Implementing good practice in epilepsy care.
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Examples of evidence-based guidelines for epilepsy care exist. However, guidelines are of little use if they are not recognised, implemented and supported. The object of this study was to establish the degree to which good practice guidelines for epilepsy have been implemented and to identify positive and negative factors that affect their implementation. Semi-structured questionnaires were sent to 750 randomly selected health professionals working in primary and secondary care in England. The sample comprised nurses (200), adult consultants (including learning disability consultants) (300), paediatric consultants (150) and general practitioners (100). Aspects of good practice are being implemented in some areas, but not generally, therefore service provision is likely to remain fragmented until this is addressed. Professionals have been prevented from successful implementation of guidelines to sustain good practice due to a number of factors, most notably lack of time, workload, competing priorities and staffing levels. Factors that have promoted and encouraged the successful adoption and application of good practice include inputs from epilepsy specialist nurses (ESNs), appropriate, timely and accessible professional development opportunities and the support and enthusiasm of colleagues. (+info)
Tayside-Fife clinical trial of cognitive-behavioural therapy for medication-resistant psychotic symptoms. Results to 3-month follow-up.
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BACKGROUND: Evidence for the efficacy of cognitive-behavioural therapy for schizophrenia is promising but evidence for clinical effectiveness is limited. AIMS: To test the effectiveness of cognitive-behavioural therapy delivered by clinical nurse specialists in routine practice. METHOD: Of 274 referrals, 66 were allocated randomly to 9 months of treatment as usual (TAU), cognitive-behavioural therapy plus TAU (CBT) or supportive psychotherapy plus TAU (SPT) and followed up for 3 months. RESULTS: Treatment effects were modest but the CBT condition gave significantly greater improvement in overall symptom severity than the SPT or TAU conditions combined (F (1,53)=4.14; P=0.05). Both the CBT and SPT conditions combined gave significantly greater improvement in severity of delusions than did the TAU condition (F (1,53)=4.83; P=0.03). Clinically significant improvements were achieved by 7/21 in the CBT condition (33%), 3/19 in the SPT condition (16%) and 2/17 in the TAU condition (12%). CONCLUSIONS: Cognitive-behavioural therapy delivered by clinical nurse specialists is a helpful adjunct to routine care for some people with chronic psychosis. (+info)
Reasons for referral to hospital.
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In a study in North-east Scotland, nine out of ten patients had a "medical" reason for referral to hospital-in half it was the severity of their illness and in half the need for investigation or special treatment. One out of five patients was in need of intensive nursing care and one out of 20 patients had a social reason for admission to hospital. General practitioners with access to cottage hospital beds would choose to treat over one quarter of their own patients. The choice of hospital was influenced by the doctor's diagnostic certainty. (+info)
A multisite survey of suctioning techniques and airway management practices.
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BACKGROUND: Ventilator-associated pneumonia, common in critically ill patients, is associated with microaspiration of oropharyngeal secretions and may be related to suctioning and airway management practices. OBJECTIVES: To describe institutional policies and procedures related to closed-system suctioning and airway management of intubated patients, and to compare practices of registered nurses and respiratory therapists. METHODS: A descriptive, comparative, multisite study of facilities that use closed-system suctioning devices on most intubated adults was conducted. Nurses and respiratory therapists who worked at the sites completed surveys related to their practices. RESULTS: A total of 1665 nurses and respiratory therapists at 27 sites throughout the United States responded. The typical respondent had at least 6 years' experience with patients receiving mechanical ventilation (61%) and a baccalaureate degree or higher (54%). Most sites had policies for management of endotracheal tube cuffs (93%), hyperoxygenation (89%) and use of gloves (70%) with closed-system suctioning, and instillation of isotonic sodium chloride solution for thick secretions (74%). Only 48% of policies addressed oral care and 37% addressed oral suctioning. Nurses did more oral suctioning and oral care than respiratory therapists did, and respiratory therapists instilled sodium chloride solution more and rinsed the suctioning device more often than nurses did. CONCLUSIONS: Policies vary widely and do not always reflect current research. Consistent performance of practices such as wearing gloves for airway management and maintaining endotracheal cuff pressures must be evaluated. Collaborative, research-based policies and procedures must be developed and implemented to ensure best practices for intubated patients. (+info)
Methods in informatics: using data derived from a systematic review of health care texts to develop a concept map for use in the neonatal intensive care setting.
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A qualitative systematic review of textbooks and clinical guidelines identified assessment criteria for initiation of nipple feeds in premature infants cared for in the neonatal intensive care unit (NICU) setting. Using a structured method for text source selection and data extraction, 43 health care texts were systematically reviewed yielding 153 separate statements related to assessing premature infants' feeding readiness. Following this procedure, a pile sort method was conducted wherein an expert neonatal nurse practitioner (NNP) grouped the statements according to similarity in meaning. Ten piles of terms emerged from this process. Each pile was "named," depicting discrete components used when assessing premature infants' readiness for nipple feeding. Using these public data and the private knowledge of the NNP informant, a concept map was constructed to illustrate a framework for decision support development and to examine the map's usefulness for structuring knowledge that will provide input to an intelligent decision support system. (+info)
Role and experience determine decision support interface requirements in a neonatal intensive care environment.
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The aim of this paper is to describe a novel approach to the analysis of data obtained from card-sorting experiments. These experiments were performed as a part of the initial phase of a project, called NEONATE. One of the aims of the project is to develop decision support tools for the neonatal intensive care environment. Physical card-sorts were performed using clinical "action" and patient "descriptor" words. Thirty-two staff (eight junior nurses, eight senior nurses, eight junior doctors, and eight senior doctors) participated in the actions card-sorts and the same number of staff participated in separate descriptors card-sorting experiments. To check for consistency, the card-sorts were replicated for nurses during the action card-sorts. The card-sort data were analysed using hierarchical cluster analysis to produce tree-diagrams or dendrograms. Differences were shown in the way various classes of staff with different levels of experience mentally map clinical concepts. Clinical actions were grouped more loosely by nurses and by those with less experience, with a polarisation between senior doctors and junior nurses. Descriptors were classed more definitively and similarly by nurses and senior doctors but in a less structured way and quite differently by junior doctors. This paper presents a summary of the differences in the card-sort data for the various staff categories. It is shown that concepts are used differently by various staff groups in a neonatal unit and that this may diminish the effectiveness of computerised decision aids unless it is explored during their development. (+info)
Evaluation of the draft international standard for a reference terminology model for nursing actions.
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PURPOSE: The purpose of this study was to evaluate the draft ISO reference terminology model (RTM) for nursing actions. Nursing RTM models attempt to include concepts that are universally represented in nursing documentation to improve the depiction of nursing practice in computerized systems. METHOD: Content analysis was used to decompose interventions into words and phrases, which were then mapped to the six model categories used to represent nursing actions in the draft ISO RTM. The decomposition of interventions was applied to nurses' documentation of pain interventions entered into a clinical information system. FINDINGS: Consistent with the ISO standard requirements, all (100.00%) of the interventions contained an word or phrase and a <>. Additional findings are discussed in relation to earlier studies of terminology models. CONCLUSIONS: It is recommended that terminology and information system developers consider this model in their ongoing system development, evaluation, maintenance, and revisions. Further evaluation of the ISO RTM for nursing will contribute to the goals of this specific model and the harmonization and integration with other health care models. (+info)
Determining sources for formal nursing terminology systems.
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OBJECTIVE: The purpose of this study is to assess the relative merits of aspects--labels or informal definitions--of traditional nursing terminology systems as the foundational sources for target formal nursing terminology systems. DESIGN: This study builds upon and compares the findings of two previous experiments in which formal terminology systems, one based on informal definitions, the other based on labels, were developed under the GALEN approach and used to generate hierarchies of nursing interventions drawn from the Nursing Interventions Classification. MEASUREMENTS: The two generated hierarchies were compared to see whether, and to what extent, they captured a test set of hierarchical relationships implicit within and derived from the Nursing Interventions Classification. An analysis of the relevant conceptual representations was carried out in those cases where a hierarchical relationship from the test set was absent from either of the generated hierarchies. RESULTS: The hierarchy generated from the formal terminology system based on informal definitions contained none of the test set of hierarchical relationships. Reasons included structural differences between conceptual representations; different levels of specificity; and deficiencies within the formal terminology system itself. The hierarchy generated from the formal terminology system based on labels contained all but one of the test set. The reason for the one absence was inconsistent usage within source and target. CONCLUSIONS: While it may be possible to derive formal terminology systems from informal definitions for nursing interventions, the inherent complexity within those informal definitions brings into question the utility of such systems. This study demonstrates that it may be more productive to base formal nursing terminology systems on labels, simpler sources with limited discursive content and a higher degree of consistency. (+info)