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.     

A profile of European ICU nursing

OBJECTIVE: To evaluate major similarities and major differences between Western European countries in intensive care unit (ICU) nurse staffing, education, training, responsibilities, and initiative. DESIGN: A questionnaire was sent to Western European doctor members of the European Society of Intensive Care Medicine, to be passed on to the nurse-in-charge of their ICU. RESULTS: 156 completed questionnaires were analyzed: 49% were from university hospitals, 26% from university-affiliated hospitals, and 25% from community hospitals; 42% of the hospitals had more than 700 beds, 67% of the ICUs had between 6 and 12 beds, and 54% were mixed medical-surgical units. Among British units, 79% had more than three full-time nursing equivalents (FTE) per ICU bed, while in Sweden 75% of units had less than two FTE/ICU bed. University hospitals had more nursing staff per bed than community hospitals. As regards training, 33% of nurses followed a training course before starting work on the ICU and 64% after starting on the unit, and 85% had easy access to continuing education, particularly in the university hospitals. In an emergency, more than 70% of nurses regularly initiated oxygen administration, mask ventilation, or cardiac massage. In Sweden 100% of nurses and in Switzerland 91% of nurses regularly inserted peripheral intravenous catheters, but only 7% of German nurses did. No German nurses and only 12% of British nurses regularly performed arterial puncture, but in Sweden 75% of nurses regularly did. CONCLUSION: Even though the number of participants were limited, our questionnaire revealed variations in nurse staffing patterns among European countries and in their systems of training and education. Nurse autonomy also varies widely between countries.     

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.     

Improving undergraduate nursing research education: the effectiveness of collecting and analyzing oral histories

Nine oral histories of retired RNs (age range from 60 to 77) were collected by trained senior nursing students in their nursing research class. Attitudes toward nursing research of the 18 undergraduate baccalaureate nursing students participating in the collection and analysis of oral histories were compared with 20 students who did not participate. Both groups of students completed a pretest and posttest Attitudes Toward Nursing Research Questionnaire. The participating students had significantly positive changes in their attitudes toward nursing research. The nonparticipating group did not. While reminiscing about their careers, the retired RNs related historical events that influenced their nursing practice. Three themes emerged: World War II, technology, and intensive care units. Through an open-ended, written questionnaire following the interview, the nurses expressed positive benefits of participation. The collection and analysis of oral histories was an effective experiential learning strategy with positive outcomes for the students and the retired nurses who were interviewed.     

An exploration of the value of specialist neurosurgical nurses

The differences in the knowledge and skills of 75 nurses working in a variety of practice settings were examined using a case study vignette of a neurosurgical patient developed by researchers. The case study tested nursing care throughout a patient's hospital experience, including admission, presurgery, postsurgery and discharge preparation. The findings showed that nurses who had specialised in neurosurgery scored markedly higher, in all aspects of practice knowledge, than expert nurses in other specialties and general nurses. Patients undergoing neurosurgery are safer if they have nurses who are experienced, skilled and knowledgeable to care for them.     

Neurological intensive care admissions: identifying candidates for intermediate care and the services they receive

OBJECTIVE: The high cost and scarcity of intensive care unit (ICU) beds has resulted in a need for improved utilization. This study describes the characteristics of patients who are admitted to the ICU for neurosurgical and neurological care, identifies patients who might receive all or most of their care in an intermediate care unit, and describes the services the patients would receive in an intermediate care unit. METHODS: We describe patients who received neurological care and who were part of a prospective study of 17,440 patients admitted to 42 ICUs at 40 United States hospitals. We identified patients who received only monitoring during ICU Day 1 and then used a previously validated equation to distinguish which patients were at low risk (< 10%) for subsequent active life-supporting therapy. We also describe the services these patients received during their ICU stay. RESULTS: Among 3000 patients admitted to the ICU for neurological care, 1350 received active therapy and 1650 (55%) underwent monitoring and received concentrated nursing care on ICU Day 1. After excluding those patients who received active therapy at admission, 1288 (78%) of the 1650 patients who underwent monitoring at admission were at low risk (< 10%) for subsequent active therapy; 95.8% received no active therapy. These patients who were at low risk for subsequent active therapy were significantly (P < 0.001) more often admitted postoperatively, were younger and less severely ill, and had lower ICU and hospital mortality rates (0.9 and 3.9%, respectively) than patients who received active treatment at admission. CONCLUSIONS: Patients receiving neurological care at an ICU who receive only monitoring during their 1st ICU day and have a less than 10% predicted risk of active treatment can be safely transferred to an intermediate care unit. Some of these patients may not require ICU admission. We suggest guidelines for equipping and staffing neurological intermediate care units based on the type and amount of therapy received by these patients.     

The clinical competency of community health workers in the eastern highlands province of Papua New Guinea

A case study of the clinical competency of community health workers employed in the Eastern Highlands Province of Papua New Guinea was conducted in March 1993. Of the 79 who graduated from the Onamuga Community Health Worker Training School between 1989 and 1992, only 24 were currently employed in the province. Current knowledge and clinical competency were compared with results on completion of basic community health worker training. Results showed that 22 of the 24 maintained their knowledge competency, and 15 maintained clinical competency. It was found that those community health workers (CHWs) employed at a health subcentre use 40% to 50% of their skills, whilst those at a district health centre or provincial hospital use only 20% to 30% of their skills. Only 8% of the CHWs studied used all the skills obtained in their basic training. This study indicates that the CHW is being viewed by some health managers as a replacement for the nurse aide. If CHWs' skills are to be maintained, certainly good supervision, inservice training and adequate logistic support are needed, but so also is a change in management thinking. The CHW has been trained specifically to improve the access to essential primary health care services of people living in rural areas, especially in preventive and maternal and child health care. If in practice the CHW is not given the opportunity to practise and hence maintain these skills, the whole logic of the CHW training scheme will need to be reexamined.     

Hematologic emergencies in the intensive care unit

Hematologic emergencies in the oncology population may require an admission to the intensive care unit (ICU). Syndrome of inappropriate antidiuretic hormone, hypercalcemia, tumor lysis syndrome, and disseminated intravascular coagulation are diseases defined in this article. These are common conditions in oncology patients that are reduced or prevented with close monitoring and accurate assessments. The purpose of this article is to introduce intensive care nurses to these disease entities so they will have a better understanding of the care involved with an oncology patient in the ICU unit.     

A history of the training of asylum nurses

The national training scheme for asylum attendants, devised in the late 19th century, did not arise ex nihilo. Several philanthropic and imaginative madhouse keepers of the previous century had understood the link between successful treatment of lunatics and the quality of staff who cared for them. They had therefore aimed to recruit a 'good class' of person to work in their institutions, and to create an environment which would tend towards the civilization of the patients. A few even entertained the notion that training attendants would enhance their ability to understand and care for those in their charge. Training received increasing attention in both medical and political circles throughout the 19th century until a national scheme was inaugurated in 1891. The scheme achieved only a modest success in that, while it drew upon the undoubted enthusiasm of those who trained under it, it did not enhance the attendants' career opportunities or their pay once they had qualified. Training as a means of solving management problems was doomed to failure, and widespread dissatisfaction amongst asylum nurses erupted during the 1920s, only 30 years after the scheme had started.     

Operational definition of the quality of nursing care at an intensive care unit of a teaching hospital

The purpose of this study is the development of valid standards and criteria of nursing care quality for intensive care units (ICUs) based on Donabedian's approach to quality access. Eighteen standards and 219 criteria have been formulated by ICU staff nurses at a school-hospital, according to a protocol. These standards/criteria have then been evaluated by 14 experts in ICU Nursing from 5 other hospitals by means of a written questionnaire. The results indicated a high acceptance thereof and only one criterion was rejected. This showed that staff nurses and the experts involved had similar concepts about quality of ICU practice. The developed operational definition may be a basis to quality access tool. Staff nurses participation in this process is recommended.     

Ratings of the performances of practicing internists by hospital-based registered nurses

PURPOSE: To examine the feasibility and reliability of ratings completed by hospital-based registered nurses of the humanistic qualities, communication skills, and selected aspects of the clinical skills of practicing internists. METHOD: In 1988-1989, registered nurses who worked in the same 175 hospitals as 232 internists with admitting privileges at these hospitals rated the internists' performances. The nurses were selected from medicine floors, specialty floors, and intensive care units and/or critical care units, using lists provided by head nurses. A total of 1,877 rating questionnaires with 13 performance categories were collected (with a mean of 8.01 nurses per internist). The ratings were analyzed to determine measurement characteristics and the relationships of the nurses' demographic characteristics to the ratings. In addition, for each of ten performance categories for 152 of the internists, the average rating each internist received from nurses was compared with the average rating each internist received from peer physicians. Statistical analysis used Pearson correlations, canonical correlations, factor analyses, Student's t-tests, analysis of variance, and stepwise multiple regression. Finally, the internists themselves, including physicians who were not actually rated by the nurses, were asked to complete a brief questionnaire that included questions about their opinions of the use of nurses' ratings. RESULTS: The nurses' ratings correlated moderately strongly with the peer physicians' ratings and had a common structure. However, the nurses' ratings were lower for several humanistic qualities, including respect, integrity, and responsibility, and their ratings were higher for medical knowledge and verbal communications. Across the 13 performance categories, approximately 10-15 ratings from nurses were needed to obtain a reliable assessment of an internist's humanistic qualities and communication skills. Many internists felt that nurses' ratings should be used equally with, or at least as a lesser contribution to, ratings by peer physicians of humanistic qualities and communication skills. CONCLUSION: Nurses' ratings appear to provide a feasible and reliable method of evaluating the internists' communication skills and humanistic qualities, when used in conjunction with ratings by peer physicians.     

Factors influencing selected lengths of ICU stay for coronary artery bypass patients

This study examines factors influencing the length of intensive care unit stay for patients after coronary artery bypass surgery. Profiles of patients with selected lengths of ICU stay were identified for Group 1 (< or =1 day) and Group 2 (> or =2 days). Medical records of 175 patients who had undergone this procedure at an urban teaching hospital were reviewed. Patients who had a 1-day ICU length of stay were younger (mean=62.39, SD=10.88) and had comorbidities such as hypertension. Those patients with an ICU length of stay 2 days or longer were older (mean=68.18, SD=11.84) and had preoperative comorbidities such as congestive heart failure, chronic obstructive pulmonary disease, ejection fraction <50%, and need for an intra-aortic balloon pump. Atrial dysrhythmias, low cardiac output syndrome, renal insufficiency, and respiratory insufficiency were the postoperative complications associated with a prolonged ICU length of stay. Knowledge of the factors influencing selected lengths of ICU stay will enable nurses to choose patients for critical pathways and to anticipate postoperative problems in high-risk patients.     

Coping with transition: neonatal nurse practitioner education for the 21st century

As neonatal intensive care nurses face downsizing and/or cross-training, new opportunities are emerging for advanced practice nurses in follow-up care of neonatal intensive care unit graduates, case management, quality improvement, and community hospital care. This article identifies current issues in neonatal nurse practitioner (NNP) education as the model has shifted from hospital-based, certificate programs to graduate degree programs offered by colleges/universities of nursing. Opportunities for increasing NNP role flexibility and recommendations for bridging the transition to a 21st century education model for neonatal advanced practice nurses are also discussed. Despite the turmoil of change and uncertainty, the future for neonatal advanced practice nurses is positive. Successful nurses will master the skills of adaptability, flexibility, self-directed learning, leadership, and the provision of relationship centered care. Neonatal nursing educators must constantly monitor clinical practice and re-evaluate the curriculum to ensure the necessary knowledge and skills for successful practice can be achieved from the educational program. It is critical that faculty are cognizant of emerging trends and changing roles in the practice area. Additional learning opportunities may be required for graduates to successfully move into the next century.     

Enrolled nurse conversion: trapped into training

The introduction of Project 2000 in the late 1980s aimed to replace the existing two levels of nurse training with a single level of entry. This entailed phasing out training for enrolled nurses (ENs) and 'conversion' courses were introduced to allow ENs to upgrade their qualification. As part of a larger study of continuing education and training in the National Health Service (NHS), a cohort of ENs taking part in an open-learning conversion course were interviewed. Sixteen nurses described their motives for undertaking the course and the impact of the course on their work and home lives. Data collected in interviews were analysed using qualitative methods and revealed that all of these nurses felt under pressure to take part in the course. Participation in the course was associated with changes in home and work life. The findings of the study have implications in terms of study leave policy.     

Frictional forces when rectangular guiding arches with varying edge bevel are employed

PURPOSE: This study tested social skills training (SST), didactic training (DT), and no training (NT) on adolescents' social skills for resisting peer pressure to engage in acquired immunodeficiency syndrome (AIDS) and pregnancy risk behavior. METHODS: A total of 307 Latino and Anglo youth ages 13-18 years were assigned at random to receive 18 h of SST, 18 h of DT, or NT. RESULTS: Significantly (p < 0.05) greater increases in assertiveness followed SST compared to DT or NT for three trained skills: condom negotiation, asking a friend about their sex/drug history, and discussing a friend's risk of AIDS. Untrained negotiation skills (e.g., purchasing a condom) did not increase significantly. SST did not result in increased assertiveness for refusal skills. DT increased knowledge of AIDS significantly more than SST; both DT and SST increased knowledge significantly more than NT. CONCLUSIONS: Social skills training can increase assertiveness for certain negotiation skills that may decrease risk of AIDS for Latino, Anglo, and male and female adolescents. Both DT and SST can increase knowledge of AIDS prevention. Differences between experimental groups were supported by differences between trained and untrained skills within the SST condition, adding to discriminant validity.     

Teaching Rwandan families to care for people with AIDS at home

AIDS causes disabling symptoms during its chronic and terminal phases. Families throughout the world, whether related to the patient by blood or affection, provide most of the personal care for him or her at home during these phases. Whether the family has access to advanced medical care or not, they can be taught simple comfort measures and nursing care skills that will improve the well-being of the patient. In Rwanda, a small country in east-central Africa, Red Cross volunteers were trained to teach these skills. The volunteers then returned to their villages to help local families. Six months later, 24 of these families were interviewed about the impact of the volunteers' visits. Families indicated they had benefited from being taught the caregiving skills. They also appreciated the emotional support attendant to the volunteers' visits. In summary, the training course enabled volunteers both to enhance family nursing care skills and to provide emotional support to families caring for people with AIDS at home. This training can also be used by volunteers to assist families caring for members ill with other endemic chronic infectious diseases.     

A prospective study on the behavior of pediatric intensive care unit nurses, concerning the care given to suicidal children

Pediatric intensive care units use sophisticated medical technology and are staffed by deeply committed nurses who are subjected to significant psychological stress. This stress varies with the type of patient and influences the style and quality of care. With this respect, children and adolescents admitted after a suicidal attempt are considered catalysts. However, there have been no systematic studies of how pediatric intensive care nurses respond emotionally to their interactions with these patients. This epidemiological study conducted in five Parisian Teaching Hospital pediatric intensive care units used a specially designed questionnaire to evaluate nurses' responses on the basis of style of care. Children under 16 years of age admitted after attempted suicide were studied comparatively with same age children admitted for status asthmaticus or encephalopathy with seizures. Results highlighted the differences in nurses' psychological responses to these situations and their difficulties in interacting with patients. This study provides strict methodological guidelines for investigating an issue often discussed emotionally or on the basis of anecdotal data.     

Crisis in training pediatric psychologists.

Examines the shortage in the US of personnel who are trained in child mental health care that results in underservice to children, youth, and families. Doctoral programs offering specialty training are in short supply, as are pediatric psychology training programs. In addition, many clinical psychology programs are ill-equipped to offer curriculae for the development of skills and knowledge bases required by child psychologists. It is concluded that a training conference is needed to communicate the issues involved in this mental health provider crisis if children are to have access to psychological services. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do clinical and formal assessments of the capacity of patients in the intensive care unit to make decisions agree?

BACKGROUND: The complex environment and technology of intensive care unit (ICU) care may impair the ability of patients to participate in medical decision making or give informed consent. We studied the agreement of the intuitive assessments of residents and nurses of ICU patients' cognition, judgment, and decision-making capacity, and whether those assessments agreed with abbreviated formal mental status testing. METHODS: Using a prospective survey case study, we assessed 200 English-speaking patients within 24 hours of their ICU admission. Formal assessment of cognition, judgment, and insight was performed by a research assistant. We obtained independent intuitive ratings by nurses and residents of patient cognition, judgment, and ability to participate in medical decision making or give informed consent. RESULTS: Residents' and nurses' assessment of cognition and judgment showed a high degree of agreement with weighted ks of greater than 0.76. Assessments of cognition by residents and nurses agreed with Folstein Mini-Mental State Examination in 70% and 73.6% of cases, respectively. Forty percent of the population had an unimpaired Mini-Mental State Examination score of greater than 23, and an additional 12% of the subjects were mildly impaired with scores of 20 to 23. When asked whether they would approach patient or family for consent for an invasive procedure, nurses and physicians said they would request informed consent from 66% and 62% of the patients, respectively. CONCLUSIONS: Residents and nurses caring for patients newly admitted to the ICU agree in their assessment of cognition, judgment, and capacity to participate in medical decision making, and are not unduly influenced by ventilator status. Their assessments correlate highly with abbreviated formal mental status testing.     

Pathways to mental health care among South African adolescents: analysis of referrals to an adolescent psychiatric unit

Assessment forms of 670 adolescents referred over four years to an adolescent psychiatric unit were analyzed to establish how they entered mental health care. The first part of the study examined referral sources; the second established the appropriateness of referral. Adolescents were referred via a number of pathways, of which school sources, psychiatric services, and social agencies were prominent. Interestingly, 60.7% of the referrals were from persons not trained in mental health care. No significant difference in appropriateness of referral was found between trained and nontrained sources. Thus, the unique referral base of adolescents in need of mental health care must be recognized. Although the majority in this study were not mental health care workers, the findings show that their referrals were clinically appropriate. This suggests that by improving the mental health skills of this sector, the provision of psychiatric care to adolescents could be enhanced.