Management of delirium in medicine : experience of a close observation unit

Objective(s): A new model of care for the management of patients with delirium was developed and evaluated. Method: A 4-bedded Close Observation Unit (COU) was introduced. The model comprised an education strategy for assistants in nursing (AIN), environmental adaptations and AIN to patient ratio of 1:4. Outcomes in all patients with delirium before and after introduction of the new model of care were compared. Results: 105 patients were admitted to COU, of whom 100 (95%) were diagnosed with delirium. In-hospital mortality improved after introduction of the unit (15% versus 5%; p=0.002) without significant change in length of stay, discharge destination or falls frequency. Conclusion: A dedicated unit for delirium management within medicine achieved a reduction in mortality.

Evolving and expanding : the scope of practice of the infection control practitioner

Infection control practitioners (ICPs) work across the full spectrum of health care settings and carry out a broad range of practice activities. Whilst several studies have reported on the role of the ICP, there has been little investigation of the scope of infection control practice. This knowledge is essential to inform the professional, legal, educational and financial implications of this specialist role. One hundred and thirteen ICPs from a range of health care settings across Queensland were surveyed. Respondents were asked to rate the extent to which they were and should be engaging in the range of practices identified by Gardner, Jones & Olesen (1999). Significant differences were evident between what ICPs said was their actual practice versus what they thought they should be doing. Overall, the respondents consistently reported that they should be engaging in more of the range of infection control activities than they were, particularly with regard to management practices. A number of differences were found according to the context in which the practitioners worked, such as the type and size of facility and their employment status. The results of this study indicate that the scope of infection control practice has clearly moved beyond those practices that are confined by the hospital wall and defined by surveillance activities.

Peer-led diabetes self-management programme for community-dwelling older people in China : study protocol for a quasi-experimental design

Aim. A protocol for a new peer-led self-management programme for communitydwelling older people with diabetes in Shanghai, China. Background. The increasing prevalence of type 2 diabetes poses major public health challenges. Appropriate education programmes could help people with diabetes to achieve self-management and better health outcomes. Providing education programmes to the fast growing number of people with diabetes present a real challenge to Chinese healthcare system, which is strained for personnel and funding shortages. Empirical literature and expert opinions suggest that peer education programmes are promising. Design. Quasi-experimental. Methods. This study is a non-equivalent control group design (protocol approved in January, 2008). A total of 190 people, with 95 participants in each group, will be recruited from two different, but similar, communities. The programme, based on Social Cognitive Theory, will consist of basic diabetes instruction and social support and self-efficacy enhancing group activities. Basic diabetes instruction sessions will be delivered by health professionals, whereas social support and self-efficacy enhancing group activities will be led by peer leaders. Outcome variables include: self-efficacy, social support, self-management behaviours, depressive status, quality of life and healthcare utilization, which will be measured at baseline, 4 and 12 weeks. Discussion. This theory-based programme tailored to Chinese patients has potential for improving diabetes self-management and subsequent health outcomes. In addition, the delivery mode, through involvement of peer leaders and existing community networks,is especially promising considering healthcare resource shortage in China.

Weight stigma in maternity care : women's experiences and care providers' attitudes

Background: Weight stigma is pervasive in Western society and in healthcare settings, and has a negative impact on victims’ psychological and physical health. In the context of an increasing focus on the management of overweight and obese women during and after pregnancy in research and clinical practice, the current studies aimed to examine the presence of weight stigma in maternity care. Addressing previous limitations in the weight stigma literature, this paper quantitatively explores the presence of weight stigma from both patient and care provider perspectives. Methods: Study One investigated associations between pre-pregnancy body mass index (BMI) and experiences of maternity care from a state-wide, self-reported survey of 627 Australian women who gave birth in 2009. Study Two involved administration of an online survey to 248 Australian pre-service medical and maternity care providers, to investigate their perceptions of, and attitudes towards, providing care for pregnant patients of differing body sizes. Both studies used linear regression analyses. Results: Women with a higher BMI were more likely to report negative experiences of care during pregnancy and after birth, compared to lower weight women. Pre-service maternity care providers perceived overweight and obese women as having poorer self-management behaviours, and reported less positive attitudes towards caring for overweight or obese pregnant women, than normal weight pregnant women. Even care providers who reported few weight-stigmatising attitudes responded less positively to overweight and obese pregnant women. Conclusions: Overall, these results provide preliminary evidence that weight stigma is present in maternity care settings in Australia. They suggest a need for further research into the nature and consequences of weight stigma in maternity care, and for the inclusion of strategies to recognise and combat weight stigma in maternity care professionals’ training.

Pain management

Regardless of the setting in which they work, nurses are responsible for the assessment and management of clients with pain. Pain is a key consideration in all patient care, and nurses play a critical role in pain management. Indeed, throughout history nurses have made important contributions to our understanding and management of pain through research and clinical practice. This chapter aims to provide an introduction to some key concepts in pain management and to encourage you to reflect on some of your own assumptions about pain.

Emerging work practice with a telehealth stethoscope

We investigated the collaboration of ten doctor-nurse pairs with a prototype digital telehealth stethoscope. Doctors could see and hear the patient but could not touch them or the stethoscope. The nurse in each pair controlled the stethoscope. For ethical reasons, an experimenter stood in for a patient. Each of the ten interactions was video recorded and analysed to understand the interaction and collaboration between the doctor and nurse. The video recordings were coded and transformed into maps of interaction that were analysed for patterns of activity. The analysis showed that as doctors and nurses became more experienced at using the telehealth stethoscope their collaboration was more effective. The main measure of effectiveness was the number of corrections in stethoscope placement required by the doctor. In early collaborations, the doctors gave many corrections. After several trials, each doctor and nurse had reduced corrections and all pairs reduced their corrections. The significance of this research is the identification of the qualities of effective collaboration in the use of the telehealth stethoscope and telehealth systems more generally.

The legitimation and reproduction of discourse-practice gaps in work-life balance

Purpose - Critical scholarship on work-life balance (WLB) and its associated practices maintains that workplace flexibility is more than a quasi-functionalist response to contemporary problems faced by individuals, families or organisations. Beginning with Fleetwood’s contention that WLB discourses have become "detached" from their associated practices, this paper explores how workplace practices support or challenge dominant WLB discourses evident in socio-cultural, political and organisational sources. Design/methodology/approach - We analyse individual and group interview transcripts derived from 122 white-collar employees in two different organisational contexts (one public, one private) in the construction industry in Australia. Findings - Four major themes were identified in the data which illustrate discourse practice gaps. First, the demands facing this particular industry/ sector were framed as heightened and unique. Second, productivity was prioritised, dominating employees’ care-giving and lifestyle concerns. Third, employees’ caring responsibilities were communicated as personal and individual choices. Fourth, commitment and efficiency were judged on the basis of presence in the workplace. Research limitations/implications - Even in industries that have embraced WLB, workplace practices legitimate and reinforce the status quo, and maintain a gap between the promises of WLB and its potential to ameliorate conflict and assist workers to span the boundaries of paid work and other life domains. Originality/value - While the practices demonstrated in the research are focused on one industry, the study provides a critical analysis of how the contextually-influenced meaning of WLB is constructed, created and contested in these workplaces and the effects it produces.

Application of the self-efficacy model in nursing practice [自我效能模式於護理臨床應用之剖析]

Self-efficacy has two cognitive components, efficacy expectations and outcome expectations, and their influence on behavior change is synergistic. Efficacy expectation is effected by four main sources of information provided by direct and indirect experiences. The four sources of information are performance accomplishments, vicarious experience, verbal persuasion and self-appraisal. How to measure and develop interventions is an important issue at present. This article clearly analyzes the relationship between variables of the self-efficacy model and explains the implementation of self-efficacy enhancing interventions and instruments in order to test the model. Through the process of the use of theory and feasibility in clinical practice, it is expected that professional medical care personnel should firstly familiarize themselves with the self-efficiency model and concept, and then flexibly promote it in professional fields clinical practice, chronic disease care and health promotion.