Reducing depression in older home care clients: design of a prospective study of a nurse-led interprofessional mental health promotion intervention.
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Statistical quality control in nursing homes: assessment and management of chronic urinary incontinence.
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This article describes a statistical quality control system that allows nurse managers to monitor staff performance of a critical patient care function. Descriptive data concerning patients' incontinence frequencies were collected during a two-day assessment period for 87 patients under conditions that guaranteed that the patients' protective garments were changed on a one- or two-hour basis. The average and expected norms of patient wetness were calculated for a sample of patients in four different nursing homes. Periodic monitoring of patient wetness in each sample and the use of statistical quality control charts permitted nurse managers to determine if nursing aides were changing patients on either a one- or a two-hour schedule. The implications of the research for meeting federal incontinence care standards and for assuring high-quality patient care are discussed. (+info)
A taxonomy of nursing care organization models in hospitals.
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The nature of nursing practice in rural and remote areas of Greenland.
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BACKGROUND: The Greenlandic Healthcare Reform (2010) required improved quality of services for health promotion, prevention of infectious and lifestyle diseases, family nursing and evidence-based clinical nursing. AIM: To investigate current nursing practice in Greenland and to identify whether it meets the requirements of healthcare reform. DESIGN: This ethnographic study utilised documentary analysis, participant observation and qualitative interviewing carried out in remote areas of Greenland during 2011-2012. Eight registered nurses, four women and four men, aged between 35 and 55, participated in this study. Four were working at healthcare centres in towns and four were working at nursing stations in villages. The nurses were educated in Greenland or a Nordic country and had been practicing nursing for at least 2 years in an Arctic region. They were observed for 1-5 days, and subsequently interviewed. Interviews included in-depth questioning, based on emerging outcomes from observation. Interviews were recorded and transcribed; they were analysed within a phenomenological-hermeneutic approach. RESULTS: Nurses in rural and remote areas navigate their health promotion and preventive work with conflict between health strategies and everyday realities, where unpredictable tasks often lead to prioritisation of urgent, acute work. There is interaction between personal and professional skills. Everyday life is characterised by opportunities and challenges in the grey areas, namely nursing, medical and social work. CONCLUSION: The nature of nursing practice in rural and remote Greenland is characterised by a high degree of variability and complexity, with a requirement for a wide range of knowledge and skills. Nurses need to be better prepared with regard to acute medical care, preventive care, social work, humanistic approaches and information technology to implement the ideology of health strategies. (+info)
A pilot study to explore the feasibility of using theClinical Care Classification System for developing a reliable costing method for nursing services.
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While nursing activities represent a significant proportion of inpatient care, there are no reliable methods for determining nursing costs based on the actual services provided by the nursing staff. Capture of data to support accurate measurement and reporting on the cost of nursing services is fundamental to effective resource utilization. Adopting standard terminologies that support tracking both the quality and the cost of care could reduce the data entry burden on direct care providers. This pilot study evaluated the feasibility of using a standardized nursing terminology, the Clinical Care Classification System (CCC), for developing a reliable costing method for nursing services. Two different approaches are explored; the Relative Value Unit RVU and the simple cost-to-time methods. We found that the simple cost-to-time method was more accurate and more transparent in its derivation than the RVU method and may support a more consistent and reliable approach for costing nursing services. (+info)
Estimating patient-level nursing home costs.
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This article presents a methodology developed to estimate patient-level nursing home costs. Such estimates are difficult to obtain because most cost data for nursing homes are available from Medicare or Medicaid cost reports, which provide only average values per patient-day across all patients (or all of a particular payer's patients). The methodology presented in this article yields "resource consumption" (RC) measures of the variable cost of nursing staff care incurred in treating individual nursing home patients. Results from the application of the methodology are presented, using data collected in 1980 on a sample of 961 nursing home patients in 74 Colorado nursing homes. This type of approach could be used to link nursing home payments to the care needs of individual patients, thus improving the overall equity of the payment system and possibly reducing the access barriers facing especially Medicaid patients with high-cost care needs. (+info)
Analysis of a hospital-based stomatherapy service.
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We have analysed the activities of a hospital-based stomatherapy service between 1980 and 1983. The average numbers of patients seen per annum included 395 out-patients, 307 in-patients and 116 home visits. Of the 276 in-patients with colostomies, 72% had underlying malignant disease; 17% were performed as emergencies and 51% were temporary stomas. Hospital mortality for patients with a temporary stoma was 19% and only 59% had their temporary stoma reversed. Only 45% of colostomy patients received preoperative counselling and 11% had no regular follow-up. Complications were recorded at some stage after colostomy in 25% but only 10% required surgical refashioning. Of the 184 in-patients with ileostomies, 52% had ulcerative colitis and 41% had Crohn's disease. Only 13% of ileostomies were performed as emergencies, and only 11% were temporary. In contrast to colostomy, 83% of ileostomy patients received preoperative counselling and adequate follow-up was provided for 98% of patients. Complications were recorded in 57% of patients after ileostomy but surgical reconstruction was needed in only 18%. (+info)
Effectiveness of health checks conducted by nurses in primary care: results of the OXCHECK study after one year. Imperial Cancer Research Fund OXCHECK Study Group.
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OBJECTIVE: To assess the effectiveness of health checks by nurses in reducing risk factors for cardiovascular disease in patients from general practice. DESIGN: Randomised controlled trial. SETTING: Five urban general practices in Bedfordshire. SUBJECTS: 2136 patients receiving an initial health check in 1989-91 and scheduled to be re-examined one year later in 1990-2 (intervention group); 3988 patients receiving an initial health check in 1990-2 (control group). All patients were aged 35-64 years at recruitment in 1989. MAIN OUTCOME MEASURES: Serum total cholesterol concentration, blood pressure, body mass index, confirmed smoking cessation. RESULTS: Mean serum total cholesterol was 2.3% lower in the intervention group than in the controls (difference 0.14 mmol/l (95% confidence interval 0.08 to 0.20)); the difference was greater in women (3.2%, P < 0.0001) than men (1.0%, P = 0.18). There was no significant difference in smoking prevalence, quit rates, or body mass index. Systolic and diastolic blood pressure were 2.5% and 2.4% lower respectively in the intervention group. The proportion of patients with diastolic blood pressure > or = 100 mm Hg was 2.6% (55/2131) in the intervention group and 3.4% (137/3987) in the controls (difference 0.9% (0.0 to 1.7)); the proportion with total cholesterol concentration > or = 8 mmol/l 4.8% (100/2068) and 7.6% (295/3905) (difference 2.7% (1.5 to 4.0)); and that with body mass index > or = 30 12.4% (264/2125) and 14.0% (559/3984) (difference 1.6% (-0.2 to 3.4)). CONCLUSIONS: General health checks by nurses are ineffective in helping smokers to stop smoking, but they help patients to modify their diet and total cholesterol concentration. The public health importance of this dietary change depends on whether it is sustained. (+info)