The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial

Objectives:
To determine the effectiveness of collaborative care in reducing depression in primary care patients with diabetes or heart disease using practice nurses as case managers.

Measuring self-care in chronic heart failure : a review of the psychometric properties of clinical instruments

Background : Improved self-care skills and behaviors are an important outcome of patient education and counseling. Both researchers and health professionals need to utilize instruments that are reliable and valid at measuring this outcome to advance our understanding as to the efficacy of clinical practice directed toward improving self-care.

Objective : The aim of this study was to identify instruments that measure chronic heart failure (CHF) self-care and demonstrate their psychometric properties.

Methods : A search of Medline, Cumulative Index to Nursing and Allied Health Literature, Medline, PsycArticles, Psychology and Behavioral Sciences Collection, and PsycINFO databases elucidated studies published between January 1980 and February 2009 that measure CHF self-care. The clinical instruments selected were disease-specific measures of CHF self-care behaviors that are promoted in best practice guidelines. Only instruments that reported estimates of reliability and validity were included in this review. Psychometric properties of the instruments were evaluated according to practice guidelines.

Results : The literature search identified 14 instruments published in peer-reviewed journals that measured constructs that predict or correlate to self-care rather than self-care itself. Only 2 disease-specific measures of self-care were identified (Self-care Heart Failure Index [SCHFI] and European Heart Failure Self-care Behavior Scale [EHFScBS]) that have undergone rigorous psychometric testing in CHF populations. Five aspects of validity had been demonstrated with EHFScBS, and 6 aspects of validity had been demonstrated with SCHFI. Two of 3 aspects of reliability have been demonstrated in both instruments.

Conclusion : Only 2 reliable and valid tools have been developed to specifically measure CHF self-care. Further use of these instruments in the research arena may reduce gaps in our understanding of CHF self-care and further shape clinical practice directed at improving it.

Managing post-discharge care at home: an analysis of patients' and their carers' perceptions of information received during their stay in hospital

This small-scale study carried out in a Melbourne metropolitan hospital explored patients’ and their carers’ perceptions of information, adequacy of information, and their utilization of information concerning post-discharge care received from health professionals during their stay in hospital. The research design consisted of two stages. Stage one involved a qualitative approach using focused interviews of five pairs of patients and their carers, 2 weeks after discharge from hospital. Five main themes emerged from the content analysis of the interview transcripts: information given by health professionals to patients and carers, patients’ and carers’ psychological well-being, activities of daily living, caring tasks of the patients, and community linkages. A quantitative approach was used for stage two involving two sets of questionnaires, one for the patient and one for the carer, developed from the themes identified in stage one. A pilot study was conducted on three pairs of patients and their carers, 2 weeks after discharge from hospital. The main study consisted of a convenience sample of 40 pairs of patients and their carers who completed the questionnaires 2 weeks post-discharge. Data analysis of stage two of the study consisted of descriptive statistics and cross-tabulations. The main findings suggested that carers received very little information from health professionals concerning their patients’ health problems and care at home. The carers’ health and employment states were often not considered in their patients’ discharge plan. Carers who were present with their patients when they received information concerning post-discharge care experienced a decrease in anxiety during their patients’ convalescence at home, greater satisfaction with the information they received, and their patients experienced fewer medical problems post-discharge. The implications for nursing practice and research include recommendations for a more effective system of discharge planning, and further research to include a larger population with a more varied group of participants.

Examining adverse events after intensive care unit discharge : outcomes from a pilot questionnaire

Adverse events are common in acute clinical settings but little is known about these events occurring after Intensive Care discharge. This study aimed to develop a reliable and valid tool for exploring clinicians’ opinions of factors associated with post-Intensive Care adverse events. A convenience sample of Australian Intensive Care Liaison Nurses was invited to complete and appraise a questionnaire using structured guidelines. Content validity and internal consistency were assessed.

Twelve Intensive Care Liaison Nurses completed the questionnaire. Cronbach?s alpha coefficient showed high internal consistency for the questionnaire; all 24 items on the questionnaire had coefficients greater than 0.852. The content validity index of the questionnaire overall was 0.76.

The post-Intensive Care adverse events questionnaire demonstrated reliability and validity. It is a tool that can be used to explore clinicians? opinions of factors associated with these events. The tool is important as it facilitates further insight into the causes of post-Intensive Care adverse events.

Challenges in managing elderly people with diabetes in primary care settings in Norway

Objective
To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings.

Design
Focus-group interviews.

Subjects and setting
Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32–59 years with clinical experience ranging from 1.5 to 38 years.

Results
Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines.

Conclusion
Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.