Outcomes of implementing primary nursing in the care of people with chronic lung diseases: the nurses' experience

Patientinnen- und patientenbezogene Auswirkungen von prozessverantwortlicher Pflege

Background

Since January 2022, a primary nursing system called process-responsible nursing (PP) has substituted the standard room care system in an intensive care unit (ICU) at our institution. The process of the development and implementation of PP is already being evaluated in a separate study as an actual analysis prior to implementation, as well as after 6 and 12 months.

Aim

This pilot randomized controlled trial (RCT) aims to test the feasibility of an RCT. For this purpose, the duration of delirium, among other things, will be compared in the project ICU with the results of standard care in another ICU at the university hospital. As secondary aims, the incidence of delirium, anxiety, the satisfaction of relatives, and the effects of PP on nurses will be assessed.

Methods

It is planned to recruit about 400–500 patients over a period of one year. They will be allocated to PP or standard care. Delirium will be assessed using the Confusion Assessment Method for Intensive Care Units by specifically trained nurses three times a day. Anxiety in patients, the satisfaction of relatives, and the effects of PP on nurses will be evaluated using the numeric rating scale, a standardized questionnaire, and a focus group interview, respectively.

Expected results

The primary hypothesis is that compared to usual care PP reduces the duration of delirium by at least 8 h. Additional hypotheses are that PP reduces anxiety in patients and increases the satisfaction of relatives.

Health-related quality of life and healthcare experiences in breast cancer patients in a study of Swedish women

BACKGROUND

Nearly 7,000 women are diagnosed with breast cancer in Sweden every year. The primary treatment is surgical and consists mainly of partial or modified radical mastectomy followed by adjuvant treatment. The diagnosis and treatment may cause distress and decreased health-related quality of life.

OBJECTIVE

The aim of the present report was to study health-related quality of life and satisfaction with hospital stay.

METHODS

One hundred women were invited to participate in the study, of which 85 accepted. Participants filled in the 36-item Short-Form Health Survey and a study-specific questionnaire, both preoperatively and postoperatively and 6 months after surgery.

RESULTS

Women with breast cancer experienced an improved health-related quality of life over time, but they reported poorer health-related quality of life than the norm value after surgery. The lowest scores at all time points were observed on the scales role-physical and role-emotional. Patients were very satisfied with the treatment and care they had received. Three of 4 women felt that the nursing staff had a considerate and conscientious manner, for example, when removing drains.

CONCLUSION

Diagnosis and treatment of breast cancer have impact on the women's health-related quality of life. Measures to meet patients' needs during short hospitalization need to be considered.

IMPLICATIONS FOR PRACTICE

Nurses must ensure that patient's physical and emotional needs are identified and met and that appropriate counseling is provided.

Job satisfaction in relation to change to all-RN staffing

BACKGROUND

A university hospital clinic changed from a mixed to only registered nurse staffing, to reduce the staff and to encourage a philosophy of patient centred care. The aim was to maintain the same level of service and quality of care at a lower cost.

AIM

The main purpose of the study was to examine job satisfaction in relation to the change from mixed to only registered nurse staffing and reduction in number of staff.

METHODS

Data were collected by an established questionnaire measuring job satisfaction. Non-parametric statistics were used to analyse the data. The questionnaire was distributed to 22 nurses on the ward on three occasions, covering a period of 3 years.

RESULT

The experience of having time to plan patient care changed during the investigation period, from 'sometimes' to 'most often having time'. Nurses with longer work experience gave more verbal information to patients and perceived less stress. Information about job performance was more important to newcomers on the ward and became less important with time. However, quite a few have had regrets over choice of work and had considered non-caring work, nevertheless the results show no significant changes in overall job satisfaction.

Multicomponent individualized smoking cessation intervention for patients with lung disease

AIMS

This paper reports a study examining the process and outcomes of a long-term, multicomponent smoking cessation intervention for patients with lung disease initiated while hospitalized and provided over 1-year postdischarge.

BACKGROUND

Successful smoking cessation interventions are of primary importance for people with lung disease. Initiation of such an intervention in hospital settings is particularly important as patients may be especially motivated to quit as a result of strong perceptions of vulnerability while hospitalized for a smoking-related disease. Tailoring the intervention to each person's needs is a promising approach to practice.

METHODS

All patients who smoked and were admitted to a pulmonary unit over 2 years were invited to participate in this quasi-experimental study (n = 85), and 69 continued beyond the first month. The intervention was shaped by the TransTheoretical Model and used nicotine replacement therapy, along with individual and group counselling and support grounded in the nurse-patient relationship. The intervention was provided during hospitalization and by telephone after discharge at 1 week, and 1, 3, 6 and 12 months.

RESULTS

At 12-months postdischarge, 39% of the patients reported continuous abstinence from smoking from the time they joined the programme and 52% were not smoking at that time. No relationship was found between abstinence and the number of quit attempts, readiness to quit, nicotine dependency and length of hospital stay. Readiness to quit had increased and nicotine dependency decreased significantly by the end of the programme. No gender differences were found for the main variables.

CONCLUSIONS

Comprehensive, individualized smoking cessation interventions for hospitalized patients having lung disease, with a 1-year follow-up, was successful. Abstinence was high in comparison with other studies. This may in part be explained by significantly enhanced motivation to quit during the smoking cessation programme.

Ethical issues in participatory action research

The purpose of this article is to describe the ethical issues arising out of participatory action research (PAR), on the basis of both an empirical study and the research literature, and to discuss how to deal with these issues. The data consist of the experiences and results of three phases of PAR relating to orthopaedic patients with rheumatoid arthritis (RA) and the analysis of 20 articles on the ethics of action research. As a result, the following ethical issues and the ways to treat them were discussed: informed consent, confidentiality and anonymity, protecting an individual from harm, the role of the researcher, the location of 'power' in PAR, and the ownership of the research. The flexibility of PAR in use and its main features are also related to the decisions made and actions taken in response to ethical issues. It is particularly important in PAR to proceed according to the participants, and to involve them from the beginning of the process, in order to insure the equal balance of power between participants and researcher.

Primary nurses' performance: role of supportive management

BACKGROUND

Most studies examining primary nursing focus on outcome variables such as enhanced patient and staff satisfaction with care, perceived autonomy and quality of care, whereas only limited research has examined processes of implementing and maintaining primary nursing. In addition, the few studies that have explored process variables discuss only direct relationships between the design of the primary nursing care-delivery system, process and nurse outcomes, and disregard how such variables interact.

AIM

This study sought to address previous inconsistent findings about the impact of primary nursing care-delivery models on the performance of nurses by incorporating the moderating role of supportive management practices.

METHOD

Three hundred and sixty-eight nurses from a variety of wards completed questionnaires that assessed the degree of primary nursing on their unit, the support practices of their direct supervisor and their perceptions of the cost of seeking support from their supervisor. In addition, the direct supervisor evaluated the nurse's performance in the unit.

RESULTS

Primary nursing did not exert a direct impact on nurses' performance. Rather, the interaction of primary nursing with supervisor support was more predictive of performance: if supervisor support was high, performance was substantially higher than if supervisor support was low. In addition, nurses' perceptions of the costs of seeking support had a detrimental impact on their performance.

CONCLUSIONS AND LIMITATIONS

The study was cross-sectional and relied on self-report data only. Nevertheless, the findings show that supportive management practices are crucial to the success of implementing primary nursing.

Individualized nursing care: an empirically generated definition

Individualization is considered a particularly important feature of nursing care by nurses, patients and their families, and by health care administrators. Descriptions in the literature suggest that individualized care requires some background knowledge of the patient, which nurses use to devise care plans that treat each patient as unique. However, few research-based descriptions of individualized care exist. The purpose of this article was to offer a definition of individualized nursing care synthesized from research findings. Descriptions of nursing care individualization emerged from two previously conducted grounded theory studies of nursing practice. Data relevant to the concept were retrieved from each study. These data were compared and contrasted in order to identify and describe individualized care from the perspectives of nurses and patients. The analysis resulted in a definition of individualized nursing care that makes explicit the characteristics of such care, thus providing a framework for designing and evaluating nursing care that recognizes patients as unique persons.