satisfaction and satisfaction with nursing communication on an adult psychiatric ward

A client satisfaction survey was undertaken on an adult psychiatric admission ward in Sheffield, England, being sent to all clients discharged from the ward over 12 months. The questionnaire consisted of a general satisfaction element, and two questions asking about satisfaction with nursing communication. The response rate was 81 from 199 forms sent. General satisfaction levels were lower than for a sample of 3120 mainly out-patient psychiatric clients in the USA. Satisfaction with nursing communication was significantly correlated with general satisfaction. The survey allowed the number of dissatisfied clients to be identified, and their views highlighted. One aspect often reported by dissatisfied clients was a perceived lack of time from staff. The importance of nursing communication with respect to client satisfaction is highlighted by the study.     

An efficient system for controlled distal colorectal irrigation

We have found this setup to be most useful. For those surgeons who incorporate rectal irrigation as part of their treatment plan for patients with rectal injuries, we would recommend trial of this simple yet effective technique. The more senior anesthesia and nursing staff who have suffered through the vagaries of widespread fecal contamination from the beginning to the end of the operation rapidly become advocates of this procedure.     

Record-keeping and routine nursing practice: the view from the wards

This paper examines general nurses' views of the nursing record and its routine usage in contemporary hospital practice. It draws on ethnographic data generated on a surgical ward and a medical ward in a single District General Hospital in the United Kingdom (UK). A key research finding was ward nurses' equivocal attitudes to the nursing record. On the one hand, because of its links with the nursing process, the nursing record was highly valued as a symbol of professionalism and ward staff were loathe to criticise it directly. On the other hand, however, the nurses in this study clearly found it difficult to reconcile their professional ideals with the ways in which the nursing record was routinely employed on the wards. In this paper it is suggested that at one level, nurses' ambivalence towards the nursing record reflected the distortion of its founding philosophy by the new managerialism in the contemporary UK health care context. At another level, however, there are also difficulties which arise from the tension between the assumptions about the nature of nursing work which underpin the nursing record and the workplace reality on hospital wards.     

A multiregional study of nurses' beliefs and attitudes about work safety and patient assault

OBJECTIVE: The study attempted to increase understanding of nursing staff members' beliefs and concerns about work safety and patient assault. METHODS: A study conducted at a university-affiliated psychiatric facility in California in the late 1980s was replicated in five other psychiatric settings. Data were collected using the Attitudes Toward Patient Physical Assault Questionnaire, containing 31 statements designed to elicit nurses' beliefs about safety concerns, staff performance, and legal issues related to assaults. RESULTS: A total of 557 nursing staff members at the six sites responded to the questionnaire; 84 percent were female. The majority (76 percent) had been physically assaulted at least once, but 71 percent reported feeling safe in their work environment most of the time. Compared with female staff members, males tended to believe that assaults were to be expected, that assaulted staff have personality traits that make them vulnerable to assault, and that legal action against assaultive patients might jeopardize their jobs. Recently hired staff were more confident that their facilities did not admit unmanageable patients and that the environment was adequate to prevent assaults. Staff who had been assaulted more frequently tended to believe that assaults were to be expected. CONCLUSIONS: The study highlights a nationwide concern among nursing staff about safety. Ensuring a safe working environment requires better training, more adequate staffing, and a security plan to protect staff, patients, and others.     

Spirituality and the treatment of the dually diagnosed: an investigation of patient and staff attitudes

Spirituality is a neglected area of study and research in the treatment of addictions. The role of spirituality in the treatment of the dually diagnosed has received particularly scant attention. One hundred and one patients on an in-patient dual-diagnosis unit, as well as the 31 members of the nursing staff who treat them were surveyed. Patients and staff were questioned about their spiritual beliefs and what was the role of spirituality in the patients' recovery from addiction. Staff were questioned about their own spirituality and what they think the patients' level of spirituality is. In addition the staff were asked what they think the patients' view of spiritually is. Results indicate that the patients and staff are equally spiritually oriented. The patients view spirituality as essential to their recovery and value spiritual programming in their treatment more than some concrete items. The nursing staff underestimated both the patients' level of spirituality and this importance placed on spiritual issues. The authors suggest that more attention should be given by staff to spirituality in the treatment of this population.     

Managing problem behaviors of elderly patients

Professional as well as nonprofessional staff who work with the elderly in nursing homes must be reminded repeatedly that most problem behaviors are symptoms of such underlying problems as unresolved conflicts, the loss of normal, appropriate life roles, and the anticipation of illness and death. The author describes how those problems are reflected in such "senile" behaviors as incoherence, incontinence, ritualism, and inappropriate sexual behaviors. She believes the concept of personality regression under stress is a useful framework for helping staff understand and manage such behaviors. She illustrates how nonprofessional staff can help patients achieve a more satisfactory adjustment by using certain behavior modification techniques, by roleplaying, and by identifying feelings responsible for porblem behaviors and helping patients ventilate them.     

Good practice in the management of adults with malignant cerebral glioma: clinical guidelines. Working Group, Royal College of Physicians

This paper proposes guidelines for good practice in the management of adults with malignant cerebral glioma. These guidelines were developed by a working group comprising representatives of the medical specialties involved in patient care, specialist nursing staff, purchasers, charitable bodies, and patient and relative representatives. Both the research literature on the effectiveness of medical intervention, and the views of patients and relatives about the care they had received were considered. The document proposes a consensus view about ways to improve patient care and considers several stages of the illness and its care: I, the diagnostic phase; II, deciding on an appropriate treatment plan; III, the organization of follow-up services; IV, the management of transitions from hospital to community settings; and V, purchasing care for patients with malignant brain tumours. An audit package derived from the guidelines is available which will enable staff within a treatment centre to compare their practice against these standards. A final section suggests topics which require further research, and sets out the core requirements for studies that will help answer questions about treatment and the benefits for patients in terms of improved quality of life.     

Experiment in managing sociopathic behaviour disorders

A ward catering for both sexes admitted patients with aggressive suicidal, or otherwise disturbed behaviour for observation and treatment until decisions could be made about their long-term needs. Patients were referred from the police, special hospitals, and the courts and some were transferred from other wards in the hospital. A third of the first 100 patients were admitted for forensic reasons. Twelve inmates were discharged to long-term accommodation for disturbed patients. The ward was intended to provide fairly short-term accommodation, though no time limits were set, and it was run as a medium secure unit. The ward was run by 16-18 nurses with support from medical teams, occupational therapists, and clinical psychologists. It has secured its status as a special unit within the hospital and will continue with the active support of the hospital staff.     

Quantitation of change in the medullary compartment in renal allograft by ultrasound

PURPOSE: This study was completed to determine the current knowledge and documentation patterns of nursing staff in the prevention of pressure ulcers and to identify the prevalence of pressure ulcers. METHODS: This pre-post intervention study was carried out in three phases. In phase 1, 67 nursing staff members completed a modified version of Bostrom's Patient Skin Integrity Survey. A Braden Scale score, the presence of actual skin breakdown, and the presence of nursing documentation were collected for each patient (n = 43). Phase II consisted of a 20-minute educational session to all staff. In phase III, 51 nursing staff completed a second questionnaire similar to that completed in phase I. Patient data (n = 49) were again collected using the same procedure as phase I. RESULTS: Twenty-seven staff members completed questionnaires in both phase I and phase III of the study. No statistically significant differences were found in the knowledge of the staff before or after the educational session. The number of patients with a documented plan of care showed a statistically significant difference from phase I to phase III. The number of patients with pressure ulcers or at risk for pressure ulcer development (determined by a Braden Scale score of 16 or less) did not differ statistically from phase I to phase III. CONCLUSION: Knowledge about pressure ulcers in this sample of staff nurses was for the most part current and consistent with the recommendations in the Agency for Health Care Policy and Research guideline. Documentation of pressure ulcer prevention and treatment improved after the educational session. Although a significant change was noted in documentation, it is unclear whether it reflected an actual change in practice.     

Swallowing problems in the nursing home: a novel training response

Various studies suggest that between 50% and 75% of nursing home residents have some difficulty in swallowing. Some of these residents are assessed and treated by speech pathologists, but many are managed by nursing staff without specialist input. A training program called Swallowing ... on a Plate (SOAP) has been developed by the Centre for Education and Research on Ageing and the Inner West Geriatrics and Rehabilitation Service to help address swallowing-related problems in local nursing homes (Inner West of Sydney, Australia). The training program teaches nursing staff how to identify, assess, and manage swallowing problems, including making appropriate referrals. Several new instruments were developed specifically for this program including two assessment checklists, a set of management guidelines, and a swallowing care plan. Evaluation of the program--including 3 months follow-up--showed it to be highly successful. A stand-alone training resource has been produced for wide distribution to help staff implement the program as a permanent aspect of their nursing care. This paper describes the development, content, presentation, resource, and evaluation of the above program.