Kvinnors erfarenheter av sjuksköterskors bemötande i vårdandet av deras bröstcancer En litteraturöversikt

Bakgrund: Bröstcancer är den vanligaste cancerformen bland kvinnor i Sverige. Att drabbas av bröstcancer beskrivs som en utmaning för kvinnans självkänsla, självbild, kvinnlighet och existens. Kvinnorna vill bli bemötta som en enskild individ och inte som en diagnos samt uppleva känslomässigt stöd från sjuksköterskorna. Syfte: Syftet är att genom en vetenskaplig litteraturöversikt beskriva vad kvinnor med bröstcancer har för erfarenheter av sjuksköterskors bemötande. Metod: Underlaget till denna litteraturöversikt består av 15 kvalitativa artiklar varav två delvis kvantitativa. Litteraturen har sökts via databaserna PubMed och Cinahl. Resultatet har sammanställts med hjälp av en analysmetod för kvalitativ forskning. Resultat: Majoriteten av kvinnorna var nöjda och tillfreds med sjuksköterskornas bemötande. Få kvinnor uttryckte missnöje. Kvinnorna uttryckte att sjuksköterskorna hade en viktig roll under deras sjukdomstid och kunde tillmötesgå deras behov. Sjuksköterskornas bemötande uppfattades empatiskt, hänsynsfullt och omtänksamt. De negativa erfarenheter vissa kvinnor beskrev var dålig uppföljning, obesvarade frågor om psykiska besvär, brist på emotionellt stöd och en rädsla av att vara till besvär. Slutsats: Sjuksköterskorna spelar en central roll i mötet med- och i tillfrisknandet hos kvinnor med bröstcancer.

Expressão da ética na assistência de enfermagem aos jovens intoxicados

Analisar sobre o processo de cuidar da equipe de enfermagem na visão dos usuários intoxicados por tentativa de suicídio. Metodologia: estudo descritivo exploratório, de abordagem qualitativa, realizada em um centro de assistência ao intoxicado da Paraíba/Brasil, com nove usuários. Como critérios de inclusão, participaram as pessoas que tentaram o suicídio por intoxicação, nos meses de abril e maio de 2010, período de coleta de dados do estudo, e que tivessem condições de responder as questões formuladas. A coleta de dados foi realizada por meio de entrevista semiestruturada com uso de formulário, cujos dados foram tratados pela Análise Temática. A pesquisa foi aprovada conforme avaliação do Comitê de Ética em Pesquisa da UEPB e mediante CAAE nº 0003.0.349.133-10. Resultados: os participantes concentraram-se na faixa etária de 14 a 26 anos, predominando o gênero feminino e o consumo de agrotóxicos na tentativa de suicídio. A análise dos discursos permitiu identificar que todos os integrantes demonstraram-se satisfeitos com a assistência de enfermagem, entretanto, apontaram ausência de comunicação com os profissionais cuidadores e atraso para a realização dos procedimentos. Conclusão: a ética na assistência de enfermagem supõe o estabelecimento da valorização do humano durante as atribuições profissionais, proporcionando o bem-estar daqueles que não enxergam a dádiva maior, que é nesse plano, a vida

Viabilidade do processo de enfermagem no contexto hospitalar

The Nursing Process (NP) is considered as the dynamics of the systemized and inter-related actions of human care. We believe that the nursing manager, as the representative of all the nursing care provided in the hospital setting, is an important agent for the implementation of institutional policies, such as the NP, in the service. However, there is little information in the literature about the NP in the perspective of the nurse manager. The objective of this study was to analyze the viability of the Nursing Process in the hospital context based on the attitudes of the nurse managers toward the Process. We conducted a descriptive-exploratory research study, of quantitative approach, with a population of 45 nurse managers that worked in the state hospitals located in Natal, RN and in the university hospitals of the UFRN. Two instruments were used for the collection of data: a nursing process questionnaire, constructed for use in this study, and the scale for the measurement of the attitudes titled Positions on the Nursing Process. The population is predominantly feminine (91,0%) and have relative nursing practice experience (Mean=17,6 years). However, they have little experience in management (Mean=8,6 years). They express little knowledge of the PE nursing terms and little experience with the Process. They have a positive atitude toward the NP (Mean = 110,9); are favorable to its developement in the service (86,7%); 48,9% indicated little possibility of institutionalization in the service and 37,8% indicated large possibility. The Spearman test for association between the variables of attitude about the NP and the possibility of its institutionalization demonstrated a weak negative association in the total individual scores of the attitudes (-,316) as in the 20 itens of the instrument, with coefficients varying from 0,014 to 0,464. Factorial analysis of the instrument identified three underlying factors to the attitudes of the managers in this study: relevance, operationalization and collaboration, with Cronbach Alpha coeficients of 0,955, 0,844 and 0,807, respectively, and 0,956 for the whole instrument, indicating that the scale and its factorial subscales have internal consistency. We conclude that there is a weak tendency for the managers with a favorable attitude to have a negative perception about the possibility of institutionalization of the NP in the service. The favorable position does not appear to be sufficient for the viability of this methodology in the hospital sector, results that is worrisome for nursing. This situation suggests that the difficulties with the institution of the NP in the hospitals may be related to other factors, including the organizational conditions. We believe that the institucionalization of the NP in a servisse where it is not known and not practiced, constitutes the introduction of an innovative work technology that involves many demands, among them the adherence of the persons to the proposed innovation. This demands time and the institutional adjustments and the human resources necessary. In this process, the involvement of the health professional of the institution is necessary. This situation brings to light the discussions of professional autonomy, the action limits and perspectives, the redefinition of roles, delimiation (or consensus) of the objects of study and of the work processes, among others.

Entre as dimensões de segurança e de risco na interação médico-enfermagem-pais na Unidade de Terapia Intensiva Neonatal

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Desperdício de dieta enteral em UTI: análise de modo de falhas e efeitos de danos ao paciente grave

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Vad man ska kunna och hur man ska vara : En studie om enhetschefers och vårdbiträdens yrkeskompetens inom äldreomsorgens särskilda boendeformer

The dissertation What to do and how to be reflects upon the professional skills needed by unit managers and nursing staff within the institutions of eldercare. Throughout the study, three conceptions are essential: formal education and training, professional skills, and individual competence. In order to understand the professional skills within its proper context, an activity perspective has been applied. The study is based on empirical materials, historical and present national and municipal documents, interviews with and observations of unit managers as well as questionnaires filled in by nursing staff members. A main result is the stress the respondents put on the importance of individual competence among unit managers and nursing staff members. “How to be” is more important than formal training and professional skills. To work with – and develop – individual competence therefore becomes momentous both to job activities and to education. The result shows a discrepancy between the way professional skills are discussed and the actual work performance. A lot of tasks carried out by unit managers and nursing stuff are never mentioned in connection with professional skills. The unit manager’s task is to lead both unit operations and staff work. Such responsibilities demand basic knowledge in social sciences, an overall understanding of the work activities from political management, job conditions and duties of the nursing staff. The professional skills given priority are those present in organisations and leadership. Problematic are economic and budget tasks which may sometimes cause unit managers to give up their economic responsibility, favouring client – directed over economy – directed care. The main task of the nursing staff is the care of elderly. It calls for social, caring, medical and housekeeping skills. For this one needs an upper secondary level education supplying the students with solid knowledge within social science as well as basic medicine and an overall understanding of the situation and needs of the elderly. Throughout the study, knowledge of the demented and of other mental disorders is emphasized as well as treatment of elderly persons suffering from those disorders. Units still have a long way to go before reaching the goal that every nursing staff member be given a formal education. Some municipalities already offer employees shorter nursing staff training. As to the rest, the educational development is neglected.

Sedation in paediatric intensive care

Paediatric intensive care is an expanding specialty that has been shown to improve the quality of care provided to critically ill children. An important aspect of the management of critically ill children includes the provision of effective sedation to reduce stress and anxiety during their stay in intensive care. However, to achieve effective and safe sedation in these children, is recognised as a challenge that is not without risk. Often children receive too much or too little sedation resulting in over sedation or under sedation respectively. These problems have arisen owing to a lack of information regarding altered pharmacokinetics and pharmacodynamics of medicines administered to critically ill children. In addition there are few validated sedation scoring systems in practice with which to monitor level of sedation and titrate medication appropriately. This study consisted of two stages. Stage 1 investigated the reproducibility and practicality of two observational sedation assessment scales for use in critically ill children. The two scales were different in design, the first being simple in design requiring a single assessment of the patient. The second was more complex in design requiring assessment of five patient parameters to obtain an overall sedation score. Both scales were found to achieve good reproducibility (kappa values 0.50 and 0.62 respectively). Practicality of each sedation scale was undertaken by obtaining nursing staff opinion about both scales using questionnaire and interview technique. It was established that nursing staff preferred the second, more complex sedation scale mainly because it was perceived to give a more accurate assessment of level of sedation and anxiety rather than merely level of sedation. Stage 2 investigated the pharmacokinetics and pharmacodynamics of midazolam in critically ill children. 52 children, aged between 0 and 18 years were recruited to the study and 303 blood samples taken to analyse midazolam and its metabolites, I-hydroxyrnidazolam (I-OR) and 4-hydroxymidazolam (4-0H). Analysis of plasma was undertaken using high performance liquid chromatography. A significant correlation was found between midazolam plasma concentration and sedative effect (r=0.598, p=O.OI). It was found that a midazolam plasma concentration of 223ng/ml (±31.9) achieved a satisfactory level of sedation. Only a poor correlation was found between dose of midazolam and plasma concentration of midazolam. Similarly only a poor correlation was found between sedative effect and dose of midazolam. Clearance of midazolam was found to be 6.3mllkglmin (±0.36), which is lower than that reported in healthy children (9.Il-13.3mllkg/min). Age related differences in midazolam clearance were observed in the study. Neonates produced the lowest clearance values (l.63mllkg/min), compared to children aged 1 to 12 months (8.52mllkg/min) who achieved the highest clearance values. Clearance was found to decrease after the age of 12 months to values of 5.34mllkglmin in children aged 7 years and above. Patients with renal (n=5) and liver impairment (n~4) were found to have reduced midazolam clearance (1.37 and 0.74ml/kg/min respectively). Plasma concentrations of I-OH and 4-0H ranged from 0-5 1 89nglml and 0-27 Inglml respectively. All children were found to be capable of producing both metabolites irrespective of age, although no trend was established between age and extent of production of either metabolite. Disease state was found to affect production of l-OH. Patients with renal impairment (n=5) produced the lowest I-OH midazolam plasma ratio (0.059) compared to patients with head injury (0.858). Patients with severe liver impairment were found to be capable of manufacturing both metabolites despite having a severely damaged liver.

Expressão da ética na assistência de enfermagem aos jovens intoxicados

Analisar sobre o processo de cuidar da equipe de enfermagem na visão dos usuários intoxicados por tentativa de suicídio. Metodologia: estudo descritivo exploratório, de abordagem qualitativa, realizada em um centro de assistência ao intoxicado da Paraíba/Brasil, com nove usuários. Como critérios de inclusão, participaram as pessoas que tentaram o suicídio por intoxicação, nos meses de abril e maio de 2010, período de coleta de dados do estudo, e que tivessem condições de responder as questões formuladas. A coleta de dados foi realizada por meio de entrevista semiestruturada com uso de formulário, cujos dados foram tratados pela Análise Temática. A pesquisa foi aprovada conforme avaliação do Comitê de Ética em Pesquisa da UEPB e mediante CAAE nº 0003.0.349.133-10. Resultados: os participantes concentraram-se na faixa etária de 14 a 26 anos, predominando o gênero feminino e o consumo de agrotóxicos na tentativa de suicídio. A análise dos discursos permitiu identificar que todos os integrantes demonstraram-se satisfeitos com a assistência de enfermagem, entretanto, apontaram ausência de comunicação com os profissionais cuidadores e atraso para a realização dos procedimentos. Conclusão: a ética na assistência de enfermagem supõe o estabelecimento da valorização do humano durante as atribuições profissionais, proporcionando o bem-estar daqueles que não enxergam a dádiva maior, que é nesse plano, a vida

Expressão da ética na assistência de enfermagem aos jovens intoxicados

Analisar sobre o processo de cuidar da equipe de enfermagem na visão dos usuários intoxicados por tentativa de suicídio. Metodologia: estudo descritivo exploratório, de abordagem qualitativa, realizada em um centro de assistência ao intoxicado da Paraíba/Brasil, com nove usuários. Como critérios de inclusão, participaram as pessoas que tentaram o suicídio por intoxicação, nos meses de abril e maio de 2010, período de coleta de dados do estudo, e que tivessem condições de responder as questões formuladas. A coleta de dados foi realizada por meio de entrevista semiestruturada com uso de formulário, cujos dados foram tratados pela Análise Temática. A pesquisa foi aprovada conforme avaliação do Comitê de Ética em Pesquisa da UEPB e mediante CAAE nº 0003.0.349.133-10. Resultados: os participantes concentraram-se na faixa etária de 14 a 26 anos, predominando o gênero feminino e o consumo de agrotóxicos na tentativa de suicídio. A análise dos discursos permitiu identificar que todos os integrantes demonstraram-se satisfeitos com a assistência de enfermagem, entretanto, apontaram ausência de comunicação com os profissionais cuidadores e atraso para a realização dos procedimentos. Conclusão: a ética na assistência de enfermagem supõe o estabelecimento da valorização do humano durante as atribuições profissionais, proporcionando o bem-estar daqueles que não enxergam a dádiva maior, que é nesse plano, a vida

Calidad de atención científico humanístico que presta el personal de enfermería y su relación con el nivel de satisfacción del usuario del Centro de Salud Cojitambo. Azogues, 2014

Antecedentes: el tema de calidad de la atención en salud hoy en día es clave, y urgente de conocer, entender y aplicar por el personal de salud y en particular para el profesional de Enfermería, para lograr la calidad en los servicios de salud es necesario el control, la evaluación objetiva y sistemática de la atención de enfermería ya que se han convertido en una prioridad dentro de la profesión, debido a que el consumidor demanda atención de calidad, existiendo un mayor compromiso con la responsabilidad directa ante él público. Objetivo: determinar la calidad de atención que presta el personal de enfermería del centro de salud “Cojitambo” y su relación con el nivel de satisfacción del usuario. Metodología: se trata de un estudio descriptivo de corte transversal que permitirá determinar la calidad de atención que presta el personal de enfermería del centro de salud “Cojitambo” y su relación con el nivel de satisfacción del usuario. Universo: para el tamaño de la muestra se considera una población infinita con una proporción de insatisfacción del 20% con un nivel de confianza del 96% y una precisión del 4%. Con estos valores el tamaño de la muestra a estudiar es de 385 pacientes. Como técnicas se utilizará la entrevista, observación directa e indirecta, como instrumento el formulario avalado por la Universidad Técnica Particular de Loja en la investigación realizada por el Dr. Carlos Arévalo previa a la obtención de la maestría en gerencias en salud para el desarrollo local, para procesar la información se utilizará los programas Excel, Word y SPSS, los datos serán analizados con estadística descriptiva y presentadas en tablas y gráficas. Uso de resultados: la presente investigación pretenderá obtener datos relacionados con la medición de la calidad de atención que brinda el personal de enfermería y el nivel de satisfacción del usuario que acude al centro de salud Cojitambo.

Testing a model for developing, implementing and evaluating a strategy to improve the quality of nursing and midwifery care in an acute hospital trust.

Abstract:
Background: Health care organisations
worldwide are faced with the need to develop
and implement strategic organisational plans
to meet the challenges of modern health care.
There is a need for models for developing, implementing and evaluating strategic plans that engage practitioners, and make a measurable difference to the patients that they serve. These presentations describe the development, implementation and evaluation of such a model by a team of senior nurses and practice developers, to underpin a strategy for nursing and midwifery in an acute hospital trust. Developing a Strategy The PARIHS (Promoting Action on Research Implementation in Health Services) conceptual framework (Kitson et al, 1998) proposes that successful implementation of change in practice is a function of the interplay of three core elements: the level of evidence supporting the proposed change; the context or environment in which the change takes place, and the way in which change is facilitated. We chose to draw on this framework to develop our strategy and implementation plan (O’Halloran, Martin and Connolly, 2005). At the centre of the plan are ward managers. These professionals provide leadership for the majority of staff in the trust and so were seen to be a key group in the implementation process.

Analysis of the feasibility of early hospital discharge after autologous hematopoietic stem cell transplantation and the implications to nursing care

Autologous hematopoietic stem cell transplantation is a conduct used to treat some hematologic diseases and to consolidate the treatment of others. In the field of nursing, the few published scientific studies on nursing care and early hospital discharge of transplant patients are deficient. Knowledge about the diseases treated using hematopoietic stem cell transplantation, providing guidance to patients and caregivers and patient monitoring are important nursing activities in this process. Guidance may contribute to long-term goals through patients' short-term needs. To analyze the results of early hospital discharge on the treatment of patients submitted to autologous transplantation and the influence of nursing care on this conduct. A retrospective, quantitative, descriptive and transversal study was conducted. The hospital records of 112 consecutive patients submitted to autologous transplantation in the period from January to December 2009 were revisited. Of these, 12 patients, who remained in hospital for more than ten days after transplantation, were excluded from the study. The medical records of 100 patients with a median age of 48.5 years (19-69 years) were analyzed. All patients were mobilized and hematopoietic stem cells were collected by leukapheresis. The most common conditioning regimes were BU12Mel100 and BEAM 400. Toxicity during conditioning was easily managed in the outpatient clinic. Gastrointestinal toxicity, mostly Grades I and II, was seen in 69% of the patients, 62% of patients had diarrhea, 61% of the patients had nausea and vomiting and 58% had Grade I and II mucositis. Ten patients required hospitalization due to the conditioning regimen. Febrile neutropenia was seen in 58% of patients. Two patients died before Day +60 due to infections, one with aplasia. The median times to granulocyte and platelet engraftment were 12 days and 15 days, respectively, with median red blood cell and platelet transfusions until discharge of three and four units, respectively. Twenty-three patients required rehospitalization before being discharged from the outpatient clinic. The median time to granulocyte engraftment was 12 days and during the aplasia phase few patients were hospitalized or suffered infections. The toxicity of the conditioning was the leading cause of rehospitalization. The nursing staff participated by providing guidance to patients and during the mobilization, transplant and outpatient follow-up phases, thus helping to successfully manage toxicity.

THE MEASUREMENT OF HUMANISTIC AND DEHUMANISTIC BEHAVIORS IN HOSPITAL NURSING ENVIRONMENTS

The purpose of this investigation was to develop a reliable scale to measure the social environment of hospital nursing units according to the degree of humanistic and dehumanistic behaviors as perceived by nursing staff in hospitals. The study was based on a conceptual model proposed by Jan Howard, a sociologist. After reviewing the literature relevant to personalization of care, analyzing interviews with patients in various settings, and studying biological, psychological, and sociological frames of reference, Howard proposed the following necessary conditions for humanized health care. They were the dimensions of Irreplaceability, Holistic Selves, Freedom of Action, Status Equality, Shared Decision Making and Responsibility, Empathy, and Positive Affect.^ It was proposed that a scale composed of behaviors which reflected Howard's dimensions be developed within the framework of the social environment of nursing care units in hospitals. Nursing units were chosen because hospitals are traditionally organized around nursing care units and because patients spend the majority of their time in hospitals interacting with various levels of nursing personnel.^ Approximately 180 behaviors describing both patient and nursing staff behaviors which occur on nursing units were developed. Behaviors which were believed to be humanistic as well as dehumanistic were included. The items were classified under the dimensions of Howard's model by a purposively selected sample of 42 nurses representing a broad range of education, experience, and clinical areas. Those items with a high degree of agreement, at least 50%, were placed in the questionnaire. The questionnaire consisted of 169 items including six items from the Marlowe Crowne Social Desirability Scale (Short Form).^ The questionnaire, the Social Environment Scale, was distributed to the entire 7 to 3 shift nursing staff (603) of four hospitals including a public county specialty hospital, a public county general and acute hospital, a large university affiliated hospital with all services, and a small general community hospital. Staff were asked to report on a Likert type scale how often the listed behaviors occurred on their units. Three hundred and sixteen respondents (52% of the population) participated in the study.^ An item analysis was done in which each item was examined in relationship to its correlation to its own dimension total and to the totals of the other dimensions. As a result of this analysis, three dimensions, Positive Affect, Irreplaceability, and Freedom of Action were deleted from the scale. The final scale consisted of 70 items with 26 in Shared Decision Making and Responsibility, 25 in Holistic Selves, 12 in Status Equality, and seven in Empathy. The alpha coefficient was over .800 for all scales except Empathy which was .597.^ An analysis of variance by hospital was performed on the means of each dimension of the scale. There was a statistically significant difference between hospitals with a trend for the public hospitals to score lower on the scale than the university or community hospitals. That the scale scores should be lower in crowded, understaffed public hospitals was not unexpected and reflected that the scale had some discriminating ability. These differences were still observed after adjusting for the effect of Social Desirability.^ In summary, there is preliminary evidence based on this exploratory investigation that a reliable scale based on at least four dimensions from Howard's model could be developed to measure the concept of humanistic health care in hospital settings. ^

Uncovering the evidence of non-expert nephrology nursing practice

Expertise in nursing has been widely studied although there have been no previous studies into what constitutes expertise in nephrology (renal) nursing. This paper, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, provides evidence of the characteristics and practices of non-expert nephrology nurses. Using the grounded theory method, the study took place in one renal unit in New South Wales, Australia, and involved six non-expert and 11 expert nurses. Sampling was purposive then theoretical. Simultaneous data collection and analysis using participant observation, review of nursing documentation and semistructured interviews was undertaken. The study revealed a three-stage skills-acquisitive process that was identified as non-expert, experienced non-expert and expert stages. Non-expert nurses showed superficial nephrology nursing knowledge and limited experience; they were acquiring basic nephrology nursing skills and possessed a narrow focus of practice.

Recognition of expertise : an important concept in the acquisition of nephrology nursing expertise

The present article, which is abstracted from a larger study into the acquisition and exercise of nephrology nursing expertise, aims to explore the concept of recognition of expertise. The study used grounded theory methodology and involved 17 registered nurses who were practising in a metropolitan renal unit in New South Wales, Australia. Concurrent data collection and analysis was undertaken, incorporating participant observations and interviews. According to nurses in this study, patients, doctors and other nurses recognized that some nurses were experts while others were not. In addition, being trusted, being a role model and teaching others were important components of being recognized as an expert nephrology nurse. Of importance for nursing, the results of the present study indicate that knowledge and experience are not sufficient to ensure expert practice; recognition of expertise by others is an important function of expertise acquisition.