Nurses' knowledge of infection control

The article is based on a research study examining infection control in nurse education and practice. A survey of a large population was carried out to establish the perceived importance of microbiological knowledge to nurses and to ascertain whether this knowledge was present. The results suggest that although microbiological knowledge is considered necessary for safe infection control practice, nurses' actual knowledge falls far short of the level required for 'informed' practice. What this implies in relation to patient care, and recommendations regarding education and practice, are discussed.     

The practice of health education in acute care settings in Hong Kong: an exploratory study of the contribution of registered nurses

A multiple case study design was used to explore the practice of health education in acute care settings in Hong Kong. Two case studies, a medical ward and a surgical ward, were selected to reflect the real setting in which nurses carry out health education in acute care. Data collection methods involved the use of non-participant observation and semi-structured interviews. Seven nurses and eight patients were interviewed to explore their understanding of health education concepts, the use made in the wards of health education and the factors influencing such practice in the acute settings. Individual and cross-case analysis showed that respondents' understanding of the concept of health education was limited to patient information-giving. Although the importance of health education in acute patient care was acknowledged, the degree to which health education featured in nurses' practice was minimal. Many available opportunities for health education were missed and factors such as nurses' busy-ness and the associated lack of time and staff were identified as influencing health education practice in these acute care settings. Implications for practice and future studies were discussed in the light of these findings.     

Clinical oncology nurses' perceptions of research

Within the realm of oncology nursing, research has been an integral part in its development as a specialty practice. Yet despite the growing volume of published nursing research studies, little is known about how nurses working in oncology care settings perceive research. Therefore, the purposes of this study were to examine clinical oncology nurses' perceptions of research and to determine factors influencing their perceptions. Two hundred and eighty-three registered nurses providing cancer care to patients in 40 health care agencies across northern Ontario participated in the survey. Data were collected using a questionnaire developed by Alcock and colleagues (1990) which addressed nurses' perceived value of research, their role, interest and experience in research as well as the research climate of the agency. The findings showed that respondents valued nursing research and perceived a research role for staff nurses. However, the respondents did not perceive strong administrative or collegial support for nurses' involvement in research activities. In addition, the study results indicated that the clinical oncology nurses' perceptions of research were influenced by educational preparation.     

Mediating conflict and control: practice challenges for nurses working in palliative care

A work-based professional development program was offered to a group of registered nurses working in palliative care. The goal of the program was to improve skills in psychosocial care (Yates et al., 1996). Participants were encouraged to reflect critically on their practice experience within a group setting. The focus of the group discussion and reflection were shared practice incidents. Each participant was given the opportunity to identify and describe an incident from their professional practice that presented a challenging issue within palliative nursing. This paper explores the themes of conflict and control, evident within the collection of fifteen practice incidents and discusses the nurses' role as mediator. The concepts of patient advocacy and professional autonomy are challenged through the nurses' experience of providing care within a hierarchical and bureaucratic health service. The outcome of reflection for the organization is most effective when shared experience and collective action (rather than individual practice) are the focus.     

An optimization study on unprogrammed cryopreservation of human CD34+ bone marrow cells and their subsequent storage in an -80 degrees C mechanical freezer

Forty-one patients for whose direct care at least one machine was used and 33 registered nurses from the same five non-critical care units as the patients and from one related unit, participated in a semistructured tape-recorded interview to identify the core categories of the human-machine interface in clinical nursing practice and the relationships between them. Constant comparative analysis was used to organize and process the data. Patients perceived the machines as neutral because of their view of health care and because nurses were the interface between them and the machines. Nurses perceived the machines as either positive or negative, depending on their effect on the nurses' professional competence and the extent to which they worked directly with them.     

Issues of death and dying: the perspective of critical care nurses

A major shift in the care of terminally ill people, due to advances in technology, and the development of legislation regarding patient self-determination and autonomy, has occurred over recent years. Critical care nurses (CCNs) are involved daily in issues of death and dying and are very aware of the needs, fears and psychosocial issues of patients and their families. Professional associations see a legitimate role for nurses in assisting the dying to achieve a dignified death. For legislation, policies and guidelines surrounding end-of-life issues to be effective, and to assist nursing staff with these sensitive, often difficult concerns, it is important that data on the opinions and perspectives of CCNs be objectively obtained. In a study by the Department of Social and Preventive Medicine at the University of Queensland, questionnaires were sent to 1100 randomly sampled community members and almost 1200 health professionals (nurses, general practitioners and specialists), including 299 CCNs. The response rate of CCNs to a 30-page postal questionnaire was 79 per cent (n = 231), indicating those nurses' high levels of interest in and/or concern regarding this area. CCNs supported the use of advance directives, the appointment of proxies and the need for doctors and nurses to give sufficient medication to relieve pain, even if this hastened the death of the patient. In addition, CCNs, more than any other professional group, supported the right of the terminally ill patient to physician-assisted suicide or euthanasia, their responses being very similar to those of community members. CCNs clearly face issues which, from legal, medical and ethical viewpoints, cause them concern. In sharing their personal experiences, CCNs stressed the need for more communication between doctors and patients, as well as between doctors and nurses. In addition, CCNs saw a clear role for themselves as advocates for patients/families in the decision-making process.     

Reaction of different cell populations in mouse thymus to a single gamma-irradiation

Acute care facilities are no longer viewed as the center of the health care network. Efforts to reduce hospital length of stay will continue to spur the growth of care delivered in homes. With the downsizing of many hospitals, the need for nurses in acute care settings will decline. Many acute care nurses are finding themselves seeking employment opportunities in home health care settings. The purpose of this study was to examine nurses' experiences when they change from hospital-based practice to home health care nursing. The qualitative mode of inquiry was used to conduct taped-recorded interviews of 25 baccalaureate-prepared nurses in a large metropolitan area. Stressors experienced by the nurses were identified as well as adaptations required to minimize role stress. Continuing education programs can provide information and skills needed to improve nurses' competencies to function in a health care system projected to be more community-based, which includes home health care.     

Endotracheal suctioning: a literature review

Endotracheal suctioning (ETS) is a necessary practice carried out in intensive care units. In involves the removal of pulmonary secretions from a patient with an artificial airway in place. All intensive care nurses should be aware when performing this intervention of the potential hazards a patient is exposed to, and should endeavour to prevent or minimize these. This literature review explores the criteria available to indicate a need for ETS and discusses the potential adverse effects of ETS and how these can be avoided during the procedure. The question is raised as to the frequency with which the procedure should be performed. The current dilemma facing nurses is the overwhelming view that ETS should be performed only when indicated as necessary by assessment, to minimize the exposure of the patient to the hazards of ETS, but also recognition that ETS is a necessary procedure to maintain a patent airway and clear secretions. As nurses are accountable for all aspects of their practice, they need to be able to make an informed choice about the frequency with which ETS is performed. It is hoped that this review will increase nurses' awareness of the potential hazards surrounding ETS, and enable them to question their practices regarding their ability to assess individual patient needs and determine the frequency with which ETS should be performed.     

The family and critical care nursing: a brief review of the literature

While there is generalised agreement in the literature on the importance of involving family members in critical care practice, there is little in regard to the roles and responsibilities of both nurses and families. There are many factors that can influence the nurse-family relationship, in both positive and negative dimension, and this relationship can impact significantly on the family member's experience of critical illness. It can also impact on his or her perception of need and need satisfaction. However, the complex nature of critical care practice may be too demanding, both physically and emotionally, for nurses to respond to many of the family's needs and concerns.     

Hospital ethics committees and nurses' participation

The hospital ethics committee's mandates of patient care review, policy formation, and education make them central to nurses and healthcare delivery. In a study examining nurses' communication exchange frequency and perceived effectiveness as members of hospital ethics committees, nurses represented the largest proportion, were moderately active, and rated their participation effectiveness the highest: they are more involved in discussions regarding patients than policy formation and education. Nurse administrators can provide strategies and education for nurses that enhance nurses' participation in all three committee functions. Policies affect patient care; therefore, policy decisions, too, benefit from nurses' participation.     

District nurses' perceptions of palliative care at home

A postal survey of 148 district nurses (DNs) was carried out to explore their experiences of terminal care and their views of the palliative care team. Information was also gathered on DNs' perceived educational needs in relation to palliative care. The high response rate of 87% and the additional comments that many nurses offered illustrates their desire to provide high-quality care. Factors that appeared to hinder achievement of this goal and led to stress included size of caseload, lack of knowledge and experience in managing difficult symptoms as well as time constraints. High levels of satisfaction with the palliative care team were recorded but a need for further education and improved communication were identified.     

Pharmacologic inhibition of particulate-induced bone resorption

The traditional hospital-based approach to Australian nurse education curricula was primarily based on the medical model and directed towards the preparation of nurses who were able to give care to individual clients. The major focus was on the needs of the individual. A notable absence in curricula was any consideration of the role or importance of families to individual and family health. This was despite the continuing involvement that nurses have in their practice with the families of their clients. This paper describes the experiences of introducing a family nursing subject in an undergraduate, preregistration nursing programme which focuses on the family as a unit of care. Educational strategies, clinical experiences, and evaluation of the unit of study are discussed.     

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.     

Acarbose controls postprandial hyperproinsulinemia in non-insulin dependent diabetes mellitus

Older adults who become acutely confused when hospitalized present challenges to nurses because of their increased care needs and risk for injury. This study evaluated the feasibility of introducing the NEECHAM Confusion Scale as part of usual nursing care as a first step in improving nurses' ability to assess, prevent, and manage acute confusion in hospitalized older adults. By addressing several of the factors that influence adoption and continuation of a new practice, this study found that staff nurses could successfully use the NEECHAM Confusion Scale.     

Struggling for control: the care experiences of 'difficult' patients in mental health services

Although there is increasing recognition of the existence of 'difficult' patients who present particular challenges to mental health nurses, no research has been conducted into their perceptions of services and their experiences of care. This study identifies mental health service users who are defined by nurses as 'difficult' and explores their perceptions of their care experience. The results support earlier studies which suggested that 'difficult' patients challenge nurses' competence and control: despite their different roles both nurses and 'difficult' patients were aware of the struggle to gain or retain a notion of control. Respondents were able to identify the qualities of nurses and nursing interventions which had a positive effect on their care experience. Where nurses were perceived to demonstrate respect, time, skilled care and a willingness to give patients some control and choice in their own care, feelings of anger were reduced. These findings are discussed within the conceptual framework of 'power over' and 'power to' and implications for practice and research are considered.     

Are practice nurses an unexplored resource in the identification and management of alcohol misuse? Results from a study of practice nurses in England and Wales in 1995

Changes in the health promotional work undertaken in primary care, including the work needed to meet the 'Health of the Nation' alcohol targets, have led to a rapid expansion of the number of practice nurses in England and Wales. However, there has been little evaluation of this role. This study provides data, for the first time at a national level, about practice nurses' work in identifying and managing patients drinking above recommended sensible guidelines. Data were collected by postal questionnaire from all nurses in a 50% random sample of 1852 practices (drawn from a general practitioner (GP) national study, undertaken at the same time). 43% of nurses responded from 62% of the targeted practices. Respondents reported identifying a mean of 3.1 patients per month who were drinking above recommended sensible guidelines. These patients tended to be male, above 40 years of age and in contact with the nurse for the first time about this problem. Most patients were categorized as having a potential alcohol problem; few were classified as currently dependent. Very little intervention work was undertaken by nurses except for referral to the GP. If real progress is to be made in meeting the 'Health of the Nation' targets on population alcohol consumption, then primary care work in identifying alcohol misusing patients needs to be developed as a matter of urgency. The patients identified by practice nurses are those patients relevant to the 'Health of the Nation' alcohol targets. More emphasis needs to be placed on the valuable contribution practice nurses can make, particularly through the use of screening instruments and brief interventions.     

Factor XIIa activation of plasminogen is enhanced by contact activating surfaces and Zn2+

The aim of this study was to: (i) describe the practice patterns of Finnish public health nurses during the development of primary health care based on the 'population responsibility' principle; and (ii) to identify the relation of public health nurses' task division models and types of community (rural/town) to their practice patterns. A detailed recording of public health nurses' home and clinic visits was developed and used during three annual study periods in 8-9 health centers by 93-118 public health nurses. The total number of recorded visits varied annually from 4842 to 6841. Statistical significance was determined by Chi-squared. Significant differences were found between the three study periods and also in the practice patterns of public health nurses (PHN) with different task division models and of PHN working in different types of community. However, the short study periods limited the practical importance of these findings.     

Benevolence, a central moral concept derived from a grounded theory study of nursing decision making in psychiatric settings

Fourteen experienced nurses participated in an explorative study aimed at describing the experiential aspects of moral decision making in psychiatric nursing practice. In-depth interviews were conducted according to the grounded theory method. These were transcribed, coded and categorized in order to generate conceptual categories. The concept of benevolence was identified as a central motivating factor in the nurses' own accounts of situations in which decisions were made on behalf of the patient. This seems to conceptualize the nurses' expressed aim to do that which is 'good' for the patient in responding to his or her vulnerability. This study indicates the need for further research into the subjective, experiential aspect of ethical decision making from a contextual perspective.