Patients' perspective of quality of care in a high-dependency unit

Patient's self-determination in intensive care-from an action- and confirmation theoretical perspective. The intensive care nurse view

When becoming an intensive care patient life changes dramatically. In order to save life, different actions are performed by the caregivers and the patient's ability to exercise self-determination is non-existent. After the acute phase the patient is more awake and the possibilities for self-determination change. The purpose of this study was to describe intensive care nurses' (ICNs) views of patient's self-determination in an intensive care unit and to systematize ICNs' nursing actions for supporting patient's self-determination from an action- and confirmation-theoretic perspective. In order to answer these questions, 17 interviews with ICNs were conducted by the use of the Critical Incident Technique (CIT). The transcripts were then analysed using a hermeneutic analysis method and structured by the SAUC model for confirming nursing. The main findings were that the ICN thought that the ICU patient's self-determination was low and restricted. It was more common that the ICN acted to strengthen the patient's self-determination in nursing care, but there were no specific nursing goals for patient's self-determination. The most common actions for supporting self-determination were supplying the patient with information and engaging the patient in making a day plan. The nursing implications are that the ICN's view of human being as an acting subject is important for the ICN's awareness to recognise the patient's own personal resources to handle the critically ill situation and that the ICN's competence to manifest qualified nursing is necessary for strengthening patient's self-determination.

Does intermediate care minimize relocation stress for patients leaving the ICU?

Relocation stress is a phenomenon in which physical and psychological disturbances are experienced following transfer from one environment to another [Carpenito LJ. (2000). Nursing Diagnosis. Application to Clinical Practice, 8th edn]. The purpose of this review was to identify whether a period of intermediate care minimizes the problems associated with relocation stress after discharge from the intensive care unit (ICU) and before transfer to the ward. Methods of retrieving the literature involved identifying key terms, utilizing a range of databases and applying specific criteria in order to delineate the boundaries of the search. Using electronic and manual search methods, 11 studies were selected, both primary and secondary research. Following tabulation and critiquing of the studies, the findings of the review suggest that the factors which contribute towards relocation stress are the loss of one-to-one nursing, a reduction of visible monitoring equipment, lack of continuity of care and inadequate preparation of the patient for the transfer. The evidence also indicates that in order to minimize these factors, early planning and preparation of the patient for transfer are required, incorporating strategies of gradual reduction in nursing attention and monitoring equipment and the provision of information. Although the benefits of intermediate care are established as being advanced monitoring, appropriate nurse-to-patient ratio, heightened demonstration of expert knowledge and skill, there is no sufficient evidence to indicate a period of intermediate care that can ease the transition from the ICU to the ward.

Health care implications and space allocation of research published in nursing journals

PURPOSE

To examine how research is disseminated through nursing journals and to examine characteristics of published research.

DESIGN

A cross-sectional descriptive survey was conducted with manuscripts from 78 nursing journals that publish research.

METHOD

The final issue for 1999 was examined. Pairs of independent raters content-analyzed all research manuscripts.

DISCUSSION

Research studies comprised 241 (42.9%) of the manuscripts and 51.4% of the journal space. Many empirical studies omitted validity and reliability. Few manuscripts reported the date for completion of data collection, and fewer than one third contained the length of time from acceptance to publication.

CONCLUSIONS

Enhanced instrumentation reporting, shorter time from data collection to publication, and an increase in journal space devoted to research might enable nurses to make more cutting-edge clinical decisions.

Quality of life and the high-dependency unit

This study was designed to identify and measure the patients' perspective of the concept quality of life within the context of a high-dependency unit (HDU). Data were collected in two phases. In phase one, 55 patients were interviewed, which resulted in the concept clarification of quality of life as: physical, social, psychological and family/friends. In phase two, 51 patients undertook quality-of-life assessment using validated instruments the Quality of Life Index (Ferrans & Powers 1985) and the Global Quality of Life Scale (Hyland & Sodergren 1997). Post-HDU patients demonstrated improvements upon pre-admission scores in both instruments (the social domain in the quality of life index being the exception), although this only reached statistical significance P<0.05 in the overall index score and within the domains of health and family. When exploring variables of age and severity of illness (Apache 2 score, Knaus et al. 1980) it was the people who were older and physiologically compromised to an increased extent (P<0.05) who demonstrated higher levels of satisfaction with their resulting quality of life. This study has been successful in providing patients with an opportunity to participate more actively in service evaluation and has identified the need for future evaluation of HDUs to move beyond physiological measures, to incorporate the impact that illness leading to admission to an HDU has upon the patients' ability to function and their resulting quality of life.