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The aim of the study was to assess nursing diagnoses and nursing interventions that were accordingly implemented during the care of inpatients with major depression in Greece. Twelve nurses working in three major psychiatric hospitals were recruited. Semi-structured interviews were used and audio-recorded data indicated that risk for suicide, social isolation, low self-esteem, sleep problems, and imbalanced nutrition are the nursing diagnoses most commonly reported. Establishing trust and rapport is the primary intervention, followed by specific interventions according to each diagnosis and the individualized care plan. The findings of the study also highlight the need for nursing training in order to teach nurses initial assessment procedures and appropriate evidence-based intervention techniques.

An exploratory, retrospective evaluation of Ambulatory Integration of the Medical and Social (AIMS), a care coordination model designed to integrate medical and non-medical needs of patients and delivered exclusively by social workers was conducted to examine mean utilization of costly health care services for older adult patients. Results reveal mean utilization of 30-day hospital readmissions, emergency department (ED) visits, and hospital admissions are significantly lower for the study sample compared to the larger patient population. Comparisons with national population statistics reveal significantly lower mean utilization of 30-day admissions and ED visits for the study sample. The findings offer preliminary support regarding the value of AIMS.

SUMMARYAim: The aim of this study was to determine nursing diagnoses and interventions in the care plans of elderly patients undergoing surgery.Methods: This descriptive and retrospective study was conducted with the files of 129 elderly patients undergoing surgery in a university hospital in Turkey. Data were collected using a questionnaire and nursing care plans. Frequency and percentage calculations were used to evaluate the data.Results: The mean age of hospitalized patients was 72.8±5.8 years; 28.7% of patients were hospitalized at a general surgery clinic and 51.9% were male. Nurses had been using 14 nursing diagnoses and 171 different nursing interventions while planning their care of elderly patients undergoing surgery. The most frequently used nursing diagnoses were falling risk, infection and hypertension.Conclusion: Nurses use limited diagnoses and standard interventions to plan the care of elderly surgical patients.

Each year in the United States, 31% of elders who die do so in hospitals, accounting for over half a million deaths often involving expensive and unnecessary treatments (Zhao & Encinosa, 2010 ). Re-hospitalizations of frail elders with end-stage illnesses are a concern for the hospitals that have discharged them and for the facilities in which they live. In 2011, Schervier Nursing Care Center, a 364-bed skilled nursing and rehabilitation facility in the Bronx, NY, looked at its re-hospitalization rates. It was discovered that a large percentage of the residents being sent to the hospital were from the long-term and subacute populations with end-stage diseases that were no longer responding to treatment. This article describes the development of two innovative programs whose goals were to increase the number of residents receiving palliative care, increase the number of completed advance directives, reduce re-hospitalizations, and increase hospital referrals to the nursing home for palliative care. The key components of both programs and their outcomes are described. The development and implementation of these programs were the author's capstone project for the Zelda Foster Social Work Leadership Fellowship in Palliative and End-of-Life Care.

Psycho-spiritual Care in Health Care Practice is an original contribution to our knowledge about spiritual care in many ways. Not least of these is its first-person approach combined with criticali...

This article presents intensive psychiatric nurses' work and nursing care. The aim of the study was to describe expressions of cultural knowing in nursing care in psychiatric intensive care units (PICU). Spradley's ethnographic methodology was applied. Six themes emerged as frames for nursing care in psychiatric intensive care: providing surveillance, soothing, being present, trading information, maintaining security and reducing. These themes are used to strike a balance between turbulence and stability and to achieve equilibrium. As the nursing care intervenes when turbulence emerges, the PICU becomes a sanctuary that offers tranquility, peace and rest.

In 1995, the Veterans Health Administration reorganized its health services structure to emphasize ambulatory care. Successful health care planning and improving access to ambulatory care services now depends upon a better understanding of health care needs and outpatient services. Because the veteran population is heterogeneous, it is important to understand the health, access issues, and utilization of ambulatory care services in order to develop effective strategies and interventions to ensure access to and utilization of ambulatory care. Drawing on a focus group methodology with 86 Native American veterans, representing 34 tribes, this study is a qualitative examination of the health, access, use of the Department of Veterans Affairs Health Care services, barriers to health care, and satisfaction with care experienced by Native American veterans. Results reveal problems in accessing care, receiving appropriate care, and coordinating care within the VA health care system. Policy and program recommendations include increasing outreach and education efforts regarding the availability of benefits and services, improving coordination of services between the Indian Health Service and the VA, and reemphasizing the importance of patient-centered care.

Context: Spinal cord injury (SCI) rehabilitation nurses document the occurrence of educational and care management efforts in traditional nursing documentation methods but not the intensity (or dose) of such interactions. This article describes a process to capture these nursing interventions.Methods: Nurses at 6 US inpatient SCI centers used 2 in-person meetings and weekly telephone calls over 9 months to develop a taxonomy of nursing patient education efforts and care management.Results: This was subsequently incorporated into a point-of-care documentation system and used to capture details of nursing care for 1,500 SCI rehabilitation patients enrolled in the SCIRehab study. The taxonomy consists of 10 education and 3 care management categories. The point-of-care system includes time spent on each category along with an indication of whether the patient and/or family received the education/care management. In addition, a subjective measure of patient participation in nursing activities is includ...

The physician can play an important role in managing high-risk nursing home residents without restraints and working with interdisciplinary care teams in comprehensive fall evaluations. A reduction or elimination of physical restraints can be measured for a facility over time, and it represents a relevant quality indicator of physician and facility interactions during the process of care. We discuss how the physician's role fits into this quality of care equation for nursing homes and its implications for new clinical, research, and policy directions for long-term care.

This article describes a unique interdisciplinary alcoholism treatment program created to provide treatment to alcoholics with severe health problems. There is evidence that severely ill alcoholics may be placed in nursing homes because it is the only available form of care. It is estimated that up to 49% of patients in nursing homes have an alcohol problem. This high representation may be due to a lack of treatment programs, which are able to manage or treat an alcoholic who also requires skilled nursing care. One nursing home's response to this unmet need was to create an alcohol treatment program within its own facility. Working with the State alcohol-treatment-licensing agency, a 10-bed unit was established for the primary treatment of alcoholism for patients who were also medically appropriate for skilled nursing care. The 30-day program was staffed by licensed alcohol counselors and consisted of alcohol education; individual, group and family counseling; and skilled nursing care for co-exis...

The obesity epidemic has touched all segments of society and every health care sector including the nursing home industry. Understanding the issues related to the care of obese nursing home residents is important in light of this epidemic. Such issues include the difficulties related to access to nursing homes, the structural preparedness of nursing homes to care for obese patients, and the potential for staff injuries. Policies regarding strategies to improve nursing home access for obese patients, mitigate disparities in quality of care and health outcomes owing to obesity, and better prepare for the growing obesity epidemic are needed.

PURPOSE To examine the usefulness of writing about a memory of an aesthetic experience, and then transfer the aesthetic experience to a health care situation. METHODS The study was accomplished at two university colleges of health sciences in Sweden. It started with student nurses (N=291) writing about a memory of an aesthetic experience. Then they transferred the aesthetic experience to a purposeful clinical practice. FINDINGS The results showed that each student could report on a positive memory of an aesthetic experience. Embedded in each story was an aesthetic experience that was meaningful to the student. Domains of memory most frequently reported were music, work of art and nature. Themes derived from the aesthetic memory were happiness and awareness. The awareness theme comprized the value of aesthetic experiences for the patients, and for student nurses. CONCLUSION The process of writing about a memory of an aesthetic experience provided an alternative model for nursing education that could improve patient care.

Oral health care has been shown to have low priority in nursing and has been only partly successful. To create more positive effects than those achieved through traditional oral health care education, this project tested an educational model for nursing staff personnel. In addition to traditional oral health care education, some of the nursing staff members passed an additional dental auscultation period and served as oral care aides. The aides were responsible for the oral health care of the residents at their nursing facilities (intervention group). The intervention nursing facilities were compared with facilities where nursing personnel only received a traditional oral health care education program. Assessments were made at baseline and at a 6-month follow-up. At follow-up it was shown that the nursing staff in the intervention group gave higher priority to the oral health care work than the nursing staff in the control group.

The ambulatory care setting is becoming an increasingly important environment for clinical teaching. This reflects the changing focus of healthcare delivery with more procedures and patient treatment being delivered in this setting. Maximizing learning opportunities for students without compromising patient care has never provided a greater challenge. This paper shares 12 educational tips for developing an ambulatory care teaching centre where both students and patients benefit from a protected yet realistic clinical setting.

Internationally, 20th century medical education concentrated on equipping new graduates with technical skills and pushing the frontiers of technological sciences to extend and enhance life in ways unimaginable in previous decades. In the 21st century, health services are expected to be characterized not by the "fix-up-when-things-go-wrong" type of care that 20th century physicians have become so good at, but by preventive care that can obviate much of the need for these fix-up services. Enabling doctors to deal with the different health care needs of future patients will require a values shift in medical education. The United States leads the world in per capita health care expenditure yet trails in many important measures of health status. It epitomizes many elements of both the good and the bad in current medical education that may be less obvious in other countries that are less wealthy, less technologically oriented, and less committed to individual freedoms. In this paper we use the US as a case study to argue the need for a fundamental shift in values away from the 20th century emphasis on disease, specialization and treatment, and towards health, generalization and prevention. We draw on data from the National Ambulatory Medical Care Survey to compare roles of primary care physicians and other office-based medical specialties in delivering preventive health care. We also estimate the cost of providing preventive care in terms of physician time. Finally, we contemplate how medical education values must change in the US and other countries if 21st century physicians are to be prepared to meet the health care needs of their communities.

As the US population ages, the proportion of patients receiving long-term care is increasing. To meet the challenge of providing quality care for these patients, physicians need to be prepared to efficiently evaluate their needs and formulate individualized care plans. In this article, Drs King and Lipsky discuss the unique aspects of caring for nursing home patients, including the role of patients' families in the overall plan. They present a practical, structured approach to evaluation and follow-up care, which they have encapsulated into two handy assessment forms.

The expansion of managed care may have significant implications for the treatment of women with mental health problems seen in primary care and by specialty mental health practitioners. Using data on office visits by women with mental health problems from the 1990-1994 annual National Ambulatory Medical Care Survey, we examine characteristics of office visits by payment type. We find that women with HMO-paid visits are much more likely to see a primary care practitioner rather than a specialist. While treatment patterns in primary care do not differ by payment type, treatment patterns in specialty care differ substantially. Women in HMOs are more likely to receive medications and less likely to receive psychotherapy, particularly longer duration psychotherapy, than are those with FFS payment.

The emergence of hospice care in the nursing home is a trend about which we have virtually no information. As a first step to a more comprehensive examination of this phenomenon, we provide a descriptive analysis of nursing homes that contain special care hospice units and a preliminary analysis of the determinants of nursing homes with special care hospice units. We found that being small, being a proprietary facility, being part of a chain, and being located in a more competitive environment are significantly related to having a hospice special care unit.

In this article we describe how providing regular foot care for the residents of public housing at an on-site nursing clinic has become a vital part of the clinic's services for the elderly and disabled residents. Good foot care contributes significantly to the health and well-being of elderly and at-risk groups of clients. With relatively little extra education for the nursing staff and for minimal cost, foot care can become an integral part of nursing services provided in many different types of community health settings. A framework for initiating and implementing a foot care program is highlighted.

Background: Because of concerns about the educational value of hospitalized patients, there has been a recent upsurge of interest in ambulatory care settings for learning. Although it is assumed that such settings are better for student and resident education, there is very little evidence comparing the experiences and their relative values in the 2 settings. Purpose: We carried out a study to evaluate tutor and trainee perceptions of the differences between educational experiences on 2 inpatient clinical teaching units and in an ambulatory care medical clinic. Methods: Over a 6‐month period, 69 internal medicine trainees in the 2 settings evaluated education‐related aspects of their patient interactions using a 3‐part questionnaire. Faculty tutors completed a 2‐part questionnaire concerning education‐related aspects of patients usually seen in the ambulatory care clinic. Results: There was a broader case mix in the ambulatory care clinic, but trainees perceived that experiences with patients on the inpat...

Ambulatory medical detoxification for alcohol has become increasingly more popular in the last several years as a cost-effective alternative to inpatient withdrawal. Critical research has demonstrated both effectiveness and safety for carefully selected patients. This article will review admission criteria for ambulatory detoxification programs including: general, drug, medical, psychological, and social. Further, I will detail patient management guidelines that are unique to ambulatory care. These guidelines will summarize the initial assessment, supportive care, medication management, and follow-up. The guidelines help assure a safe withdrawal from alcohol in an ambulatory setting.

Continuity of patient care between hospital and community is becoming increasingly important with a trend to shorter hospital stays and more care in the community. This paper describes how community nurses determine patient care provision after hospital discharge. The research presented is a component of a larger study exploring the interface of hospital and community nursing services. Semi-focused interviews were conducted with twelve community nurses to elicit their perceptions and experiences of discharge planning. The findings revealed that although discharge planning influenced continuity of care, community nurses make autonomous decisions about the provision of care to patients in the community setting.

(1993). Acute Care vs. Chronic Care Models of Service to the Elderly. Loss, Grief & Care: Vol. 6, No. 4, pp. 55-66.

The purpose of this study was to conduct a longitudinal evaluation of a university primary care (PC) medical residency programme and use the results to plan for future curriculum development. Overall performance and the ambulatory medical care of three consecutive resident cohorts training from 1982 to 1987 was assessed by attending physicians. PC residents' performance in ambulatory continuity practice was also compared to that of traditional residents' performance in 1985–86. The scoring profile of primary care attendings was compared to that of other attendings. Residents received lowest scores in diagnostic evaluation, leadership and administration. Their best evaluations were in medical care, personal attributes and communication. Two of the three primary care cohorts received lower medical care scores in ambulatory continuity practice compared to other rotations, but had higher overall scores in ambulatory continuity practice than did traditional residents in 1985–86. Primary care attendings gave lo...

Although home health care traditionally is conceptualized as nursing care, in today's environment care at home may be delivered by a myriad of professional and nonprofessional practitioners. In fact, many patients who receive home care do not receive billed nursing visits. We studied a group of patients (n = 200) who received no billed nursing care, but rather received billed care from therapists, social workers and home health aides. This cohort of patients differed from patients who received billed nursing care in several ways: they were more frequently referred to home care from the community, their prognoses on admission to home care were significantly better, and their outcomes from home care services were considerably more favorable. Clearly patients not receiving billed nursing care have service and resource needs different from those of the population receiving billed nursing care. Therefore, new perspectives must be used when considering how to assess, deliver and perhaps pay for the requirements of these patients.

Nursing homes in urban Boston during the early 1970s were dependent on emergency wards and outpatient departments for primary medical care of their residents. The Boston City Hospital Telemedicine program, later to become part of the Urban Medical Group, was an innovative approach to dealing with this problem through the use of teams consisting of nurse practitioners, physician assistants, and physicians. This approach, which emphasized the delivery of primary medical care at the nursing home, reduced the use of hospital-based services and improved continuity of care. This article describes the development of the concept and the challenges encountered at the state and federal levels in expanding the program.

Springer Publishing Company, New York, 2015ISBN 1-877-687-7476,188 pages, $40.00Edited by Kelly Carlson, PhD, APRN, BC Worcester State University, Worcester, Massachusetts, USAReviewed by Anne Mast...

Risk assessment and management in mental health nursing, edited by Phil Woods and Alyson Kettles, Oxford, Wiley-Blackwell, 2009, 264 pp., £28.99 (paperback), ISBN 9781405152860 Risk assessment and ...

Nursing homes are an important part of the long-term care continuum, and this book provides the reader with new approaches on transforming palliative care in this setting. Bern-Klug gives an in-dep...

(2009). Nursing care, documentation and discourse. Progress in Palliative Care: Vol. 17, No. 3, pp. 109-110.

Background Several residential aged-care facilities have replaced the institutional model of care to one that accepts person-centered care as the guiding standard of practice. This culture change is impacting the provision of aged-care services around the world. This systematic review evaluates the evidence for an impact of person-centered interventions on aged-care residents and nursing staff. Methods We searched Medline, Cinahl, Academic Search Premier, Scopus, Proquest, and Expanded Academic ASAP databases for studies published between January 1995 and October 2012, using subject headings and free-text search terms (in UK and US English spelling) including person-centered care, patient-centered care, resident-oriented care, Eden Alternative, Green House model, Wellspring model, long-term care, and nursing homes. Results The search identified 323 potentially relevant articles. Once duplicates were removed, 146 were screened for inclusion in this review; 21 were assessed for methodological quality, resulting in nine articles (seven studies) that met our inclusion criteria. There was only one randomized, controlled trial. The majority of studies were quasi-experimental pre-post test designs, with a control group (n = 4). The studies in this review incorporated a range of different outcome measures (ie, dependent variables) to evaluate the impact of person-centered interventions on aged-care residents and staff. One person-centered intervention, ie, the Eden Alternative, was associated with significant improvements in residents’ levels of boredom and helplessness. In contrast, facility-specific person-centered interventions were found to impact nurses’ sense of job satisfaction and their capacity to meet the individual needs of residents in a positive way. Two studies found that person-centered care was actually associated with an increased risk of falls. The findings from this review need to be interpreted cautiously due to limitations in study designs and the potential for confounding bias. Conclusion Typically, person-centered interventions are multifactorial, comprising: elements of environmental enhancement; opportunities for social stimulation and interaction; leadership and management changes; staffing models focused on staff empowerment; and assigning residents to the same care staff and an individualized philosophy of care. The complexity of the interventions and range of outcomes examined makes it difficult to form accurate conclusions about the impact of person-centered care interventions adopted and implemented in aged-care facilities. The few negative consequences of the introduction of person-centered care models suggest that the introduction of person-centered care is not always incorporated within a wider “hierarchy of needs” structure, where safety and physiological need are met before moving onto higher level needs. Further research is necessary to establish the effectiveness of these elements of person-centered care, either singly or in combination.

Correspondence: Terrah L Foster Vanderbilt University School of Nursing, 461 21st Avenue South, 409 Godchaux Hall, Nashville, TN 37240, USA Tel +1 615 343 6025 Fax +1 615 343 5898 Email terrah.l.foster@vanderbilt.edu Abstract: Pediatric palliative care aims to enhance life and decrease suffering of children and adolescents living with life-threatening conditions and their loved ones. Oncology nurses are instrumental in providing palliative care to pediatric oncology populations. This paper describes pediatric palliative care and provides an overview of literature related to the physical, psychological, social, and spiritual domains of palliative nursing care for children and adolescents with cancer. Nurses can provide optimal palliative care by accounting for children’s understanding of death, encouraging early initiation of palliative care services, and improving utilization of pediatric palliative care in cancer settings. Specific roles of registered nurses and advanced practice nurses in pediatric palliative care will be addressed. Recommendations for future research are made to further advance the science of pediatric palliative care and decrease suffering for children and teens with cancer.

(1996). Palliative Care in the Nursing Home. Progress in Palliative Care: Vol. 4, No. 3, pp. 77-78.

(1996). Nursing Care in the Community (Book) Journal of Community Health Nursing: Vol. 13, No. 3, pp. 203-203.

A study of nursing home staff found that nurses generally are not knowledgeable about psychiatric symptoms and do not seek out psychiatric intervention for their patients who need it. Even when nurses are knowledgeable about psychiatric symptoms and have had special training in mental health care it is found that they nonetheless rarely seek psychiatric intervention for their patients. The problem to be redressed lies not merely in increased education alone. It also resides in the organizational character of health care delivery in nursing homes, which makes adequate nursing response to mental illnesses impossible.

More efficient use of medical manpower, improved delivery of care, greater work satisfaction for all concerned: these are among the goals well served by the new types of health professional whose t...

This descriptive survey identified the characteristics of hospice patients, their primary caregivers and major nursing care problems. Data from 350 patients in 41 states were collected by the hospice nurses who cared for the patients. Patient records served as a source for the data. Pain, physical decline, family emotional difficulties, respiratory distress and constipation were identified as the most frequent major nursing care problems. This study is intended to provide the basis for more definitive investigations of nursing care measures. Questions for further analysis of one of the nursing problems, physical decline, are suggested.

Recent attention has been directed toward providing specialized skilled nursing facility care for patients suffering from dementia. This paper explores and details how The Hebrew Home for the Aged at Riverdale developed such a unit and its applicability for the provision of appropriate care to demented elderly in other settings. The leadership roles of professional care staff, particularly the social worker in the development of this project are highlighted.