Using images to communicate the hidden struggles of life on dialysis

Background Nurse‐patient communication in the hemodialysis context is unique given the amount of time spent together in a confined clinical room. Poor communication may lead to low-quality nursing care and undesirable patient outcomes.

Aim To explore the use of images as a visual communication technique for nurses and patients in the hemodialysis context.

Methods Descriptive qualitative design. Fifty-two cards containing specific photos, illustrations, and words were used to facilitate conversations about being on hemodialysis between patients (n = 9) and two nurse interviewers. Interview transcripts were thematically analysed.

Findings An overall theme titled ‘revealing the hidden struggles of living on dialysis’ conceptually captured three sub-themes: (1) the increased importance of relationships; (2) the struggle with money; and (3) quality over quantity of life. The cards assisted in uncovering these often covert (to nurses) aspects of dialysis patients' lives.

Conclusion Nurses may need to be aware of the dialysis patients' hidden struggles which include the importance of relationships, financial issues, and the importance of quality aspects such as travel. The use of images may assist in revealing the important issues for each patient struggling with the restrictive life that is imposed by dialysis.

A systematic narrative review of consumer-directed care for older people: implications for model development

Consumer-directed care is increasingly becoming a mainstream option in community-based aged care. However, a systematic review describing how the current evaluation research translates into practise has not been published to date. This review aimed to systematically establish an evidence base of user preferences for and satisfaction with services associated with consumer-directed care programmes for older people. Twelve databases were searched, including MedLine, BioMed Central, Cinahl, Expanded Academic ASAP, PsychInfo, ProQuest, Age Line, Science Direct, Social Citation Index, Sociological Abstracts, Web of Science and the Cochrane Library. Google Scholar and Google were also searched. Eligible studies were those reporting on choice, user preferences and service satisfaction outcomes regarding a programme or model of home-based care in the United States or United Kingdom. This systematic narrative review retrieved literature published from January 1992 to August 2011. A total of 277 references were identified. Of these 17 met the selection criteria and were reviewed. Findings indicate that older people report varying preferences for consumer-directed care with some demonstrating limited interest. Clients and carers reported good service satisfaction. However, research comparing user preferences across countries or investigating how ecological factors shape user preferences has received limited attention. Policy-makers and practitioners need to carefully consider the diverse contexts, needs and preferences of older adults in adopting consumer-directed care approaches in community aged care. The review calls for the development of consumer-directed care programmes offering a broad range of options that allow for personalisation and greater control over services without necessarily transferring the responsibility for administrative responsibilities to service users. Review findings suggest that consumer-directed care approaches have the potential to empower older people.

Peeling the onion: understanding others' lived experience

BACKGROUND: Society and some healthcare professionals often marginalise pregnant women who take illicit substances. Likewise the midwives who care for these women are often viewed as working on the edge of society. The aim of this research was to examine the lived world of these midwives to gain insight into the world of their work.

DESIGN: A phenomenological study informed by Heidegger, Gadamer and Merleau-Ponty was chosen to frame these lived experiences of the midwives. Using face-to-face phenomenological interviews data were collected from 12 midwives whose work is only caring for women who take illicit drugs.

RESULTS: The 3 fundamental themes that emerged from the study were: making a difference, establishing partnerships: and letting go and refining practice. Conclusions and impetus for this paper: Lived experiences are unique and can be difficult for researchers to grasp. The stories told by participants are sometimes intangible and often couched in metaphor. This paper aims to discuss lived experience and suggests that like an onion, several layers have to be peeled away before meaning can be exposed; and like peeling onions, each cover reveals another layer beneath that is different from before and different from the next. Exemplars from this midwifery study are used to explain lived experiences.

Assessment of simulated clinical skills and distance students: can we do it better?

Australian universities have traditionally been able to supplement clinical education, for undergraduate nursing courses, delivered on placement with weekly clinical teaching in the simulated environment. The Objective Structured Clinical Assessment (OSCA) tool has been used in this simulated environment to assess clinical skills. Recently, however, online delivery of undergraduate nursing courses has become more common. The move from an internal mode of teaching to an online external mode is seen worldwide and poses challenges to staff and students as well as changing the teaching and learning culture of institutions (Philip and Wozniak, 2009). This cultural shift and the resulting diminishing timeframe for students to acquire and practice simulated clinical skills imply that it may become necessary to rethink assessment forms such as the OSCA assessment. This study examines whether or not the OSCA tool developed by Bujack et al. (1991a) is the best tool to be used in this new context, where online teaching is supplemented by very short, annual, intensive periods of study. Skills acquisition theories dictate that time is required to produce an ideal skills acquisition environment (Quinn, 2000) but the time constraints placed on students in such intensive periods of study could influence skills acquisition. This cross-sectional qualitative study used semi-structured interviews and focus groups to collect data. 65% of the nursing faculty participated in the study. The teaching of the Bachelor of Nursing (BN) occurred on two campuses and staff from both areas participated. This group of nurse academics was employed across the range of academic levels (from lecturer to professor) at the University. Data analysis followed a generic thematic analysis framework. Findings in this study show that there are a variety of attitudes and underpinning beliefs amongst staff in relation to the OSCAs. Doubts were raised in regard to the suitability of the use of the OSCA tool in this setting. It also became apparent during this study that the OSCA tool possibly serves purposes other than an assessment tool.

Family presence during management of acute deterioration: clinician attitudes, beliefs and perceptions of current practices

BACKGROUND: The nature of acute clinical deterioration has changed over the last three decades with a decrease in in-hospital cardiac arrests and an increase in acute clinical deterioration. Despite this change, research related to family presence continues to focus on care during resuscitation rather than during acute deterioration. AIM: To explore healthcare clinician attitudes, beliefs and perceptions of current practices surrounding family presence during episodes of acute deterioration in adult Emergency Department patients. METHODS: Clinicians (n=156) from a single study site in Melbourne, Australia completed a 17-item survey. RESULTS: Participants disagreed that family members would interrupt (59.0%) or interfere (61.5%) with patient care if present during episodes of patient deterioration. Most (77.6%) participants stated that they included family during episodes of patient deterioration. Females, nurses and Australians/New Zealanders had a more positive attitude towards including family during episodes of patient deterioration when compared to males, doctors and clinicians of other ethnicities. Nurses with post-graduate qualifications and those with more years of experience had a more positive attitude towards including family during episodes of patient deterioration than nurses without post-graduation qualification and with less years of experience. CONCLUSIONS: Clinicians had predominantly positive attitudes towards including family during episodes of patient deterioration and perceived it to be a common day-to-day practice. Gender, profession, country of birth, education level and years of experience all impacted on clinician attitudes, beliefs and perceptions of family presence during acute deterioration.

Qualitative observation in a clinical setting: challenges at end of life

This paper explores the methodological challenges associated with undertaking qualitative observation in the clinical setting at end of life. The authors reflect on their experiences of using non-participant observation to explore the nursing care delivered to dying patients in acute hospital wards. The challenges of observation as a method, clearly defining the participant group and involving vulnerable populations, such as the dying patients and their families, will be discussed. Consideration is also given to defining and working within the observational field, the researchers' dual roles, cost versus benefit, impact of culture, religion and ethnicity, and the determination of research limits/boundaries, with reflections from the authors' own experiences used to exemplify the issues.

A critical review of public health interventions aimed at reducing alcohol consumption and/or increasing knowledge among pregnant women.

ISSUES: It is well established that alcohol can cross the placenta to the fetus and can affect both physical and psychological development of the infant; however, many women continue to drink during pregnancy. It is therefore important to determine whether interventions can be successful in reducing alcohol consumption among pregnant women. Past reviews have investigated the effectiveness of clinical interventions in reducing alcohol consumption in pregnancy; however, the aim of the current review was to focus on the effectiveness of public health interventions. APPROACH: A critical literature review was conducted by searching several electronic databases using key words such as 'pregnancy', 'alcohol', 'interventions' and 'public health'. Studies were included if they utilised a public health intervention and included alcohol consumption or levels of knowledge as an outcome measure. KEY FINDINGS: Seven studies were included in the review. Interventions included multimedia and educational interventions. Improvements in knowledge were reported in six studies, whereas one study found contradictory results. Four studies used alcohol consumption rates as an outcome measure, and although a reduction in consumption was reported, the results were non-significant. IMPLICATIONS: The effectiveness of public health interventions that aim to increase awareness and reduce alcohol consumption among pregnant women cannot be assessed because of the paucity of studies. CONCLUSIONS: The results of this critical review emphasise a lack of evidence and highlight the need for further evaluation research on this topic.

An evaluation of an action research nursing documentation project

AIMS AND OBJECTIVES: The aim of this study is to describe healthcare professionals' experiences and perceptions of an intervention implemented in an action research project conducted to improve nursing documentation practices in four municipalities in Norway.

BACKGROUND: Documentation of individualized patient care is a continuing concern in healthcare services and could impacts the quality and safety of healthcare. Use of electronic systems has made some aspects of documentation more comprehensive, but creation of an individualized care plan remains a pressing issue.

DESIGN: A qualitative descriptive design was used.

METHODS: An action research project was conducted between 2010 and 2012 to improve the content and quality of nursing documentation in community healthcare services in four municipalities. One year after the project was completed four focus group interviews were conducted with healthcare professionals, one for each involved municipality. Two unit managers were interviewed individually. Qualitative content analysis was used.

RESULTS: Three themes emerged: healthcare professionals perceived competing interest; they experienced that they had to manage complexity and changes; and they highlighted a clear and visible leader as important for success.

CONCLUSIONS: Quality improvement activities are essential. Healthcare professionals experience a complicated situation when electronic health record systems do not support workflow. Further research is recommended to focus on the functionality and user interface of EHR systems, and on the role of leadership when implementing changes in clinical practice. This article is protected by copyright. All rights reserved.

Research and diabetes nursing. Part 2 : process of critical review

This article is the second in a six-part series addressing research and the DSN. Crirical review is a key aspect of research and evidencebased care and, therefore, of clinical and professional practice. Critical review is an analytical and reflective process that involves judging the quality of research publicarions and their relevance to practice. This article oudines key aspects of how to review publications and conference presentations, how critical review applies to clinical care, and how this process om help develop writing and critical thinking skills. Also addressed are the general aspects of critical review, and a list of further reading and useful websites is provided. Specific considerations for particular research methods such as quantitative, qualitative, evaluation studies and audits will be addressed in later articles in the series.

Challenges of measuring and linking patient outcomes to nursing interventions in acute care settings

Measuring and linking patient outcomes to nursing intervention is an important task that has professional, financial and political ramifications. The importance and complexity of measuring patient outcomes accurately should not be overlooked, as there are a number of emergent factors that influence this process. These include the turbulent context of practise, variations in care due to the large number of health professionals, individual patient characteristics impacting on outcomes, determining appropriate nursing outcome measures, nursing's lack of autonomy within the system and difficulties experienced while trying to link patient outcomes to nursing interventions. So that the results reflect reality, it is important for researchers in the field to take note and consider these factors when measuring patient outcomes. The present article aimed to examine and discuss a number of these factors as they relate to the evaluation of patient care.