Care of people with diabetes : a manual of nursing practice

Contents: Diagnosing and classifying diabetes -- Assessment and nursing diagnosis -- Monitoring diabetes mellitus -- Nutritional aspects of caring for people with diabetes -- Medication commonly used in diabetes management -- Hypoglycaemia -- Hyperglycaemia, diabetic ketoacidosis (DKA), hyperosmolar coma and lactic acidosis -- Long term complications of diabetes -- Management during surgical and investigative procedures -- Special situations and unusual conditions related to diabetes -- Diabetes and sexual health -- Diabetes in the older person -- Diabetes in children and adolescents -- Women, pregnancy, and gestational diabetes -- Psychological and quality of life issues related to having diabetes -- Diabetes education -- Discharge planning -- Community and primary care nursing and home-based care -- Complementary therapies and diabetes -- Managing diabetes in the emergency situations.

The tri-focal model of care : Advancing the teaching-nursing home concept

Providing residential aged care is challenging because of the complexity of residents' health status, difficulties recruiting and retaining skilled staff, and financial and regulatory constraints. This paper discusses some of these challenges and describes an innovative model of care, termed 'The Tri-focal model of care'. This model was developed based on the concepts of 'partnership-centred care', 'positive work environment' and the need for evidence-based practice to underpin all aspects of care. It is envisaged that the implementation of this model will provide a rich learning environment that advances the teaching-nursing home concept and the quality of residential aged care.

Incongruence between nurses' and patients' understandings and expectations of rehabilitation

Aims and objectives. To explore nurses' understandings and expectations of rehabilitation and nurses' perceptions of patients' understandings and expectations of rehabilitation.
Background. Within the context of a broadening appreciation of the benefits of rehabilitation, interest in the nature of rehabilitation is growing. Some believe that rehabilitation services do not adequately meet the needs of patients. Others are interested in the readiness of patients to participate in rehabilitation.
Design. Qualitative.
Method. Grounded theory using data collected during interviews with nurses in five inpatient rehabilitation units and during observation of the nurses' everyday practice.
Findings. According to nurses working in inpatient rehabilitation units, there is a marked incongruence between nurses' understandings and expectations of rehabilitation and what they perceive patients to understand and expect.
Conclusion. Given these different understandings, an important nursing role is the education of patients about the nature of rehabilitation and how to optimise their rehabilitation.

Relevance to clinical practice. Before patients are transferred to rehabilitation, the purpose and nature of rehabilitation, in particular the roles of patients and nurses, needs to be explained to them. The understandings of rehabilitation that nurses in this study possessed provide a framework for the design of education materials and orientation programmes that inform patients (and their families) about rehabilitation. In addition, reinforcement of the differences between acute care and rehabilitation will assist patients new to rehabilitation to understand the central role that they themselves can play in their recovery.

Factors affecting the offer of pulmonary rehabilitation to patients with chronic obstructive pulmonary disease by primary care professionals : a qualitative study

Aim: To explore health professionals’ experiences of barriers and facilitators to referring patients for pulmonary rehabilitation in a primary care setting.

Background: Pulmonary rehabilitation involves a multidisciplinary teamwork approach to improving
the quality of life for people with chronic obstructive pulmonary disease. This study aimed to find out about health care professionals’ experiences when referring patients. Reports suggest that a health care professional’s attitude towards a treatment affects the willingness of patients to accept advice.

Methods: Five focus group interviews were undertaken with 21 health professionals from North Midlands, UK. Data were analysed using a thematic analysis drawing on the techniques of grounded theory.

Findings: Chronic disease management has been delegated to Practice Nurses in many cases leaving some nurses feeling unsupported and some General Practitioners feeling deskilled. Problems with communication, a lack of adequate and timely local service provision, a difficult referral process, time pressures and lack of information were barriers to health care professionals making an offer of pulmonary rehabilitation. An explanatory model is proposed to describe how addressing barriers to referral may improve health care professionals views about pulmonary rehabilitation and therefore may mean that they present it in a more positive manner.

Opting in and opting out: a grounded theory of nursings contribution to inpatient rehabilitation

Aim: To develop a grounded theory of nursing’s contribution to patient rehabilitation from the perspective of nurses working in inpatient rehabilitation.

Design: Grounded theory method, informed by the theoretical perspective of symbolic interactionism, was used to guide data collection and analysis, and the development of a grounded theory.

Setting: Five inpatient rehabilitation units in Australia.

Participants: Thirty-five registered and 18 enrolled nurses participated in audio-taped interviews and/or were observed during periods of their everyday practice.

Findings: The analysis revealed a situation whereby nurses made decisions about when to ‘opt in’ and when to ‘opt out’ of inpatient rehabilitation. This occurred on two levels: with their interaction with patients and allied health professionals, and when faced with negative system issues that impacted on their ability to contribute to patient rehabilitation. The primary contribution nurses made to inpatient rehabilitation was working directly with patients, enabling them to self-care. Nurses coached patients when their decisions about ‘opting in’ and ‘opting out’ were based on assessment of the person in their particular context. In contrast, the nurses mostly distanced themselves from system-based problems, ‘opting out’ of addressing them. They did this not to make their working lives easier, but more manageable.

Conclusion: System-based problems impacted negatively on the nurses’ ability to deliver comprehensive rehabilitation care. As a consequence, some nurses felt unable to influence the care and they withdrew professionally to make their work lives more manageable.

The moral imperative of designating patient safety and quality care as a national nursing research priority

Since the early 1990s, research studies conducted respectively in the USA, UK and Australia have found that between 4 and 16.6 per cent of patients suffer from some kind of harm (including permanent disability and death) as a result of human errors and adverse events while in hospital. It has been further estimated that approximately 50 per cent of these human errors/adverse events resulting in harm could have been prevented. In response to the significant financial, social, and political implications of these figures, a range of processes have been put in place in an attempt to improve patient safety and quality care in Australia. Nonetheless, it is evident that more can be done to improve the status quo. One process that warrants consideration is that of peak health professional groups and organisations providing active leadership in the promotion of patient safety, such as by making a visible and recognisable commitment to patient safety as a strategic research priority area. In this paper it is contended that, given the moral importance of patient safety and quality care in nursing and related health care domains, the inseparable link between nursing practice and patient safety, and the central role that research has to play in driving safety improvements in these domains, it is morally imperative that the nursing profession gives sustained and focussed public attention to patient safety and quality care as a national research priority.

Public reporting of nursing home quality of care : Lessons from the United States experience for Canadian policy discussion

While the demand for continuing care services in Canada grows, the quality of such services has come under increasing scrutiny. Consideration has been given to the use of public reporting of quality data as a mechanism to stimulate quality improvement and promote public accountability for and transparency in service quality. The recent adoption of the Resident Assessment Instrument (RAI) throughout a number of Canadian jurisdictions means that standardized quality data are available for comparisons among facilities across regions, provinces and nationally. In this paper, we explore current knowledge on public reporting in nursing homes in the United States to identify what lessons may inform policy discussion regarding potential use of public reporting in Canada. Based on these findings, we make recommendations regarding how public reporting should be progressed and managed if Canadian jurisdictions were to implement this strategy.

Agency nursing work in acute care settings: perceptions of hospital nursing managers and agency nurse providers

• There is a paucity of research in investigating agency nursing work from the perspectives of hospital nursing managers and agency nurse providers.

• This exploratory paper examines the hospital nursing managers' and agency nurse providers' perceptions and experiences of agency nursing work.

• Individual, in-depth interviews were conducted with three agency nurse providers and eight hospital nursing managers. Because of the lack of previous research in this area, an exploratory, semi-structured interviewing technique was deemed appropriate.

• Three major themes emerged from interview data: planning for ward allocation, communication and professionalism.

• In planning for ward allocation, hospital managers were primarily concerned with maintaining adequate numbers of nursing staff in the ward settings. A major concern for agency nurse providers was inappropriate allocation of temporary staff.

• Communication was valued in different ways. While hospital managers focused on communication between the agency nurse and other permanent members of the health care team, agency providers were concerned with exchanges between agencies and hospital organizations, and between the agencies and agency nurses.

• For both groups, responsibility for professional development and the status of agency nursing as a career choice for graduate and experienced nurses were the focal aspects for consideration.

• A limitation of this study is the small number of individual interviews conducted with hospital nursing managers and agency nurse providers. Nevertheless, the findings represent the views of 11 individuals in senior managerial roles.

• The findings reinforce the need to enhance collaboration between hospitals and nursing agencies, and to examine how divergent views of agency nursing work could be reconciled – with the aim of providing quality patient care.

Impact of nursing information systems on residential care provision in an aged care provider

The challenge of an ageing population has placed a great pressure on the Australian aged care sector in the coming decades. Technology-enabled solutions such as health information systems (HIS) can be seen as a way to improve care quality, safety and process efficiency. Compared to the overall healthcare sector, the adoption of HIS in the aged care sector has been slower. One reason for this is that aged care providers are not well informed therefore not yet convinced of the positive impacts of technology solutions on their service provision. This paper reports findings from an evaluation of the impact of HIS adoption at an aged care provider in Victoria. The evaluation was conducted in two distinct areas, residential aged care and residential disability services. Overall, the findings show positive impacts of the system on individual work of the care staff and on service provision of the organisation as well as suggesting opportunities for improvement in later implementation stages. The evaluation will also inform other aged care and disability service providers of the benefits of HIS and useful lessons in adoption of technology solutions.

Concordance with phase-one cardiac rehabilitation guidelines in the inpatient setting

The aim of the paper was to examine concordance with phase-one cardiac rehabilitation (CR) guidelines, undertake an intervention that might optimise adherence to the guidelines, and establish a benchmark for practice in the coronary care unit (CCU) setting.

Integrated depression management: a proposed trial of a new model of care in a low vision rehabilitation setting

Purpose:
Depression is a common problem among people with visual impairment and contributes to functional decline. This article presents a study protocol to evaluate a new model of care for those patients with depressive symptoms in which psychological treatment is integrated into low vision rehabilitation services. Low vision staff will be trained to deliver "problem solving therapy for primary care" (PST-PC), an effective psychological treatment developed specifically for delivery by non-mental health care staff. PST-PC is delivered in 8 weekly telephone sessions of 30-45 minutes duration and 4 monthly maintenance sessions. We predict this new integrated model of care will significantly reduce depressive symptoms and improve the quality of life for people with visual impairment.

Methods and Design:
A randomized controlled trial of PST-PC will be implemented nationally across low vision rehabilitation services provided by Vision Australia. Clients who screen positive for depressive symptoms and meet study criteria will be randomized to receive PST-PC or usual care, consisting of a referral to their general practitioner for more detailed assessment and treatment. Outcome measures include depressive symptoms and behaviors, quality of life, coping and psychological adjustment to visual impairment. Masked assessments will take place pre- and post-intervention as well as at 6- and 12-month follow-up.

Conclusion:
We anticipate that this innovative service delivery model will lead to sustained improvements in clients' quality of life in a cost effective manner and provide an innovative service delivery model suitable for other health care areas in which depression is co-morbid.

Development and evaluation of a teaching and learning approach in cross-cultural care and antidiscrimination in university nursing students

Background:
Cross-cultural care and antidiscrimination are vital to ethical effective health systems. Nurses require quality educational preparation in cross-cultural care and antidiscrimination. Limited evidence-based research is available to guide teachers.

Objectives:
To develop, implement and evaluate an evidence-based teaching and learning approach in cross-cultural care and antidiscrimination for undergraduate nursing students.

Design:
A quantitative design using pre- and post-survey measures was used to evaluate the teaching and learning approach.

Settings:
The Bachelor of Nursing program in an Australian university.

Participants:
Academics and second year undergraduate nursing students.

Methods:
A literature review and consultation with academics informed the development of the teaching and learning approach. Thirty-three students completed a survey at pre-measures and following participation in the teaching and learning approach at post-measures about their confidence to practice cross-cultural nursing (Transcultural Self-efficacy Tool) and about their discriminatory attitudes (Quick Discrimination Index).

Results:
The literature review found that educational approaches that solely focus on culture might not be sufficient in addressing discrimination and racism. During consultation, academics emphasised the importance of situating cross-cultural nursing and antidiscrimination as social determinants of health. Therefore, cross-cultural nursing was contextualised within primary health care and emphasised care for culturally diverse communities. Survey findings supported the effectiveness of this strategy in promoting students' confidence regarding knowledge about cross-cultural nursing. There was no reported change in discriminatory attitudes. The teaching and learning approach was modified to include stronger experiential learning and role playing.

Conclusions:
Nursing education should emphasise cross-cultural nursing and antidiscrimination. The study describes an evaluated teaching and learning approach and demonstrates how evaluation research can be used to develop cross-cultural nursing education interventions.