Improving the use of the nursing process: the impact of charting methodology developed from King's conceptual framework on the use of the nursing process

The purpose of this study was to assess the effects of changing a nursing documentation system, developed from King's Conceptual Framework, on the use of the nursing process. The null hypothesis was that there would be no significant increase in the reflection of the use of the nursing process on the nursing care plan or nurses' notes, as a result of using a nursing documentation system developed using King's Conceptual Framework (1981). The design involved the development of a questionnaire that was used to review health records pre and post implementation of a documentation system developed based on King's Conceptual Framework and Theory of Goal Attainment (1981). A Record Completeness Score was obtained from some of the questions. The null hypothesis was rejected. The results of the study have implications for nursing administration and the evaluation of nursing practice. If the use of a documentation system developed from a conceptual framework increases the reflection of the nursing process on the patient's health record, nursing will have the means to measure patient outcomes/goal attainment. All health care organizations and levels of government are focusing on methods to monitor and control the health-care dollar. In order for nursing to clearly determine the costs associated with nursing care, measurement of patient outcomes/goal attainment will need to be possible. In order to measure patient outcomes/goals attainment nurses will need to be able to collect data on their practice. It will be critical that nursing have a documentation system in place which facilitates the reflection of the nursing process within a theoretical framework.

An electronic record system in nursing education: evaluation and utilization

The main objective of the present work is to analyze the results of the utilization and evaluation of the LORETO Record System (LRS), providing improvement areas in the teaching-learning process and technology, in second year nursing students. A descriptive, prospective, cross sectional study using inferential statics has been carried out on all electronic records reported by 55 nursing students during clinical internships (April 1º-June 26º, 2013). Electronic record average rated 7.22 points (s=0.6; CV=0.083), with differences based on the clinical practice units (p<0,05). Three items assessed did not exceed the quality threshold set at 0.7 (p<0.05). Record Rate exceeds the quality threshold set at 80% for the overall sample, with differences based on the practice units. Only two clinical practice units rated above the minimum threshold (p <0.05). Record of care provision every 3 days did not reach the estimated quality threshold (p <0.05). There is a dichotomy between qualitative and quantitative results of LRS. Improvement areas in theoretical education have been identified. The LRS seems an appropriate learning and assessment tool, although the development of a new APP version and the application of principles of gamification should be explored.

Self-evaluation guide for collegiate schools of nursing.

Cover title.

An evaluation of an intervention strategy for retention and determination of predictors of success for high -risk students in an associate degree nursing program

The purpose of this study was twofold: (1) to evaluate the effect of a specific instructional Intervention, a Nursing Theory Laboratory, on increasing the retention of high risk students in the associate degree nursing program at Miami-Dade Community College in Miami, Florida; and (2) to identify predictors of success of high risk nursing students in this associate degree nursing program.^ Data were collected from the 195 nursing students enrolled in Nursing Fundamentals during the 1985-1987 academic years, and identified as high risk students. Control and experimental groups were selected based on enrollment in the Nursing Theory Laboratory.^ Results were determined by analyzing several cross-tabulations of selected variables and yielding chi square values, t-tests, and two discriminant analyses. There was no significant relationship between age or ethnic background and enrollment in the Nursing Theory Laboratory. There was no significant relationship between enrollment in the Nursing Theory Laboratory and success in Nursing 1 (Nursing Fundamentals). There was a significant relationship between enrollment in the Nursing Theory Laboratory and success in Nursing 3 (Medical-Surgical Nursing). Writing assessment test scores in two entrance tests and high risk categories, based on the number of enrollments in required science courses, were identified as predictors of success in this program.^ The conclusion was that the Nursing Theory Laboratory does not significantly improve retention of high risk associate degree nursing students if they are enrolled in this intervention at the same time they are enrolled in Nursing Fundamentals. Since those students who were enrolled in the Nursing Theory Laboratory had a significantly higher success rate in Nursing 3, than those students who were not enrolled in the Nursing Theory Laboratory, a recommendation of this study was to offer the Nursing Theory Laboratory to high risk students prior to the beginning of nursing courses. Another recommendation was that students deficient in reading and writing skills should be required to enroll in developmental courses prior to enrollment in the nursing course. ^

An evaluation of a community matron service from the patients’ perspective

Community matrons are a relatively new government initiative aimed at case managing people with long-term conditions to reduce the number of emergency bed days used in hospitals. Although there have been extensive evaluations of similar case management projects, to date there has been little evaluation of the community matron's role and the perceptions patients have of this new service. One of the main Government agendas for care is to deliver a high quality service driven by the needs of the service users (DH, 2000). In order to drive this agenda, care is to deliver a high quality service driven by the needs of the service users (DH, 2000). In order to drive this agenda, it is important that the views and perceptions of people on the receiving end of the services are heard, valued and appropriate actions taken. This two part evaluative report sets out to explore how people with long-term conditions perceive the impact of community matrons and the differences this new service may have had on their lives. Questionnaires were sent to 100 patients who were currently being case-managed by a community matron to evaluate the community matron service from the patients' perspective. Part two reports on patients' perceptions of the community matron role and the influences of the role on their health.

The impact of nurse-directed protocolised-weaning from mechanical ventilation on nursing practice: A quasi-experimental study

Background:
Internationally, nurse-directed protocolised-weaning has been evaluated by measuring its impact on patient outcomes. The impact on nurses’ views and perceptions has been largely ignored.

Aim:
To determine the change in intensive care nurses’ perceptions, satisfaction, knowledge and attitudes following the introduction of nurse-directed weaning. Additionally, views were obtained on how useful protocolised-weaning was to practice.

Methods:
The sample comprised nurses working in general intensive care units in three university-affiliated hospitals. Nurse-directed protocolised-weaning was implemented in one unit (intervention group); two ICUs continued with usual doctor-led practice (control group). Nurses’ perceptions, satisfaction, knowledge and attitudes were measured by self-completed questionnaires before (Phase I) and after the implementation of nurse-directed weaning (Phase II) in all units.

Results:
Response rates were 79% (n=140n=140) for Phase 1 and 62% (n=132n=132) for Phase II. Regression-based analyses showed that changes from Phase I to Phase II were not significantly different between the intervention and control groups. Sixty-nine nurses responded to both Phase I and II questionnaires. In the intervention group, these nurses scored their mean perceived level of knowledge higher in Phase II (6.39 vs 7.17, p=0.01p=0.01). In the control group, role perception (4.41 vs 4.22, p=0.01p=0.01) was lower and, perceived knowledge (6.03 vs 6.63, p=0.04p=0.04), awareness of weaning plans (6.09 vs 7.06, p=0.01p=0.01) and satisfaction with communication (5.28 vs 6.19, p=0.01p=0.01) were higher in Phase II. The intervention group found protocolised weaning useful in their practice (75%): this was scored significantly higher by junior and senior nurses than middle grade nurses (p=0.02p=0.02).

Conclusion

We conclude that nurse-directed protocolised-weaning had no effect on nurses’ views and perceptions due to the high level of satisfaction which encouraged nurses’ participation in weaning throughout. Control group changes are attributed to a ‘reactive effect’ from being study participants. Weaning protocols provide a uniform method of weaning practice and are particularly beneficial in providing safe guidance for junior staff.

Evaluation of a Psychoeducational intervention for patients with Advanced Cancer who have Cachexia and their lay Carers (EPACaCC): study protocol

Aim: To evaluate a psychoeducational intervention for patients with advanced cancer who have cachexia and their lay carers.

Background: Cachexia is a frequent and devastating syndrome of advanced cancer. It has an impact on patients biologically, psychologically and socially and has profound impact on their lay carers. Prior research has predominately focused on the biological components of cachexia and associated potential treatment modalities. At present, there is no standardized supportive healthcare intervention in current practice that targets the psychosocial impact of this syndrome.

Design: A pragmatic multicentre randomized controlled trial.

Methods: Patient/carer dyads (n = 200) will be recruited into a randomized controlled trial of a DVD intervention for cachexia management. The sample will be recruited from two urban hospices in the UK. The primary outcome measure will be the General Health Questionnaire-12. Additional questionnaires focusing on distress, readiness to give care and coping skills will be used as secondary outcome measures. In addition, lay carers in the intervention group will be asked to participate in semi-structured interviews following the death of their loved one. Both Office for Research Ethics Committee approval and local governance approval at both hospices have been obtained as of February 2013.

Discussion: This is the first time that a psychoeducational DVD has been tested in a randomized controlled trial in this population. Dissemination of findings will make a significant contribution to international knowledge and understanding in this area. Findings will inform education, practice and policy.

Course/instructor evaluation : perspectives of part-time graduate students

This study explored 6 part-time graduate students' perspectives on course/instructor evaluation. The purpose was to explore whether a link exists between the evaluation for course and instructors as contained in the Faculty of Education courselinstructor evaluation form and the needs of part-time students enrolled in that program. The literature review provided contextual information concerning the 3 main subject areas based upon which the research questions were designed: learner needs in the context of part-time graduate students, courselinstructor eval~ation, and the potential lack of congruency between the 2. Using a semistructured interview process, participants identified criteria important or relevant to the evaluation process and incongruent with the course/instructor evaluation form. A qualitative research methodology using a grounded theory approach contributed to the theory on the nature of course evaluation instruments in a graduate program and addressed the notion of where power was situated within the evaluation process. Findings suggested that the concepts of relevance and the instructor's role that participants identified as important in their graduate learning experience were congruent with what they considered important components of the course/instructor evaluation form. Participants noted a lack of congruency between their expectations of a quality graduate learning experience and the format, content, intent, and timing of the evaluation process. The study confirmed that students did want a voice in the evaluation of their learning experience at both the course and program levels.

Transition to specialty practice programs in Australian emergency nursing

 Transition to Specialty Practice Programs (TSPPs) provide structured support and education to novice nurses. This study examined the prevalence, design, characteristics and functions of emergency nursing TSPPs in Australia, and found that TSPPs served an important function in recruitment, preparation and retention of emergency nurses. A framework for future emergency nursing TSPPs was developed based on study findings.

AN EVALUATION OF ANXIETY AND DEPRESSION SYMPTOMS IN FIBROMYALGIA

The objective of this study was to identify the frequency of anxiety and depression symptoms by verifying the association between anxiety traits, current depression and anxiety symptoms in fibromyalgia patients. Interviews were performed with 60 subjects diagnosed with fibromyalgia at the Rheumatology Outpatient Clinic at Universidade Federal de Sergipe between August 2007 and March 2008, in which two questionnaires were administered: the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). The frequency of anxiety and depression symptoms was, respectively, 50% and 86% for individuals with fibromyalgia, and the mean trait-anxiety score was 59.38. An association was observed between trait and state anxiety. Anxiety and depression were frequent symptoms among patients with fibromyalgia. However, anxiety appeared as a secondary symptom to depression, appearing in a more severe form, and, therefore, this comorbidity should be more valued and studied.

The evaluation of an instrument for pediatric oncology patient classification

The objectives of this study were to assess the interrater reproducibility of the instrument to classify pediatric patients with cancer; verify the adequacy of the patient classification instrument for pediatric patients with cancer; and make a proposal for changing the instrument, thus allowing for the necessary adjustments for pediatric oncology patients. A total of 34 pediatric inpatients of a Cancer Hospital were evaluated by the teams of physicians, nurses and nursing technicians. The Kappa coefficient was used to rate the agreement between the scores, which revealed a moderate to high value in the objective classifications, and a low value in the subjective. In conclusion, the instrument is reliable and reproducible, however, it is suggested that to classify pediatric oncology patients, some items should be complemented in order to reach an outcome that is more compatible with the reality of this specific population.