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domenica 26 maggio 2013
lunedì 20 maggio 2013
RESEARCH MADE SIMPLE
domenica 19 maggio 2013
Evidence Review
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Interventions for Shared Decision-Making About Life Support in the
Intensive Care Unit: A Systematic Review
Article first published online: 10 APR 2012
DOI: 10.1111/j.1741-6787.2012.00247.x
© 2012 The authors. World Views on Evidence-Based Nursing © Sigma Theta Tau International
Additional Information(Show All)
- The study was funded by the Foundation for Informed Medical Decision Making. We are thankful to Alexandra Davis, Library Scientist, The Ottawa Hospital, for her assistance developing the search strategy. David Moher, Professor, Department of Epidemiology & Community Medicine, University of Ottawa, provided guidance in the conduct of systematic reviews during the design phase of the study. Thank you to Vickie Duncan, Nursing Liaison Librarian at the University of Saskatchewan, for her assistance with the updated search.
ABSTRACT
Background
Healthcare professionals and families make decisions about the use of life support for patients in the intensive care unit (ICU), including decisions to withhold or withdraw life support at the end-of-life. Best practice guidelines recommend using a shared decision-making (SDM) approach to improve the quality of end-of-life decision-making but do not describe how this should be done in practice.Aims
To know what elements of SDM had been tested to improve communication between healthcare professionals, patients, and their family about the decision. Trials relevant to our review assessed whether these interventions were more effective than usual care.Methods
A systematic review of randomized controlled trials of SDM interventions for the decision about using life support, limiting the use of life support, or withdrawing life support for hospitalized patients. We searched databases from inception to January 2011.Results
Of 3,162 publications, four unique trials were conducted between 1992 and 2005. Of four trials, three interventions were evaluated. Two studies of interventions including three of nine elements of SDM did not report improvements in communication. Two studies of the same ethics consultation, which included eight of nine elements of SDM, did not evaluate the benefit to communication. The interventions were not harmful; they decreased family member anxiety and distress, shortened intensive care unit stay, but did not affect patient mortality.Implications for Research and Practice
Few studies have evaluated interventions to improve communication between healthcare professionals and patients/families when facing the decision about whether or not to use life support in the ICU. Interventions that include essential elements of SDM need to be more thoroughly evaluated in order to determine their effectiveness and health impact and to guide clinical practice.
Journal of Nursing Education and Practice
International Peer-reviewed and Open Access Journal for the Nursing Specialists
Nursing services: an imperative to health care marketing
Abstract
Nurses comprise a significant portion of the work force in any health care organization. This work force is one having the maximum exposure to patients. Further, they work hand in hand with the various departments of the organization. Though an unintended consequence of nursing care, nurses form a potential marketing tool for any health care organization. In that marketing tool role, however, there are hindrances that nurses face. These may result in an unhappy work environment and potentially impact the overall image of the organization. Added to this, nurses may not always be equipped with the knowledge and expertise they need to meet current demands of their position and thus not promote the best nursing role for marketing purposes. Interestingly, good nursing care goes hand-in-hand with good marketing efforts in spite of this being an unintended consequence. The promotion of a strong and highly capable nursing image is an important strategy in marketing of health care services.
The evolution of professional organizations and accreditation agencies has resulted in setting specific standards of practice for nursing graduates. These standards help to ensure delivery of patient care of some predetermined quality. Indirectly this offers marketability to the organization by promotion of the nursing image. At the executive level, nurse leaders can play an important role in development of nursing strategy formulation and at the same time influence strategic marketing design. This paper provides an overview of the role nurses may play in certain aspects of marketing.
Journal of Nursing Education and Practice
ISSN 1925-4040 (Print) ISSN 1925-4059 (Online)
lunedì 6 maggio 2013
Issue
Journal of Evaluation in Clinical Practice
Volume 19, Issue 2, pages 298–303, April 2013
Additional Information(Show All)
Re-use of this article is permitted in accordance with the Terms and Conditions set out at http://wileyonlinelibrary.com/onlineopen#OnlineOpen_Terms
Evaluating care pathways for community psychiatry in England: a qualitative study
Article first published online: 23 FEB 2012
DOI: 10.1111/j.1365-2753.2012.01822.x
© 2012 Blackwell Publishing Ltd
Abstract
Objectives
In view of forthcoming ‘payment by results’ (PbR) for mental health,
increasing number of National Health Service (NHS) Trusts are
reorganizing their community services for working age adults to create
care pathways. However, research base for the care pathways model in
mental health is limited. Our NHS Foundation Trust was one of the first
to introduce care pathways for community psychiatry in the UK. We have
carried out a qualitative study to evaluate how this model works out in
practice, including its impact on quality of patient care, mental health
professionals and primary care.
Methods
We interviewed doctors, multidisciplinary staff and Trusts managers (19
in total). Transcripts of recorded interviews were coded and analysed
thematically using a grounded theory approach.
Results
Overall, despite teething problems, working in pathways was generally
seen as a positive change. It led to more focused interventions being
offered, and practitioners being held to account over clear standards of
care. It is more cost-effective and allows for active case management
and clear clinical leadership. It is recovery focused and encourages
social inclusion. The arbitrary time frame, strict criteria and
thresholds for different teams can create issues. Improved
communication, flexible and patient-centred approach, staff supervision,
and increasing support to primary care were felt to be central to this
model working efficiently and effectively.
Conclusions
Introduction of care pathways is an important step towards effective
implementation of PbR for mental health. Our study would inform future
research into care pathways, facilitate organizational learning and help
to improve effectiveness of services.
domenica 5 maggio 2013
AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000429756.00008.ca
Feature Articles
Original Research: Telephone Follow-Up for Patients After Myocardial Revascularization: A Systematic Review
Furuya, Rejane K. RN; Mata, Luciana R. F. MSc, RN; Veras, Vivian S. MSc, RN; Appoloni, Aline H. MSc, RN; Dantas, Rosana A. S. PhD, RN; Silveira, Renata C. C. P. PhD, RN; Rossi, Lidia A. PhD, RN
Author Information
Rejane K. Furuya, Luciana R. F. Mata, Vivian S. Veras, and Aline H. Appoloni are doctoral candidates at the College of Nursing, University of São Paulo, Ribeirão Preto, Brazil, where Rosana A. S. Dantas is an associate professor, Renata C. C. P. Silveira is an assistant professor, and Lidia A. Rossi is a full professor in the Department of General and Specialized Nursing. At the time of this study, Aline H. Appoloni was a master's candidate in the graduate nursing program at the Federal University of São Carlos, São Carlos, Brazil. This study was sponsored by an unrestricted educational grant from the São Paulo Research Foundation. Contact author: Lidia A. Rossi, rizzardo@eerp.usp.br. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.
Abstract
Objective: To identify studies of telephone follow-up conducted with patients who had undergone myocardial revascularization, and to assess and synthesize the results.
Design and methods: This is a systematic review; the literature search was conducted in six electronic databases. Controlled descriptors were health education, teaching, myocardial revascularization, coronary artery bypass, angioplasty, telenursing, telephone, and hotlines; the noncontrolled descriptor was needs information. Of 170 identified studies, seven met the inclusion criteria and were selected for analysis. The Jadad scale, which ranges from 0 to 5, was used to assess the methodological quality of studies, with scores of 3 to 5 indicative of higher quality.
Findings: Five of the seven studies found statistically significant positive changes in the outcome measures of health-related quality of life, pain, physical functioning, mood symptoms, anxiety, knowledge about self-care measures, medication compliance, and the lipid profile. Four of these five studies had a Jadad score of 3 and were of higher quality.
Conclusions: This review provides nurses and other clinicians with a synthesis of research on telephone follow-up in patients after myocardial revascularization. Of the seven studies analyzed, five showed evidence of some benefit from telephone follow-up. Their findings support the use of telephone follow-up to periodically assess patient knowledge, discuss patient concerns and offer ways to address them, monitor mood symptoms and anxiety levels, and encourage behavioral and lifestyle changes. Although any telephone follow-up intervention must be adapted according to each patient's needs, the lack of similarity among and specific information about the interventions described in the analyzed studies made it difficult to evaluate specific elements. More research is needed to identify optimal content and frequency, number, and duration of calls.
mercoledì 1 maggio 2013
Volume 3, Conference Supplement, March 2013
The editorial is written by Jan Dewing, IPDJ Academic Editor.
The guest editorial is written by Annette Solman and Val Wilson
Debbie Horsfall
Anthony Jackson
Jacqueline West
Rebekkah Middleton
Toni Wright and Karen Wright
Michael Kerr, Yvonne Verner and Victoria Traynor
Jane Stokes
Journal of Nursing Education and Practice
International Peer-reviewed and Open Access Journal for the Nursing Specialists
Integrating the scholarship of practice into the nurse academician portfolio
Abstract
Many nurse academicians are also advanced practice nurses (APNs) in the United States (U.S.). Such faculty are often involved in clinical practice activities which require specific competencies for meeting legal responsibilities and standards for safety. Maintaining practice expectations often takes away the time necessary to address traditional scholarship expected by U.S. institutions for advancement and promotion, and securing tenured academic positions. Scholarship activities for APNs should encompass broad and essential criteria during review and promotional processes; especially important is documentation for the scholarship of application as it applies to APN clinical practice. Nursing faculty who practice as APNs should become adept at documenting scholarship of practice. Appropriate recognition for valid non-traditional types of scholarship activities is essential.
According to the Position Statement of the American Association of the Colleges of Nursing (AACN) on Defining Scholarship for the Discipline of Nursing, there are four different dimensions of scholarship. These expand upon the seminal work of Boyer (1990) and consist of: (a) the Scholarship of Discovery, (b) the Scholarship of Teaching, (c) the Scholarship of Application, and (d) the Scholarship of Integration. The purpose of this article is to describe each of the four types of scholarship and demonstrate how the APN/ nurse academician’s clinical practice is an application of scholarship. APN practice is multidimensional and an important basis for review and promotion in academic and/or health care settings.
This work is licensed under a Creative Commons Attribution 3.0 License.
Journal of Nursing Education and Practice
ISSN 1925-4040 (Print) ISSN 1925-4059 (Online)
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Thomas Jefferson University
Jefferson Digital Commons
School of Nursing Faculty Papers & Presentations Jefferson School of Nursing
1-1-2013
Developing Ambulatory Care Registered Nurse
Competencies for Care Coordination and
Transition Management
LINK TO FULL TEXT
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