Nursing staff between physician and patient

Departing from a report on today's understanding about nursing, the demanding duties nurses see themselves confronted with are featured in connection with the theme of this meeting. In a second part, difficulties in daily practise are treated. Furthermore, problematic aspects of collaboration within the nursing staff as well as between the disciplines burdening patients are covered. Possible improvements are proposed.     

Should physical restraints be used in an acute geriatric ward?

A prospective study was carried out in an acute geriatric ward to determine the incidence of the use of physical restraints, the reasons for using them and the consequences. Over a period of 8 months an independent observer documented all cases in which a restraint was used and followed them until it was removed. A questionnaire was submitted to the nurses as to why they applied the restraints. 16% of patients had some form of restraint applied, in 2/3 of them for up to half of their stay in the ward. In over 90% of those restrained, functional (Barthel) and cognitive (mini-mental) scores were between 0-5. In unrestrained patients, the functional score was 0-5 in 79% and the cognitive score 0-5 in 72%. The main reason for applying restraints, usually sheets or body binders, was to prevent the patient from falling out of, or slipping from chairs, rather than to stop them from rising out of them. Other important reasons, which overlapped, were to prevent the patient from interfering with nasogastric tubes, catheters, and i.v. cannulas, each in 1/3 of the group. Restraints were discarded when deterioration did not allow the patient to sit out of bed, to decrease agitation, to allow enteral or parenteral treatment, and in 12%, when there was supervision by the family. Of 33 families interviewed, none opposed application of restraints, and most left the decision to the responsible ward staff. We conclude that restraints cannot be avoided in some acutely ill, old patients with severe physical and mental dysfunction. However, ways should be sought to minimize their use, as recommended in the literature, by demanding from the staff a specific reason, signed agreement of a physician, close follow-up, and favorable environmental conditions such as suitable chairs, occupational activity, and staff cooperation in removing the restraints.     

Rehabilitation staff perceptions of characteristics of geriatric rehabilitation patients

OBJECTIVE: To determine if professionals treating older rehabilitation patients regarded them as having different characteristics than younger rehabilitation patients, to derive factors from these perceptions, and to examine the impact of the discipline of the professional and other factors on these perceptions. DESIGN: Rehabilitation professionals at a random sample of facilities accredited by the Commission on Accreditation of Rehabilitation Facilities were surveyed to determine their level of agreement with 60 items addressing characteristics of older rehabilitation patients. The items were derived from focus groups with rehabilitation staff members. PARTICIPANTS: One thousand sixty-three rehabilitation professionals from nine disciplines (nursing, occupational therapy, physiatry, physical therapy, psychology, social work, speech pathology, therapeutic recreation, and vocational counseling) responded to the questionnaire and were included in the study. RESULTS: There was a wide range of agreement levels across the 60 items (range of median agreement, 12.7% to 93.5%). Factor analysis resulted in six categories of perceptions regarding older rehabilitation patients: (1) physical limitations, (2) motivational deficits, (3) psychological distress/need for support, (4) maturity and positive coping skills, (5) need for privacy/decreased adaptability, and (6) discharge complications. Significant differences across disciplines were found for five of six factors. Nurses agreed more strongly with the negative psychological factors (2, 3, and 5) compared to physical therapists, psychologists, and social workers. Physicians scored significantly higher than two other disciplines on the physical limitations factor. These differences may be related to the distinct role each discipline plays in the rehabilitation process. Older professionals also scored higher on four factors, likely because of personal rather than professional experience with aging. CONCLUSIONS: Treating professionals recognize differences between younger and older rehabilitation patients. Many of these perceived differences can be viewed as variables that require more effort and skill on the part of the treating professional. The training of rehabilitation professionals needs to better prepare individuals from all disciplines to adapt to age-specific differences.     

Broadening the educator's role. The use of support staff in implementing staff empowerment

The move to empowerment is on. Healthcare organizations are beginning to recognize the benefits of staff empowerment to both the organization and the staff members. The question for educators is how can skills be best used to support the organization throughout the change. In this article, the role of the educator in the implementation of staff empowerment at a large tertiary care center is described.     

Recognition of depressed affect in hospitalized psychiatric patients: staff and patient perceptions

A comparison of self-report vs. observer rating of depressed mood in a heterogenous inpatient population revealed wide variations in concordance among diagnostic groups. Patients diagnosed as having Affective Psychosis and "Other' illnesses showed the highest correlation between four self-report scales and an observer rating scale. Patients with a diagnosis of depressive Neurosis showed only modest correlation, while Schizophrenics revealed no significant correlation, on these instruments, suggesting inconsistent communication of affect from Schizophrenic patients to observers. In contrast, when self-report scales were intercorrelated, patients in all four diagnostic categories showed highly significant correlations, indicating that they were consistently reporting their affective state on these instruments. The implications of these findings for future research as well as for practical clinical management are discussed.     

Nursing home residents functional ability and perceptions of choice

1. Nursing home residents have the right to be involved in decision making relative to their care, which researchers have demonstrated has a positive effect on residents. 2. The authors designed a study to explore discrepancies between residents' perceptions of choice and the amount of choice preferred and their relationship to self-care abilities and functional abilities in nursing home residents. 3. The results indicate that residents desired more choice than they felt they were given, but that this difference was not related to their perceptions of their self-care abilities. As residents' functional abilities increased, actual choice as well as desired choice increased slightly. 4. Nurses should structure the nursing home's approach to residents so that choice is maximized within the constraints of the institution.     

Quality of life in patients with endocrine tumors of the gastrointestinal tract: patient and staff perceptions

Myo-inositol (mI) as a precursor in the phosphatidylinositol second messenger system has been reported to be reduced in depression. By means of proton-magnetic resonance spectroscopy (1H-MRS) the mI levels in the frontal brain were investigated in vivo in the present study. Twenty-two patients (mean age: 42.8 +/- 10.7 years) with depressive episodes according to ICD 10 (HAMD score > 17) were compared to 22 healthy subjects (28.0 +/- 5.3 years). Two voxels (30 x 20 x 20 mm3) in the frontal lobes were examined in a Siemens Magnetom SP 4000 at 1.5 T (STEAM sequence: TR = 3500 ms, TE = 55 ms). With the total creatine (Cr) as an internal standard, mI/Cr ratios were calculated to follow the mI levels. In the left frontal lobe, mI/Cr was 0.43 +/- 0.06 in depressive patients and 0.46 +/- 0.07 in healthy subjects; concerning the right frontal lobe, mI/Cr was 0.46 +/- 0.08 and 0.48 +/- 0.06, respectively. There were neither significant differences between the two groups nor between the hemispheres. Since there was a significant positive correlation (R = 0.6) between the age and the mI/Cr in the right frontal lobe of depressed patients, age matched pairs analysis was performed (n = 2 x 10, in each group: nine females, one male, < 40 years). In the right frontal lobe, the patients' mI/Cr of 0.40 +/- 0.05 was now significantly lower than the controls' mI/Cr of 0.45 +/- 0.06. However, most of the patients were on antidepressive medication. Interestingly, it was exactly this group of patients which showed significantly lower mI levels. We regard our investigation as a pilot study which suggests an influence of age and antidepressants on mI levels and should be taken into consideration in further investigations in depressive patients.     

Feedback to nurse managers about staff nurses'' perceptions of their jobs

Perioperative antibiotic administration can decrease surgical morbidity, shorten hospitalization, while lowering the overall costs attributable to infections. Its use in surgery is widespread and often inappropriate. In this study, the authors evaluate the guidelines for selection and use of prophylactic antibiotics in surgical cancer patients at the Hospital of Cancer in Rio de Janeiro, Brazil. During 36 non-consecutive months, 1681 cancer patients submitted to surgical procedures were prospectively followed-up by members of the Hospital Infection Control Committee. The overall surgical site infection (SSI) and mortality rates were 17.7% and 4.8% respectively. Prophylactic antibiotics were used in 1262 elective surgeries (75.1%), and their use was not considered to be in accordance with the recommended protocol in 37.6% of the cases. The inadequate antimicrobial prophylaxis resulted in higher incidence of SSI than did prophylaxis in according to the protocol (21.7% vs. 16.4, Relative Risk 1.32; 95% Confidence Internal 1.05-1.67; p0.01). This study calls the attention for the need of a more strict and determined educational program in order to provide mechanisms for an adequate administration of prophylactic antibiotics to patients submitted to high-risk surgeries.     

Factors in supervisors' perceptions of physical science research personnel.

How can the use of supervisor ratings as a criterion of productivity be improved? "Forty physical science research supervisors described the behavior of productive and nonproductive research personnel using a 250-item checklist derived from interviews with research supervisors. A factor analysis of the items comprising the checklist resulted in finding five significant factors. These factors have been tentatively named General Productivity, Affability, Motivation, Ability to Communicate, and Creative Ability." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physical restraints in nursing homes: a review of the literature since the Nursing Home Reform Act of 1987

The use of physical restraints is one of the most negative features of nursing home care. Their use significantly affects the quality of life of residents. In an attempt to limit the use of restraints, the Nursing Home Reform Act (NHRA) of 1987 contained provisions regulating their use. In this article, the authors review the literature on the use and consequences of physical restraints in nursing homes since the passage of the NHRA. First, they describe the history behind the use of restraints and define what is considered to be a physical restraint. Second, they examine the four most common justifications for restraint use. Third, they describe the incidence and prevalence of restraint use. Fourth, they address demographic and clinical characteristics of residents that have been found to be associated with restraint use. Fifth, they examine negative outcomes of restraining residents. Finally, they describe alternatives to using restraints.     

Meeting design characteristics and attendee perceptions of staff/team meeting quality.

Meetings are a common tool in organizations and are used for a variety of purposes and implemented in a variety of ways. Despite the prevalence of meetings, surveys suggest that they are often unproductive and costly. The current study focused on how meetings are designed in hopes of providing practically and theoretically meaningful recommendations for improving meeting quality. A total of 18 design characteristics associated with staff/team meetings were identified and their relevance to perceptions of meeting quality was tested. Using an online panel-based respondent pool of working adults, 367 individuals participated in a survey that they completed within 48 hr of their most recent staff/team meeting. The results demonstrated that 9 of the design characteristics, spanning all 4 categories of design characteristics (i.e., temporal, physical, procedural, and attendee), significantly predicted perceptions of meeting quality. Furthermore, this study validated and greatly extended previous research showing that agenda use, meeting punctuality, facility quality, and meeting facilitator status relate to meeting quality. In addition, this study identified specific relationships to meeting quality for several facility quality characteristics, including lighting, meeting space, refreshments, and temperature, and expanded our knowledge of key characteristics by identifying agreement use and the number of attendees as important. Taken together, these findings suggest that effective meeting design warrants holistic attention to all meeting aspects. These results were robust across demographics, including organizational type, gender, and supervisory status. Implications for meeting design are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Coaches' feedback and changes in children's perceptions of their physical competence.

Examined the relation between 5 junior high school softball coaches' feedback and changes in 72 of their female athletes' self-perceptions. Data collection procedures involved observation of coaches' game and practice behaviors, as well as pre- and postseason assessments of the players' self-perceptions (e.g., perceived competence, perceived performance control, expectancy for success). Data were collected during a 9-wk season. Multivariate regression analyses revealed that a significant portion of the variance in the players' psychosocial growth was a function of both the players' demonstrated sport competence and the behaviors of their coach in response to their skill performance. Coaches' practice behaviors were significantly associated with changes in players' self-perceptions, but their game behaviors were not. Although skill competence was the largest contributor, certain coaching behaviors were also influential in explaining changes in players' perceptions of competence. The salience of these coaching behaviors can be interpreted in light of their contingency to players' performance and their role in providing players with clear and consistent evaluation of their performance. (38 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Environmental perceptions of students in same-sex and coeducational physical education classes.

Although class climate has been studied in relation to same-sex or coeducational schools and academic classroom environments, physical education presents a unique situation not frequently examined in this regard. Middle and high school students' perceptions of the environment were examined following their participation in a basketball unit. Results indicated that same-sex and coeducational physical education classes revealed quite different climates, although boys and girls in the same coeducational classes generally viewed their environments in a similar manner. Overall, girls' same-sex classes were perceived most favorably, whereas boys' same-sex classes were perceived least favorably. However, climate was viewed differently by girls and boys depending on whether they were perceiving the class as a whole or from the perspective of their own gender. In addition, teacher gender was not a factor in the results. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Accuracy and bias in adolescents' perceptions of friends' substance use.

This study tested competing hypotheses related to the false consensus effect and pluralistic ignorance by examining the accuracy and bias of adolescents' perceptions of peer substance use and the effects of their own substance use, gender, and age on perceptions of peer behavior. Two samples (ns = 163 and 2,194) that collected data on peer nominations, perceptions of peer substance use, and self-reports of substance use were used in analyses. Results from both samples provided evidence supporting the false consensus effect, that is, adolescents' reports of their friends' substance use were biased in the direction of their own use. Users and nonusers did not differ in accuracy of perceptions; however, across all substances and samples, they differed significantly in bias. Substance users displayed nearly perfect liberal bias, assuming their friends also used substances. Nonusers displayed an opposite, conservative bias, assuming their friends did not use substances. Gender and age differences in bias also were observed, with older adolescents and girls having more liberal biases than younger adolescents and boys. Results suggest the importance of differentiating the effects of actual and perceived peer substance use. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A transitional living environment for persons with brain injuries: staff and client perceptions

As part of the Iron Overload, Public Health and Genetics conference, sponsored by the Centers for Disease Control and Prevention in March 1997, a working group was convened to consider strategies to increase early case detection of hemochromatosis. This group emphasized that the primary public health goal should be to diagnose hemochromatosis before symptoms appear. To reach this goal, education and action need to be targeted to physicians and other health care workers, laboratorians, administrators, payers, and the public. Strategies to disseminate updated information and increase early case detection were prioritized according to expected effectiveness. Strategies targeting physicians are 1) to identify national and local physician-leaders and 2) to educate physicians about hemochromatosis in basic, graduate specialty, and continuing medical education. Strategies aimed at the health system are 1) to encourage laboratories to provide the transferrin saturation test as part of routine laboratory panels and 2) to work with policymakers and payers to allow reimbursement for case detection. Finally, public education is recommended to increase lay support for the early diagnosis of hemochromatosis. Attempts to educate the public should be aimed first at persons who receive diagnoses of hemochromatosis in order to ensure that they are properly treated and then at asymptomatic persons who could be screened as part of health appraisals. Although identifying physician-leaders and educating physicians are the highest priorities, physicians should not be targeted at the exclusion of payers and the public. Simultaneous efforts to reach all groups in appropriate ways should be initiated to provide the interest and infrastructure necessary to decrease morbidity and mortality from hemochromatosis.     

Identity processes and perceptions of physical functioning in adults: Theoretical and clinical implications.

Explored the relationship between identity and changes in physical functioning over the adult years. 242 adults (aged 40–95 yrs) rated themselves in 20 areas of normative functioning and identity processes. Measures included the Physical and Cognitive Change Scale, the Identity and Experiences Scale—Specific Aging, and the Rosenberg Self-Esteem Questionnaire. The findings indicate that adults as young as 40 are sensitive to age-related changes. Those 65 and older exhibited greater sensitivity to changes in competence. Identity assimilation was used most by adults under 65, particularly in the area of cognitive functioning. For individuals in both age groups, identity assimilation was positively related to self-esteem. The findings suggest that individuals may make behavioral adjustments without ruminating or becoming preoccupied, a strategy that may promote healthy adaptation to the aging process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)