The needs of relatives during the patient's stay in intensive care following routine cardiac surgery

The review outlines and discusses the original study carried out by Molter (1979) which explored the needs of relatives in the intensive care setting. It explores studies which have replicated and developed the knowledge generated by Molter's study in both USA and UK. The needs of relative are endless and individual and must be set within the context of the family. There appears to be some dissonance between relatives' perceptions of their needs and nurses understanding and ability to meet their needs. Communication and creation of a therapeutic relationship between nurses and relatives is fundamental to the provision of holistic care. There are few studies which have focused on relatives within the cardiothoracic intensive care setting.     

A triangulation approach to the identification of acute sector nurses' training needs for formal nurse practitioner status

The current confusion surrounding the definition and role function of the nurse practitioner (NP) has created a situation in which advanced clinical practice is delivered in a variety of ways and at many levels. Not surprisingly, this has led to difficulties in regulating educational provision for NPs. This study reports a survey of the perceptions of the role definitions and training needs of all nurses working at advanced clinical levels within an acute sector Trust. Although this concept is not a novel one in advanced nursing practice, the procedure adopted differed from previous studies in two fundamental ways: firstly, a unique training needs assessment instrument was used, which because of its validity and opacity, was capable of yielding a highly reliable data-base, comprising a prioritized profile of real training needs as opposed to the standard wish-list typically elicited. Secondly, it did not rely simply on the self-reported needs of the nurse sample, but also included the perceptions of the sample's immediate medical and managerial colleagues. In this way, a triangulation paradigm was adopted. The results indicated that overall, there was high agreement between the nurses and their managers, regarding both the definition of the NP role and the essential training requirements, with somewhat different opinions being offered by the medical staff. When the raw scores were standardized to correct for response bias, the data provided an operational definition of the role of the NP and a prioritized profile of training needs for nurses who wished to train to this level.     

Primary healthcare workers: training needs in mental health

Particular attention is currently being given to the role of primary healthcare workers in supporting people with mental health problems in primary care (McFadyen et al, 1996). The aim of this study was to survey the views of primary healthcare workers regarding their previous mental health training and to identify their current perceived mental health training needs. A sample of 200 primary healthcare workers within Trent Health Region were interviewed using a short semi-structured interview schedule. Forty-six completed questionnaires were also received. An additional 22 respondents participated in exploratory in-depth interviews. Respondents included GPs, health visitors, practice nurses, district nurses, midwives and community psychiatric nurses. The need for further training in communication skills, particularly basic counselling skills, was highlighted. Respondents also perceived a need for additional training in coping with their own personal stress, the assessment and treatment of depression and stress/anxiety management in clients. Several themes which developed from the research were explored, including communication skills training, problems with collaborative working, coping with personal stress, the prevention of burnout and depression training. The reason why some respondents had no mental health training needs whatsoever was also addressed.     

Teenage health and the practice nurse: choice and opportunity for both?

Teenage health issues and the means to address them have caused increasing concern over recent years. This study investigated the involvement and training of practice nurses, the topics raised during consultations with teenagers, and the comfort of the practice nurses in dealing with these topics. Data were collected using a postal questionnaire survey (response rate 80.6%). Expansion of the role of the practice nurse in teenage health may be appropriate but needs to be supported by training.     

Microscopical imaging of hydroxyapatite/mica composite and packed hydroxyapatite structure--an atomic force microscopy investigation

A focus on the importance of leisure in the development of student nurses has been neglected in the 1990s. This study considers 444 prospective nurses on conventional, diploma and degree courses in two areas of England. It examines their activities associated with socializing, their social support networks and their use of clubs, sports and hobbies before entering nursing. It is evident that students enter nurse training with a wide variety of leisure experiences. Changing recruitment patterns and the structure of nurse training has an effect on the leisure needs of prospective nurses which must be addressed.     

The management of bereavement on intensive care units

OBJECTIVE: To investigate the management of the bereaved on Intensive Care Units (ICU) throughout the United Kingdom, and to identify inadequacies that may exist either in the provision of staff training in dealing with bereavement or in the facilities or support available for the bereaved. DESIGN: Questionnaires were sent to the senior nurse and senior doctor in all general ICUs with more than four beds nationwide. The questions asked about nursing and medical practice around the time of a patient's death, as well as about staff attitudes towards, and training in, dealing with bereavement and the support they received for this role. RESULTS: We obtained a 68% (293/430) response rate. Most ICUs had facilities for relatives, but little for the specific needs of the bereaved. Only 6% of doctors and 21% of nurses had training in dealing with bereavement and grieving. A staff support group was available in 23% of ICUs, and 75% of the remainder thought it would be useful to have one. Lack of staff training and poor facilities for relatives were identified as the major concerns of ICU staff. CONCLUSION: Many doctors and nurses working in Intensive Care Units feel inadequately trained to deal confidently with the bereaved. A minority of ICUs have support mechanisms available for their staff, inspite of the perceived need for them. Furthermore, many ICU staff feel the facilities they are able to offer the bereaved are inadequate. We have identified the major inadequacies and the needs of ICU staff for improved training. Meeting these needs would play a significant role not only in reducing staff stress but also minimising the morbidity in surviving relatives.     

Improved surgical technique for the establishment of a murine model of aortic transplantation

The Scope of Professional Practice states that nurses may respond to the needs of patients by expanding their practice. Performing skin biopsies for cancer diagnosis is one such area. The provision of appropriate education, training and updating is essential. Clear guidelines for practice are required for all such procedures.     

General practitioners' opinions of continence care training

AIMS: To examine general practitioners' confidence in the diagnosis and management of urinary incontinence, to define their unmet continence training and educational needs, and to evaluate the current provision of continence care in general practice, including the role of practice nurses. METHODS: A pre-tested postal questionnaire was sent to 600 general practitioners throughout New Zealand to obtain information about their demography and training in incontinence management, their confidence in diagnosis and treatment, and their perceptions of met and unmet educational needs in continence care. They were also asked about current provision of continence promotion in their practice and their views on the role of practice nurses in caring for incontinent patients. Confidence data were recorded on five point scales and analysed using chi square tests. Cluster analysis was used to describe groups with different opinions on practice nurses' roles. RESULTS: The response rate from eligible contacts was 81.3%. Although most respondents provide continence care, only 2.6% offered special clinics for continence promotion. Fewer than half felt confident to diagnose the causes of incontinence. Confidence in managing incontinence in children was consistently lower than for other incontinence presentations. There was no difference by sex in confidence in caring for incontinent patients although female respondents were more likely to consider management of continence care part of a practice nurse's role (chi 2 = 47.5, p < 0.01) and to routinely ask well women about incontinence (chi 2 = 243.6, p < 0.01). Most respondents (71.9%) could not remember having had any formal training in the management of incontinence at either undergraduate or postgraduate level. Recall of postgraduate education was associated with greater levels of confidence in management of continence problems. There was general agreement that it was appropriate to include training in continence management in vocational and continuing medical education. CONCLUSION: A substantial proportion of general practitioners perceive a lack of adequate medical training in incontinence care at both undergraduate and postgraduate levels. There is a need for improved education for both general practitioners and practice nurses.     

Graduate nursing education: developmental disabilities and special health care needs

As children and adults with developmental disabilities and special health care needs are integrated into home, school, and community life, nurses are being required to provide leadership, advocacy, and training in community settings to a much greater extent than in the past. To assess the school and community need for formal graduate preparation for nurses who work with individuals with developmental disabilities and/or special health care needs, 25 nurses in leadership positions representing urban and rural health agencies throughout Minnesota took part in a 5-hour focus group discussion. Analysis of data summarized from this process shows five features of the recommended curriculum necessary for advanced practitioners in this specialty area: (a) discipline-specific core competencies, (b) discipline-specific specialty competencies, (c) genetic competencies not specific to nursing but necessary to function in nursing roles, (d) interdisciplinary and intradisciplinary learning experiences, and (e) clinical experiences with preceptors. The authors recommend the development of interdisciplinary graduate programs designed to prepare nurses to assume leadership roles in school health, public health, home health care, and systems management that will affect public policy and, ultimately, promote change in the systems charged with responsibility to serve this population.     

Challenges associated with assessment of risk for tuberculosis in a dental school setting

The Ballarat Health Education Forum has the express purpose of identifying and responding to the educational needs of registered nurses (RNs) in western Victoria. Since the senior nurse members of the forum believed that there was a strong need for management education amongst the nurses involved in middle management in the target region, the total nursing population was surveyed to determine if that perception was shared by RNs themselves. Results of the study confirm that educative programs in management are viewed as a high priority for the professional development of nurses but that family and work commitments are dominant factors which hinder participation. It is argued that education for the managerial role into which many nurses are thrust is sporadic and bereft of appropriate content. Background to the issue of management skills and training among RNs is provided and survey methodology and outcomes are described. The paper discusses the implications of survey outcomes and makes recommendations based on findings.     

Evidence-based care: can we overcome the barriers?

Evidence-based care has become the new mantra within the NHS, despite the fact that the concept of applying research to practice has been promoted for several decades. However, literature on the subject suggests that formidable obstacles remain to the integration of research into care delivery. This article describes a study which used Funk et al's (1991a,b) Barriers Scale with a population of nurses in a large teaching hospital in the UK. This scale was specifically developed to identify barriers to the introduction of research into practice, and modified for a UK context. The results suggest that a complex array of barriers exist but that foremost among these is the nature of the organizations within which nurses work. Comparisons are made with data from the USA, and the need to create time for nurses to implement change, and to empower them to do so, is stressed.     

High pressure areas

The study highlighted the extent of occupational distress in a group of nurses in an NHS hospital trust. The levels of distress were similar across settings and similar to levels identified in current NHS-wide studies. Levels of work pressure and emotional exhaustion were higher than previous UK norms. High levels of distress were associated with younger age, high work pressure and low social support. For general mental well-being individual factors, such as satisfaction with social support, were more predictive than organisational factors. For work-specific distress, factors in the work environment, such as work pressure, patient contact and task orientation, were more important. Strategies for addressing the needs identified were reviewed and are now being implemented.     

Transcultural therapy. 1: Mental health and learning disabilities

In this article, the first of two parts, the issues surrounding healthcare provision are discussed in the context of the UK as a multicultural society. Concerns relating to nurse education and training are identified in regard to the implications for practice surrounding diagnosis across cultures, classification of illness, and the status and influence of psychological assessments within the field of mental health and learning disability. Finally, the concept of empowerment is critically reviewed, emphasizing that service providers need to collaborate with communities. Community mental health and learning disability nurses are required to make dynamic alliances with communities, through the individual, and so redirect the power relationship to the community and subsequently respond to the demands for cultural diversity sensitively from within healthcare provision and services.     

The impact of change on the tissue viability nurse specialist: 1

Tissue viability nurse specialists in the UK have experienced difficulty in articulating their role, and this has led to a poor understanding of what they do. This article, the first of two parts, presents a literature review which examines the development of specialism in nursing and explores the factors that have influenced the development of tissue viability specialist nurses in the UK. The study described in the second part of the article uses focus group methodology to examine the practices and experiences of tissue viability nurses working in a changing healthcare environment.     

Mental health nurses working purposefully with people with serious and enduring mental illness--an international perspective

There has been a world-wide refocus on people with serious and enduring mental health problems. This has provided major challenges for all those involved in mental health care, as the last two decades have produced radical changes in service delivery and a range of new interventions. Mental health nurses are playing a central role as community based clinical case managers and are beginning to use a range of psychosocial interventions. They are also revitalizing skills in the more traditional areas of medication management and residential care. In addition, there are growing problems of substance abuse and violence which needs to be addressed. Mental health nursing is responding in this new era by various training initiatives. However, these programmes need rapid expansion as mental health nurses will continue to play a key role in the services of the future and therefore need these new skills.     

Videothoracoscopy for diagnosis and treatment of respiratory tract diseases

Orthopaedic nurses often are well-educated in dealing with patients' physical and psychologic needs but lack education in caring for the spiritual needs of man. Nurses must realize they, themselves, have spiritual needs and must invest in clarifying their own values and beliefs as well as their patients. To perform a complete spiritual assessment, nurses need to become familiar with the concept of spirituality and what it means in the care of patients. Providing spiritual care is individualized and often complex. The nursing process enables the nurse to plan patient care. Providing spiritual care is a challenge orthopaedic nurses must recognize and assume responsibility for.     

Butylated hydroxytoluene modulates DNA methylation in rats

This study was a replication of an earlier Cochran & Ganong study that investigated the perception of nurses and patients regarding the stressors faced by patients in the intensive care unit environment. As the original study was American in origin, one of the aims of the present study was to discover if the results would be replicated in a United Kingdom (UK) intensive care unit. Data collection was by the use of an environmental stress questionnaire that was an adaptation of the original data collection tool modified for use in a UK intensive care unit. The study was undertaken in two intensive care units producing a sample size of 71 patients and 71 nurses. There appears to be a wide variation in the perception of nurses and patients regarding the stress faced by patients in the intensive care unit. Similarities were noted between subject groups as to the nature of the stressors, although nurses tended to rate items over which they believed they had control as being more stressful than did the patients. Patients tended to rate items related to their illness and physical comfort as being most stressful. The results are in keeping with those from the Cochran & Ganong study.     

Family caregiving of hospitalized patients. Caregiver and nurse perceptions at admission and discharge

To ensure patients will be discharged to stable, health-promoting home environments, nurses must understand family caregivers' perceptions of the patients' needs and problems in caring for them. At the time patients were admitted to and discharged from the hospital, there was little agreement between family caregivers and nurses about the kinds of things caregivers needed to care for older patients or about problems that might prevent the continuation of caregiving. There was slightly more overall agreement between family care-givers and admission nurses than discharge nurses, despite the fact that discharge nurses reported spending more time with patients and being more knowledgeable about them. Future discharge planning models should build opportunities for nurses to communicate with other health care colleagues who can contribute to a more accurate and complete picture of patients' and family caregivers' needs and problems in the transition from hospital to home.     

The needs of parents with a child on an adult intensive therapy unit

This review examines, by means of a literature search, the needs of parents who have a critically ill child on adult intensive therapy units. These needs are compared with the needs of relatives of adult patients in ITUs. Whether nurses trained in adult nursing have the necessary skills, knowledge and attitudes to care for the parents is also discussed. Recommendations for ensuring care of the parent point to addressing skills gaps in adult-trained nurses and to reappraising visiting policies.