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This study investigated relationships among hospitalized elders' perceptions of nurse caring behaviors, the type of unit on which they received care, their satisfaction with nursing care, and their outcome of functional status. A predictive correlational nonexperimental design was used with a sample of 180 subjects, 90 from an acute care elder unit and 90 from a telemetry unit in an acute care medical center where new-nurse orientation included Nurses Improving Care for Health System Elders (NICHE) concepts of care. Elders' perceptions of nurse caring behaviors were correlated with satisfaction with nursing care (r[178] = 0.555, p = .000). Only one of seven hypotheses was supported. Type of care unit had no effect on elders' perceptions of nurse caring behaviors, satisfaction with care, or functional status outcome. Nurses who are taught how to care for acutely ill hospitalized elders are likely to demonstrate nurse caring behaviors that result in satisfaction with nursing care, better functional...

Mary Elizabeth is an Oncology Clinical Nurse Specialist from Memorial Sloan-Kettering Cancer Center in New York City, New York. She graduated from University of Delaware in 1985, with a Bachelor's degree in nursing and followed in 1989, with a Masters of Nursing from Columbia University specializing in oncology. Mary Elizabeth works as a Clinical Nurse Specialist in Memorial Sloan Kettering's ambulatory medical oncology consultative services. Her role includes modeling professional practice to the nurses of the services for which she has responsibility including mentoring and precepting nurses who are new to a practice, coordinating and evaluating their clinical experiences, and overseeing their development in the oncology nursing specialty and the ambulatory clinical practice role. Mary Elizabeth regularly "walks the walk" filling in and assisting in busy practices; this helps her maintain knowledge of the latest advances in disease management as well as experience firsthand the challenges of the ambulatory nursing role. Over the past few years, she has been practicing within MSK's busy and growing world - renowned retinoblastoma (RB) clinic. Mary Elizabeth has presented on RB nationally and at international conferences in the hopes of bringing this curable disease to the attention of nurses worldwide. Early diagnosis and early access to treatment can save lives, eyes, and vision.

Introduction This project aimed to improve the care of patients presenting via their general practitioner (GP) or emergency department (ED) with new iron deficiency anaemia (IDA) by reducing unnecessary blood transfusions; reducing unnecessary admissions for blood transfusion; arrange iron infusions in the ambulatory care ward (ACW) and streamline investigations. Methods An audit between 7th March and 7th April 2016 identified 28 patients who were admitted and had blood transfusions, 9 of these could have potentially been managed in ambulatory care with an iron infusion. 6 patients had blood in the ambulatory care ward receiving 14 units in total. Pathology started to automatically test B12, folate and ferritin in all blood tests from ED and GPs with new potential IDA. A pathway for ED and GPs was set up to enable patients to be booked into ACW for iron infusions, or given oral iron, rather than admitted to medical assessment (MAU) for blood transfusion. Criteria for further investigaiton were set. A costing estimate was developed for the cost of the iron infusion vs blood transfusion; including nursing time and consumables. Training was delivered to the ambulatory care nursing staff in administration of iron infusions and a pathway developed with pharmacy to ensure timely delivery of the iron infusion. Results The project was launched on 1 st August 2016. Over 12 months to 31 st July 2017, 65 patients, median age 70 (23–91) years, received an iron infusion in ACW. Median Hb 75 (40–130) g/dl, follow up Hb median 112 (75–155) g/dl a median of 34 (1–133) days post iron infusion. 10 patients additionally received blood, median 2 (1–6) units. There was an overall reduction in units of blood transfused in MAU from 841 to 552 comprising of mostly of a reduction in ACW units transfused from 768 to 319. There were 15 new diagnoses as a direct result of the incident presentation, 7 cancer, 7 non- cancer gastric ulcers and 1 recurrent metastatic ovarian cancer. There was an established diagnosis in 21 patients, 6 cancers and 13 non-cancer of which 6 were gastrointestinal causes. In 28 patients, no diagnosis was made. In 10 patients investigations were normal. In 9 patients it was decided they were not for appropriate for further investigation. 4 were not iron deficient, 4 had an unknown outcome and 1 patient was pregnant 2 months post iron infusion and not investigated further. Conclusions This was the sucessful development and implementation of a pathway to streamline the care of patients presenting acutely with IDA. There has been a reduction in the number of units of blood transfused in MAU and a 58% reduction in the number of units of blood transfused in ACW. 65 patients have been treated with an iron infusion with an overall improvement in their Hb, with 23% receiving significant new diagnosis.

RESUMO Objetivo: desvelar o movimento existencial da mulher após a intervenção cirúrgica cardíaca. Método: pesquisa qualitativa de abordagem fenomenológica. Teve como cenário uma instituição hospitalar em Minas Gerais, na qual dez mulheres foram entrevistadas entre dezembro de 2011 e janeiro de 2012. Resultados: após a alta hospitalar, as mulheres vivenciam comprometimentos físicos, sociais e emocionais, desejando a volta do tempo anterior ao diagnóstico, uma vez que ainda se sentem cardiopatas. Essa compreensão vaga e mediana emerge de três unidades de significação, as quais, na perspectiva da hermenêutica heideggeriana, permitiram desvelar o fenômeno da cirurgia cardíaca como um agora que limita o dia a dia das mulheres. Conclusão: o enfermeiro, na disposição de ser-com-o-ser-aí-mulher-após-a-cirurgia-cardíaca, deve promover a saúde, considerando as facetas existenciais que se mostram nos momentos de cuidado. Nessa oportunidade de encontros singulares e plenos de subjetividade se revelam as bases para a integralidade da assistência. RESUMEN Objetivo: desvelar la existencia de la mujer tras la cirugía cardíaca. Método: investigación cualitativa de enfoque fenomenológico. La escena fue un hospital en Minas Gerais, en el cual se entrevistaron diez mujeres entre diciembre de 2011 y enero de 2012. Resultados: tras el alta hospitalaria que todavía sienten las enfermedades del corazón a través de experiencias físicas, sociales y emocionales, las mujeres anhelan regresar al tiempo anterior al diagnóstico. Esa vaga y mediana comprensión viene de tres unidades de significado, las cuales, teniendo en vista la hermenéutica de Heidegger, ayudaron a descubrir que el fenómeno de la cirugía cardiaca limita la vida cotidiana de las mujeres. Conclusión: el enfermero ayudando después de la cirugía cardiaca debe promover la salud de la paciente, teniendo en cuenta sus aspectos existenciales en los momentos de atención. En esas oportunidades individuales y llenas de subjetividad residen las bases de la integralidad de la atención. ABSTRACT Objective: to unveil women's existential movement after cardiac surgery. Method: qualitative phenomenological study. The research setting was a hospital in Minas Gerais, in which ten women were interviewed between December 2011 and January 2012. Results: after hospital discharge, the women experienced physical, social and emotional impairments, and expressed the desire to go back to the time before their diagnosis, because they felt as though they still had heart disease. This vague and average understanding led to three units of meaning that, from a Heideggerian hermeneutic point of view, revealed the phenomenon of cardiac surgery as a present circumstance that limited the participants' daily lives. Conclusion: nurses supporting women patients after cardiac surgery should promote health considering existential facets that are expressed during care. The bases for comprehensive care are revealed in singular and whole meetings of subjectivity.

Background Emergency department (ED) visits for ambulatory care sensitive conditions (ACSCs) are common among older adults. The high-intensity telemedicine model of care has been proposed as an innovative approach to expand access to acute illness care, thereby preventing ED visits. The aim of this study was to assess the effect of a high-intensity telemedicine program for senior living community (SLC) residents on the rate of ED use for ACSCs. Methods We performed a prospective cohort study at a primary care geriatrics practice that provides care to 22 SLCs. Six SLCs selected as intervention facilities, with the remaining SLCs serving as controls. Consenting practice patients at intervention facilities could have patient-to-provider, real-time, or store-and-forward high-intensity telemedicine services to diagnose and treat illnesses. The primary outcome was the rate of ED visits for which the primary diagnosis was an “ambulatory-care-sensitive” condition by the Institute of Medicine, which we compared between control and intervention participants. Results During the study period, control participants had 310 ED visits for ACSCs, for a rate of 0.195 visits/person-year. Intervention participants visited the ED for ACSCs 85 times, for a rate of 0.138 visits/person-year [unadjusted rate ratio (RR): 0.71, 95% confidence interval (CI): 0.53–0.94]. Among intervention participants, ED use for ACSCs decreased at an annual rate of 34% (RR: 0.661, 95% CI: 0.444–0.982), whereas, in the control group there was no statistically significant change in ED use over time (RR: 1.01, 95% CI: 0.90–1.14). Conclusions Providing acute illness care by high-intensity telemedicine to older adults residing in SLCs significantly decreases the rate of ED use for ACSCs over 1 year, compared with no change in the rate of ED use for ACSCs among the control group.

OBJECTIVES Potentially inappropriate medication (PIM) use is an important and preventable safety concern in the care of elderly patients and has been associated with adverse drug reactions, hospitalization, and mortality. Although PIM use for the elderly is a common and serious public health issue worldwide, there are few studies examining PIM use in the ambulatory care setting in Korea. METHODS To examine the prevalence and risk factors of PIM use from ambulatory care visits by elderly patients covered by National Health Insurance (NHI) in Korea, the nationwide prescription claims data of elderly patients' ambulatory care visits in 2006 were analyzed. RESULTS Potentially inappropriate prescriptions were identified using extensive criteria that included Beers', Zhan's, and Canadian criteria. In 2006, 3,770,978 elderly patients received 40,995,267 prescriptions. 36.7% of the total prescriptions for elderly patients who visited ambulatory care clinics were identified as PIM use. Findings in this study indicated that the strongest risk factors for PIM prescriptions were the number of drugs prescribed and visit characteristics. CONCLUSION Therefore, it is necessary to develop the explicit criteria of PIM prescription in Korea that can be included in the Drug Utilization Review (DUR) system, which is expected to lead to more appropriate and judicious prescribing.

This article provides a general overview of nursing care principles including an approach to developing a nursing care plan using the nursing process as its foundation. The nursing process is a problem-solving approach used in planning patient care. This article also focuses on nursing care as it pertains to the respiratory, cardiovascular, and renal systems (fluid balance) as well as care of the recumbent patient. Knowledge of nursing care techniques and risk factors for complications puts the care provider in a position of being proactive rather than reactive to patient care needs.

Objectives: The purpose of the study is to investigate the oral health of the elderly people receiving nursing care and home care services in Chungnam. Methods: The subjects were 350 elderly people receiving 21 nursing care and home care services in Chungnam. The direct interview with the elderly people and oral examination was carried out from July, 2012 to December, 2013 after explanation fo the purpose of the study. The subjects consisted of 178 elderly people receiving nursing care services and 172 elderly people receiving home care services. Except incomplete answers, 315 data were analyzed. The questionnaire consisted of general characteristics of the subjects, characteristics by facility, oral condition, oral care behavior, correlation by factors on oral health, influencing factor on dental caries, influencing factor on periodontal disease, and influencing factor on elasticity of gingival muscle. Data were analyzed by frequency analysis, chi-square test, and multiple regression analysis using SPSS 21.0 program. Results: Multivariate analysis of influencing factors on oral health revealed that the elderly people with low education level tended to have higher incidence rate of dental caries. The influencing factors on oral health were the elasticity of gingival muscle, periodontal disease, educational level, and economic level. (p

Background Pediatricians are physicians trained to provide comprehensive nonsurgical health care for children, but parents may consult other specialists when seeking medical help for their children. This study was designed to analyze the role of pediatricians and the changes in the patterns of ambulatory visits among different specialties for children under the age of 18 years in Taiwan during the past 13 years. Methods Data on ambulatory visits of children aged 0–17 years from 1999 to 2011 were retrieved from the National Health Insurance Research Database. The physician's specialty, level of the hospital, year of visit, age of the patient, and diagnoses of each ambulatory visit were analyzed. Four of the most commonly visited specialties—pediatrics, otolaryngology, family medicine, and internal medicine—were compared. The yearly trend of ambulatory visits to different specialties, difference in various age groups, influence of hospital levels, and the top 10 diagnoses were analyzed. Results A total of 1,618,033 ambulatory visits were identified and enrolled into our study. A comparison of the proportions of ambulatory visits between 1999–2003 and 2007–2011 showed that the proportions of visits increased from 27.1 ± 1.3% to 35.4 ± 1.0% for pediatricians, decreased from 32.8 ± 1.8% to 17.0 ± 0.8% for family physicians, and did not change for otolaryngologists and internal medicine physicians. Specifically, pediatricians were visited more often if the children were younger, or if the health-care facility (level of hospital) was either a medical center or a regional hospital. Upper respiratory tract infection was the top diagnosis, followed by acute bronchitis, and acute and chronic tonsillitis. Conclusions The role of pediatricians in children's ambulatory care increased in importance from 1999 to 2011 in Taiwan. However, approximately two thirds of children sought ambulatory medical help from nonpediatric physicians. Thus, it is important to educate and encourage parents to visit pediatricians if their children require medical help.

Purpose: The purpose of this study was to identify differences between the degree of nursing need and nursing performance as perceived by caregivers of hospitalized children. Methods: Participants included 200 main caregivers from two pediatric hospitals where their children had been hospitalized for at least 2 days. Data were collected from October 30 to December 10, 2014. Results: The degree (2.64±0.40) of nursing performance perceived by caregivers with hospitalized children was found to be significantly lower than that (3.39±0.21) of nursing needs of caregivers. Of nursing needs, direct nursing had the highest score at 3.59, and nursing assessment, the lowest at 3.23. For nursing performance, nursing assessment had the highest score at 2.76, and education and counseling, the lowest at 2.35. Conclusion: These results suggest that performance of nursing activities by nurses caring for hospitalized children do not meet the nursing needs of the caregivers. Therefore it is necessary to develop nursing strategies to reduce the gap between nursing needs and nursing performance.

Objective: To examine long-term care facility (LTCF or nursing home) use and end-of-life care for individuals with Parkinson disease (PD). Methods: In this nationwide retrospective cohort study, we compared LTCF and hospice utilization among Medicare beneficiaries diagnosed with PD by demographic, clinical, and physician characteristics. We also examined the impact of outpatient neurologist care for institutionalized patients with PD on end-of-life care. Results: We identified 469,055 individuals with PD who received Medicare benefits in 2002. Nearly 25% (more than 100,000 in total) resided in an LTCF. Women with PD had greater odds of nursing facility residence (adjusted odds ratio [AOR] 1.34, 95% confidence interval [CI] 1.30–1.38) compared with men. Black individuals with PD were 34% more likely than white individuals to reside in an LTCF (AOR 1.34, 95% CI 1.30–1.38), contrary to the race patterns typically observed for LTCF use. Hip fracture (AOR 2.10, 95% CI 2.04–2.15) and dementia (AOR 4.06, 95% CI 4.00–4.12) were the strongest clinical predictors of LTCF placement. Only 33% (n = 38,334) of nursing home residents with PD had outpatient neurologist care. Eighty-four percent (n = 80,877) of LTCF residents with PD died by December 31, 2005. Hospice utilization varied little by race and sex. LTCF residents who had outpatient neurologist care were twice as likely to utilize hospice services before death (AOR 2.35, 95% CI 2.24–2.47). Conclusions and relevance: A large proportion of the Medicare PD population resides in an LTCF. There is substantial unmet need for palliative care in the PD population. Increased efforts to provide specialist care to dependent individuals with PD may improve end-of-life care.

Ambulatory Emergency Care is a key component of the service for many Acute Medical units across the United Kingdom. A well-functioning ambulatory care unit facilitiates early senior review by a consultant and may reduce the need for hospital admission by managing patients along alternative safe clinical pathways. In this article, we present 12 months of data (January 2014-January 2015) from our Ambulatory Unit at Wrightington, Wigan and Leigh NHS Foundation Trust (WWL NHSFT), which demonstrates how many different conditions can be safely managed along ambulatory care pathways and how this can significantly contribute to postive patient satisfaction survey results and meeting the A&E 4 hour target for a medium-sized Acute Trust such as WWL NHSFT. We also emphasise that the key factors of co-location of ambulatory care with the Emergency Department along with dedicated medical and nursing staff are essential to the success of this model of care.

Background Providing quality care and support to cancer patients from minority cultures can challenge community nurses when language barriers and cultural complexities intersect with the need for complex care. Objectives This article reports on a qualitative study that explores interactions between community nurses and Chinese-Australian cancer patients. Methods The research method focused on particular nurse-patient encounters and involved preencounter and postencounter interviews with the nurse, postencounter interviews with the patient, and observation of the encounters. Participants included community nurses, Chinese cancer patients being cared for at home, and their carers if present. Results Four themes were conceptualized: (1) the impact of language barriers on nurse-patient interactions, (2) patient understandings of the scope and objectives of healthcare services, (3) cultural complexities and sensitivities, and (4) valued care and support. The study demonstrates that, although many nurses do provide comprehensive, culturally competent care, language barriers can lead to task-oriented rather than comprehensive approaches, and other cultural complexities do have an impact on patient experiences and on the quality of nurse-patient interactions. Nevertheless, most patient participants experienced a feeling of security as a result of regular contact with a community nursing service. Conclusion Cancer patients with complex care needs but limited English proficiency require support to negotiate complicated community services networks. Culturally competent community nurses can provide this support. Implications for practice The study highlights the need for continuing cultural competence education for community nurses and the importance of careful discharge planning to ensure continuity of care for this vulnerable patient group.

From December 1, 2010, through May 31, 2013, the South Dakota Board of Nursing conducted a pilot study, "Virtual Nursing Care for Children with Diabetes in the School Setting." The findings from the study supported the use of the virtual nurse model of care as a safe and effective method of supervising and delegating diabetes nursing care tasks to unlicensed assistive personnel (UAP), including insulin administration.This article provides an update describing the 2014 changes made to the nursing delegation rules, the protocol established for registered nurses using the virtual nurse model of care, and the training program for UAP providing diabetes nursing care.

Infusion nursing is a unique hybrid of inpatient and ambulatory nursing. The subspecialty of nurses cares for patients requiring treatment over long periods, including cancer patients receiving chemotherapy and patients who require short bursts of treatment, such as those with multiple sclerosis, Crohn's disease, and rheumatoid arthritis. Infusion nurses are exposed to many of the common root causes of moral distress in their practice, similar to nurses caring for terminally ill or critically ill patients. The specific aims of this article are to (1) define moral distress, moral residue, and the crescendo effect; (2) describe ethical stressors that can be confused with moral distress; (3) review the effects of moral distress on different health care providers; and (4) provide strategies to manage moral distress in the workplace using a case example.

Background: Men and women are differently bodily, as well as have distinctive ways of thinking; consequently, their health care needs are not always the same. For some older adults who enter long-term care facilities, the impact of gender upon their care may not be recognized by staff.

Hospital technology has aggressively improved over the past 50 years. With the primary intent of making health care more efficient and safer, the bedside nurse has been impacted by all of these changes. The growth and utilization of point-of-care testing, automated dispensing systems, electronic medication records, electronic health records, mobile and digital radiography, and computerized provider order entry have continued to foster the growth of Nursing autonomy and the expectation of nurses' critical thinking. The usability and utility of these advancing technologies are key components to end-user satisfaction and ultimately the adoption of the technology by the bedside nurse.

Recently, the number of education programmes addressing person-centred approaches to long-term residential dementia care has increased, and nursing assistants (NAs) are often the target audience. The effectiveness of employee education programmes is actively debated, and our objective is to contribute to this discussion by exploring the knowledge NAs acquire through practice. We examined approaches to person-centred care generated during a series of interviews with NAs, and compared these to the content of five frameworks for person-centred dementia care. Our results suggest that although NAs acquire significant knowledge about person-centred dementia care during the course of their work, application of person-centred care strategies varies across NAs. We propose ways of enhancing NA education in order to address gaps in knowledge. We also recommend sustained attention to organisational factors that contribute to variability in practice.

Background: Practice tools such as health information technology (HIT) have the potential to support care processes, such as communication between health care providers, and influence care for “ambulatory care–sensitive conditions” (ACSCs). ACSCs are conditions for which good outpatient care can potentially prevent the need for hospitalization. To date, associations between such primary care practice capabilities and hospitalizations for ambulatory care–sensitive conditions have been primarily limited to smaller, local studies or unique delivery systems rather than nationally representative studies of primary care physicians in the United States. Methods: We analyzed a nationally representative sample of 1,819 primary care physicians who responded to the Center for Studying Health System Change9s Physician Survey. We linked 3 years of Medicare claims (2007 to 2009) with these primary care physician survey respondents. This linkage resulted in the identification of 123,760 beneficiaries with one or more of 4 ambulatory care–sensitive chronic conditions (diabetes, chronic obstructive pulmonary disease, asthma, and congestive heart failure) for whom these physicians served as the usual provider. Key independent variables of interest were physicians9 practice capabilities, including communication with specialists, use of care managers, participation in quality and performance measurement, use of patient registries, and HIT use. The dependent variable was a summary measure of ambulatory care–sensitive hospitalizations for one or more of these 4 conditions. Results: Higher provider-reported levels of communication between primary care and specialist physicians were associated with lower rates of potentially avoidable hospitalizations. While there was no significant main effect between HIT use and ACSC hospitalizations, the associations between interspecialty communication and ACSC hospitalizations were magnified in the presence of higher HIT use. For example, patients in practices with both the highest level of interspecialty communication and the highest level of HIT use had lower odds of ambulatory care–sensitive hospitalizations than did those in practices with lower interspecialty communication and high HIT use (adjusted odds ratio, 0.70; 95% confidence limits, 0.59, 0.82). Conclusions: Greater primary care and specialist communication is associated with reduced hospitalizations for ambulatory care–sensitive conditions. This effect was magnified in the presence of higher provider-reported HIT use, suggesting that coordination of care with support from HIT is important in the treatment of ambulatory care–sensitive conditions.

Aim To study the nurses' roles in direct nursing care delivery in the neurology ward in China. Background As patients' demands for healthcare have increased, the quality of the nursing service has become a focus of attention. Nurses play an important role in the delivery of care and can affect the quality of patient care. Methods This was a non-participation, observational, time-task/activity study. All nursing care providers were observed during two shifts (16hours) as constituents of the workload to explain the nurses' roles. Results An astonishingly low percentage (25.6%) of the total patient care workload was conducted by registered nurses. The rest of the care was provided by nursing students (10.5%), health care assistants (21%), and a substantial portion by the patients' relatives (43.7%). Conclusions Nurses' roles in direct nursing care delivery are inadequate in China. Nurse staffing and allocation must meet the increasing demand from clients to secure the highest quality and safety of healthcare.

BACKGROUND The disruption in provider continuity caused by medical resident graduation may result in adverse patient outcomes.

Aims To describe the quality of incontinence care in nursing homes. Main outcome measures were: (1) availability of structural quality indicators on ward and institutional levels; (2) use of nursing interventions as quality indicators on a process level; (3) prevalence of incontinence as an outcome indicator. Background Incontinence in older people is a major problem in nursing care that presents a high workload for nurses, increases costs and places a high burden on affected individuals. The availability of structural indicators, and the use of nursing interventions, is recommended to improve the quality of care. Only limited amounts of reliable and valid data are available regarding the quality of incontinence care in nursing homes. Design A cross-sectional multicentre study in 16 nursing homes (N = 1302) in 2013. Methods A standardized and validated questionnaire was used for data collection. Each resident was assessed by two trained nurses. Results/findings The primary outcome of the study indicated that structural indicators, such as the availability of information brochures, are limited in nursing homes. On a process level, the provision of body worn pads or underlay pads to protect beds or chairs were most frequently used and training interventions were only delivered to a small proportion of residents with incontinence. The prevalence of all types of incontinence, particularly double incontinence, was high (69·2%). Conclusion Due to the high prevalence of double incontinence and low rate of training interventions regarding this type of incontinence, ongoing efforts to improve the quality of incontinence care are warranted.

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.

The General Medical Council (GMC) defines patients approaching the end of life as being those ‘likely to die within the next twelve months’. Decisions surrounding the withholding or withdrawal of life prolonging treatment can be particularly difficult. End-of-life care encompasses more than such treatment decisions and the provision of good end-of-life care falls within the duties of a doctor outlined by the GMC.

Gulay Altun Ug ˘ras$, Sultan Babayigit, Keziban Tosun, Guler Aksoy, Yuksel Turan ABSTRACT Background: Sleep disturbance in an intensive care unit is a common problem. One of the main factors causing sleep disturbances in an intensive care unit is nocturnal patient care interventions. Aims and objectives: This study aims to determine the impact of patient care interventions performed at night in a neurosurgical intensive care unit on patients' sleep and their nursing care satisfaction. Methods: The descriptive study was conducted on 82 patients in a neurosurgical intensive care unit between January 2009 and March 2010. The data were collected by data collection instruments and Newcastle Satisfaction with Nursing Scales. The data were statistically analyzed by frequency, mean, standard deviation, chi-square, and MannYWhitney U test. Results: The study showed that 53.7% of the patients experienced sleep disturbances in the neurosurgical intensive care unit. Because of nursing interventions at night, 39.1% of these patients had their sleep affected, but this problem did not cause any negative impact on the patients' satisfaction (Newcastle Satisfaction with Nursing Scales score = 88.21 T 9.83). The patients received, on average, 42.21 T 7.45 times patient care interventions at night; however, the frequency of patient care interventions at night showed no effect on sleep disturbances in this study (p 9 .05). The most frequently given patient care interventions were, respectively, vital signs monitoring, neurological assessment, and repositioning in bed. These interventions were performed commonly at 6 A.M., 12 A.M., and 7 P.M. Conclusion: In this study, despite the patients reporting sleep disturbances in the neurosurgical intensive care unit because of nocturnal patient care interventions that prevented them from sleeping, the patients' satisfaction on the given nursing care was not negatively impacted. To reduce sleep disturbances because of nursing care initiatives and promote uninterrupted sleep in the intensive care unit, it can be useful to develop new protocols regulating night care activities.

Background With ageing, older people face cardiovascular problems as the major cause of disability and death. Although immediate medical attention is a major factor in determining outcomes of cardiac problems, lack of personnel (i.e. registered nurse, certified nursing assistant and home care aide) in nursing homes without residing doctor limits the awareness of such problems, thus making it difficult to initiate timely and appropriate intervention. Aim The aim of this study was to conceptualize critical care for nursing home residents with cardiac vulnerability and develop practical knowledge in nursing practice. Methods Conventional content analysis was performed on date from interviews with 30 nurses from 10 nursing homes in South Korea between July and November 2010. Results The analysis revealed three major cardiac problems resulting from residents' cardiac vulnerability: angina, myocardial infarction (MI) and cardiogenic shock. Through content analysis, we extracted 6 themes and 21 subthemes for nurses' conceptualization of critical care for nursing home residents with cardiac vulnerability. In nursing homes without a residing doctor, nurses assessed the physical, functional and cognitive conditions along with the responses and symptoms of residents when emergency situations related to the cardiac problems occurred. Moreover, with a lack of infrastructures of a hospital, nurses provided critical care to the elderly by using personal practice strategies based on their personal experience in facilities along with practical knowledge of nurses while following the management principles of emergencies. Conclusions and relevance to clinical practice We found that nurses conceptualized critical nursing care for cardiac problems at nursing homes, which are different from those of general hospitals. The results of this study will provide basis for the development of care guidelines and educational materials that can be used by novice nurses or nursing students.

This study aimed to describe the quality of sleep of non-intubated patients and the night-time nursing care activities in an intensive care unit. The study also aimed to evaluate the effect of nursing care activities on the quality of sleep. An overnight polysomnography was performed in 21 alert, non-intubated, non-sedated adult patients, and all nursing care activities that involved touching the patient were documented by the bedside nurse. The median (interquartile range) amount of sleep was 387 (170, 486) minutes. The portion of deep non-rapid-eye-movement (non-REM) sleep varied from 0% to 42% and REM sleep from 0% to 65%. The frequency of arousals and awakenings varied from two to 73 per hour. The median amount of nursing care activities was 0.6/h. Every tenth activity presumably awakened the patient. Patients who had more care activities had more light N1 sleep, less light N2 sleep, and less deep sleep. Nursing care was often performed while patients were awake. However, only 31% of the intervals between nursing care activities were over 90 min. More attention should be paid to better clustering of care activities.

The aim of this study was to investigate nursing staff induced repositionings and the patients' spontaneous movements during the day and night among older immobile patients in nursing care. Furthermore, the aim was to identify factors associated with the nursing staff induced repositionings and the patients' spontaneous movement frequency. An observational cross-sectional design was used. Spontaneous movements among patients (n = 52) were registered continuously using the MovinSense monitoring system. The nursing staff documented each time they repositioned the patient. Patients spontaneous movements were compared with nursing staff induced repositionings. There were large variations in the patients' spontaneous repositioning frequency during both days and nights, which shows that, although immobilised, some patients frequently reposition themselves. Analgesics were positively related to the movement frequency and psycholeptics were negatively related. The nursing staff more often repositioned the patients who were assessed as high risk than those assessed as low risk, but the patients' spontaneous movement frequency was not correlated to the risk score. This may be important when planning repositioning schedules. A monitoring system may be useful in decision making with regard to planning repositioning and positions used in the prevention of pressure ulcers among elderly immobile patients.

Background Inadequate nurse staffing has been reported to lead nurses to omit required nursing care. In South Korea, to reduce informal caregiving by patient families and sitters and to improve the quality of nursing care, a public hospital operated by the Seoul Metropolitan Government has implemented a policy of increasing nurse staffing from 17 patients per registered nurse to 7 patients per registered nurse in 4 out of 13 general nursing units since January 2013. Aim The study aims to compare missed nursing care (omission of required care) in high-staffing (7 patients per nurse) units vs. low-staffing (17 patients per nurse) units to examine the effects of nurse staffing on missed care. Methods A nurse survey conducted in July 2013 targeted all staff nurses in all four high-staffing and all nine low-staffing units; 115 nurses in the high-staffing units (response rate = 94.3%) and 117 nurses in the low-staffing units (response rate = 88.6%) participated. Missed nursing care was measured using the MISSCARE survey that included 24 nursing care elements. Nurses were asked how frequently they had missed each element on a 4-point scale from ‘rarely’ to ‘always’. Results Overall, nurses working in high-staffing units had a significantly lower mean score of missed care than those in low-staffing units. Seven out of 24 nursing care elements were missed significantly less often in high-staffing (vs. low-staffing) units: turning, mouth care, bathing/skin care, patient assessments in each shift, assistance with toileting, feeding and setting up meals. Conclusion The findings suggest that increasing nurse staffing is associated with a decrease in missed care. Less omission of required nursing care is expected to improve nursing surveillance and patient outcomes, such as patient falls, pressure ulcers and pneumonia. Implications for nursing and health policy Adequate nurse staffing should be ensured to reduce unmet nursing needs and improve patient outcomes.

Purpose To identify the interventions provided by advanced practice nurses to older people in different contexts with standardized nursing language. Data Source This is a qualitative study. Content analysis was applied to the texts of experimental research papers about advanced practice nursing for older people. Deductive coding through the Nursing Intervention Classification was carried out. Data Synthesis Seventy-three interventions codified with the Nursing Intervention Classification were extracted, mainly related to the behavioral and healthcare system domains, which could be explained due to the need for improving the psychosocial functioning and self-care of these patients to preserve their quality of life. Conclusion and Implication for Nursing Practice Advanced practice nurses interventions can be better described, reported, and analyzed along different contexts with standardized languages. Objetivo Identificar las intervenciones realizadas por las enfermeras de practica avanzada a personas mayores en diferentes contextos de atencion con lenguajes estandarizados. Fuente De Datos Se trata de un estudio cualitativo. Se aplico analisis de contenido a los textos de estudios experimentales sobre enfermeria de practica avanzada en poblacion mayor y se llevo a cabo una codificacion deductiva con las intervenciones de la Clasificacion de Intervenciones de Enfermeria. Sintesis De Datos Se extrajeron setenta y tres intervenciones codificadas con la Clasificacion de Intervenciones de Enfermeria, mayormente pertenecientes a los campos Conductual y Sistema Sanitario, lo que podria explicarse por la necesidad de mejorar el funcionamiento psicosocial y de auto-cuidado de este tipo de pacientes, para preservar su calidad de vida. Conclusion E Implicaciones Para La PraCtica De Enfermeria Las intervenciones de las enfermeras de practica avanzada pueden ser descritas, referidas y analizadas en diferentes contextos con lenguajes estandarizados.

Purpose To determine whether patients assigned to primary care nurses who use the nursing process (use of NANDA-I, NIC, and NOC) achieve better intermediate health outcomes than the population assigned to nurses who do not use the nursing process. Methods This is a retrospective cross-sectional study conducted in 34 primary healthcare centers of Area 11 of the Community of Madrid (Spain) based on electronic health records. Findings The extension of health care provided was greater in nurses who used the nursing process. Patients assigned to these nurses have better control of their chronic diseases and incur lower drug costs. Conclusions The use of the nursing process can lead to improved health of populations. Implications The development of strategies is necessary to ensure greater use of the nursing process among nurses in primary care.

Little is known about how hip-fracture patients experience involvement in their own nursing care. Yet understanding this is essential in order to both meet patient expectations and ensure delivery of high-quality nursing care. The aim of the study was to describe how elderly hip-fracture patients experienced their involvement in the nursing care they received while in the orthopaedics ward. A descriptive design with a qualitative interview approach was used. Semi-structured interviews were conducted with16 hip-fracture patients, 14 days postoperative in 2012. Systematic Text Condensation was used to analyse the data collected. The findings reveal six themes: 1) experiencing severe pain, 2) feeling dependent on the nurses, 3) feeling they were not valued, 4) poor organisation, 5) positives and negatives of sharing a room with fellow patients, and 6) positive interactions with nurses that encouraged the patient. Hip-fracture patients reported experiencing very little involvement in their nursing care, to the extent that fundamental aspects of nursing care went unfulfilled. Patients did not feel valued by the nurses. Most patients described experiencing unbearable pain during their stay in the orthopaedics ward despite the existence of evidence-based and established guidelines for pain management. The result of this study indicates that there is much to do on a number of levels in the health care system to improve patient involvement in nursing care.

The education of nurse practitioners has undergone substantial evolution since Ford and Silver (1967) first reported on the preparation of nurses to assume the role of primary care providers for children. From this modest beginning in Colorado emerged a worldwide movement to prepare nurses to diagnose and treat patients in ways that in the past had been restricted to physicians. The early programs were not usually located in schools or colleges of nursing but rather were short-term continuing education programs. Later, nurse practitioner programs were transitioned to master’s degree programs and more recently began to evolve to Doctor of Nursing Practice (DNP) Programs. The American Association of Colleges of Nursing (2014) currently lists 243 active DNP programs and 70 planned programs.

Digital health technology is already playing a larger role in how healthcare consumers receive information about health concerns and how patients manage wellness and disease. The influence of mobile apps, wireless medical devices and other tools for patient monitoring will soon be felt in almost every physician practice. In an environment where regulatory standards are still in flux, some of these technologies are validated and reliable, others are not. We present the first in a series of systematic guidelines to assist physicians in navigating digital health technologies that they will encounter in the office setting.

Primary Nursing is a model of care delivery that has been shown to improve the quality of care provided to patients and enhance the nurse–patient relationship. Although there is considerable attention in the literature on Primary Nursing concerning inpatient hospital units, there has been no discussion of Primary Nursing in short-stay units. Our hospital aimed to introduce Primary Nursing into all the units including short-stay. Staff were educated about the role of the primary nurse using Koloroutis’s (2004) Relationship-Based Care model, comprising three crucial relationships: care provider’s relationship with patients and families, with self, and with colleagues. The primary nurse develops the plan of care for individual patients based on their therapeutic relationship, which is sustained for the patient’s length of stay in the unit.

Aim: The purpose of this research is to examine the relationship between the clinical nursing competence and nursing occupational experience in hospice/palliative care nurses (HPN) in Japan. Methods: A mail survey using an anonymous self-administered questionnaire was conducted on clinical nursing competence regarding communication, care and prediction of worsening of symptoms with the authors’ previous research as a framework. The subjects were nurses working in hospice/palliative care units in Japan, and the period of survey was January to February, 2014. Results: In this study, the relationship between the clinical nursing competence and nursing occupational experience of HPNs in hospice/palliative care which was clarified in the authors’ previous research was examined. The results showed that the amount of clinical nursing experience as a nurse was related to clinical nursing competence in the care of end-of-life patients and worsening of symptoms. The abundance of specialized nursing experience was also related to clinical nursing competence in communication in addition to care and prediction of worsening of symptoms. Training experience was also shown to be effective for hospice/palliative care. Conclusion: From these results, clinical nursing competence of HPNs in care of end-of-life patients and prediction of worsening of symptoms are possibly learned through the accumulation of clinical nursing experience as a nurse. However, HPN’s clinical nursing competence in communication was suggested to be developed through nursing practice in hospice/palliative care.