Effective nursing care through researh
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    Effective nursing care through researh Effective nursing care through researh Document Transcript

    • Importance of Nursing Education Research Students are often required to participate in a specific research study in order to earn a nursing degree. As part of a nursing education, many students are required to participate in a specific research study. The opportunity for research in nursing education benefits not only the student, but also the nations nursing foundation. Increased Knowledge1. When doing research on a particular subject, nursing students have the opportunity to significantly build their base of knowledge, and the firsthand experience gives students more credibility and expertise in clinical practice. Contribution to Others2. Nursing student research also contributes to the nations overall body of knowledge, which is used to train new nurses. Without these research opportunities, the efficiency and quality of nursing care would rarely improve. Assessment3. According to the Foundation for Nursing Education, research is necessary to prove which nursing practices work effectively and which dont. Without research, a nursing education would not be based on concrete evidence. Career Trainng4. After participating in research studies, some nursing students decide to consider a career in nursing research. These students help counteract the nations significant shortage of nursing researchers. Research on Education5. In addition to research on the intricacies of nursing care, it is also necessary to study the methods used during a nursing education. Through research, teachers are able to find effective methods for educating their students on proper procedure and efficient nursing care. What is Research? Patient Safety and Quality
    • Nurses with higher education levels rate themselves ashaving more clinical expertise and are sought out fortheir guidanceDebate continues about the impact of education and experience on a nurses clinical expertise. Asurvey of registered nurses (RNs) working in hospitals in Pennsylvania reveals that more highlyeducated nurses rate themselves as having greater nursing expertise than less educated nurses.Whats more, how nurses rate their expertise correlates with how often they are selected asmentors or instructors or are consulted by other nurses for their clinical judgment. Nurses practicingin hospitals with a higher proportion of nurses with a bachelors of science in nursing (B.S.N.) weremore likely to report higher levels of expertise than nurses in hospitals with few such nurses.The researchers examined survey responses of 8,611 RNs from a 1999 survey of acute care staffworking in 182 acute care hospitals. Nurses were asked to rate their level of expertise as beginner,competent, proficient, advanced, or expert. They were also asked how often they were selected asa preceptor or consulted by other nurses for clinical judgment. Nurses were also asked to rate theirhospital environment on a variety of measures.Among the survey respondents, the average nursing experience was 13.2 years. More than a third(38 percent) held a B.S.N. degree. Most nurses (58 percent) gave themselves a rating of proficient,20 percent rated themselves as competent, and 16 percent as expert. These levels of expertisewere found to correlate with how frequently they were selected as a preceptor or asked for theirclinical judgment. Nurses with a masters degree in nursing reported having the highest level ofexpertise, followed by nurses with a B.S.N. degree and those with associated nursing degrees.Nurses practicing in hospitals with a higher proportion of B.S.N. nurses were more likely to reporthigher levels of expertise. If this proportion of B.S.N.-prepared nurses increased from 25 to 65percent, the probability of an average nurse in an average hospital reporting being an expertincreased from .10 to .16. The study was supported in part by the Agency for Healthcare Researchand Quality (HS17551).Nursing home physicians and nurses struggle withcommunication barriersNurses and physicians must communicate effectively if patients are to receive high-quality care. However,there may be barriers to effective communication in the long-term-care setting, where nurse-physicianinteraction is often done over the telephone. A recent study identified several communication barriers innursing homes, particularly related to telephone communication between nurses and physicians, that haveimportant implications for patient safety.Nurses working at 26 long-term-care facilities in Connecticut were asked to fill out a questionnaire. The 375nurses responded to questions related to openness and collaboration, logistical challenges, professionalrespect and understanding, and language comprehension. A representative sample of 21 nurses whoanswered the questionnaire were also interviewed by telephone.The communication barrier cited most often by the nurses was feeling hurried by the physician on the phone(28 percent). One-fourth of the nurses found it difficult to find a quiet location where they could make the calland 21 percent said they also had difficulty reaching the physician. Most of the interviewed nurses felt it wasimportant to be prepared properly before making the call and to be brief and to the point when talking to the
    • doctor. They also commented on how physicians were not always receptive to their calls.The researchers recommend that physicians respect the nurses more and realize that nurses know theirpatients well. Calling nurses back promptly and listening properly would also help. In turn, nurses should beprepared when they call, state what is needed from the physician, and communicate clearly. The study wassupported in part by the Agency for Healthcare Research and Quality (HS16463).Primary care nurses who convey warmth and caring enhancepatient satisfaction with carePrimary care nurses who exude warmth, positivity, energy, and capability through use of body language,gestures, facial expressions, and tone of voice enhance patient satisfaction with care, concludes a new study.University of California researchers videotaped the primary care visits of 81 nursing staff with 235 patients toassess nurses nonverbal visual and speech behaviors and their impact on patient and nurse postvisitsatisfaction, which they obtained in a postvisit questionnaire.Affective behaviors were expressed more strongly through vocal communication, and instrumental behaviors(conveying medical information or managing tasks) were revealed more strongly by visual clues.Characteristics of caring, warmth, and supportiveness appeared to contribute to patients satisfaction withnursing staff members capability and personableness. Not surprisingly, patients were less satisfied withnurses negativity and hurrying. This may reflect the pressures of limited time in medical visits and couldresult from staffing levels in primary care, note the researchers.Nursing staff members own satisfaction with the visit was related to the affective nonverbal and verbalbehavior of their patients. Pleasantness and involvement from a patient correlated substantially with nursingstaff behavior that was caring/sensitive, professional, and less hurried. In this study, more positive vocal andvisual behaviors by one were met by more positive communication from the other. The researchers suggestthat health care providers may need time to develop rapport with their patients and, ultimately, effectivecommunication may influence patients decisions to adhere to their recommended regimens. The study wassupported by the Agency for Healthcare Research and Quality (HS10922).Doctors and nurses in teaching hospitals report widespreadjob stress and sleep deprivationDespite recently mandated reductions in medical student workload hours, a new study reveals thewidespread presence of job stress and sleep deprivation among physicians and nurses in teaching hospitals.When asked to keep a running account of work activity, patient load, and work stress using handheldcomputers, physicians reported much higher levels of work stress than nurses. Both groups reported morestress during patient care activities compared with activities such as patient education, transit, orcommunication. California researchers studied 185 physicians (attending physicians, residents, and interns)and 119 nurses working in 4 teaching hospitals over an 18-month period. For one week, participantsrecorded their work activities and stress in handheld computers, whose content was sampled randomly over90-minute intervals throughout each work day. The participants also completed more than 9,500 internalsurveys on work stress during the study.Emotional stress scores among physicians were nearly 50 percent higher than those of nurses. Physiciansreported feeling less alert and more worried, tense, fatigued, unhappy, tired, upset, and stressed. Comparedwith physicians, nurses reported significantly higher levels of high physical demand and performance andlower levels of frustration. Direct and indirect care activities were associated with higher stress reports byboth groups. Approximately one-fifth of doctors and nurses sampled daily indicated 5 or fewer hours of sleepthe previous night. Lower sleep quality and quantity were predictors of higher work stress scores. Higher
    • work stress and lower sleep quality were also associated with poorer memory performance. The study wassupported in part by the Agency for Healthcare Research and Quality (HS14283). More details are in “A real-time assessment of work stress in physicians and nurses,” by Thomas Rutledge, Ph.D., Erin Stucky, M.D.,Adrian Dollarhide, M.D., and others, in Health Psychology 28(2), pp. 194-200, 2009.Performance obstacles negatively affect how ICU nursesperceive the quality and safety of care they deliverProblems with work system design in the intensive care unit (ICU) affect not only nurses workload, but alsohow nurses perceive the quality and safety of care they deliver, reveals a new study. Ayse P. Gurses, Ph.D.,of Johns Hopkins University School of Medicine, and coinvestigators surveyed 265 nurses working in 17ICUs at 7 hospitals throughout the country. Nurses were asked about 12 performance obstacles, and wereasked to respond based only on their experiences from the shift they were just completing. Performanceobstacles ranged from accompanying a patient during intrahospital transport to delay in getting medicationsfrom the pharmacy and equipment-related problems.Ten of the 12 performance obstacles were significantly associated with workload. Examples include a poorphysical work environment, dealing with too many family issues, poorly stocked patient rooms, and searchingfor patient charts. Nurses confronting these obstacles reported higher workloads, which were negativelyassociated with both perceived quality and safety of care and the quality of working life. These nurses alsosuffered higher levels of stress and fatigue.Admitting a patient to the ICU during ones shift was also associated with higher workload, even when otherobstacles were taken into account. Nurses who were female and 60 years or older reported providing higherquality and safety of care. Those working the night shift were most likely to suffer high levels of fatigue andstress. Redesigning the ICU work system to reduce performance obstacles may reduce nurses workload andquality and safety of care, suggest the researchers. Their study was supported in part by the Agency forHealthcare Research and Quality (HS14517).The rate of care quality improvement has slowed, but nursesare well-positioned to advocate for quality, equitable careThe rate of quality improvement in care has slowed. Nurses, in particular, are well-positioned to advocate onbehalf of all patients for higher quality, more equitable care. Agency for Healthcare Research and Quality(AHRQ) researchers, Karen Ho, M.H.S., and Jeffrey Brady, M.D., M.P.H., along with AHRQ director CarolynM. Clancy, M.D., summarize findings from the fifth annualNational Healthcare Quality Report and NationalHealthcare Disparities Report to underscore the slow progress in quality improvement in a recentcommentary.The reports showed that while some areas of health care made important gains, overall quality improved byan average of only 1.5 percent per year between 2000 and 2005. This took place despite ongoing effortsaround the country to improve care quality and reduce disparities.The 2007 reports showed some notable gains, such as the portion of heart attack patients who receivedrecommended tests, medications, or counseling to quit smoking, and the reduction in disparities in childhoodvaccines among blacks, Asians, and Hispanics. Measures of patient safety, however, showed an averageannual improvement of only 1 percent. These areas included how many Medicare surgery patients had notreceived timely antibiotics to prevention infection, the portion of elderly patients who had been givenpotentially harmful prescription drugs, or how many patients developed post-surgery complications.There were notable opportunities for improvement such as the lack of improvement in communication
    • between hospital patients and their physicians and nurses about new medications and discharge information,which even worsened for some age groups between 2005 and 2007. Also troubling was the lack of diversityamong the nursing workforce; nearly 82 percent of registered nurses (RNs) in 2004 were white. However, thenumber of racial/ethnic minority RNs increased threefold from 1980 to 2004 from 119,512 to 311,177.Seminars can improve nurses skills in discussing end-of-lifeissues with heart failure patients and their familiesAbout half of people diagnosed with heart failure die within 5 years, but the trajectory is unpredictable. Thus,it is important for nurses to communicate with these patients and their families about advanced planning andend-of-life issues. A new study showed that a pilot 1-hour educational seminar significantly increased theability of hospital inpatient nurses to discuss advance care issues (as self-reported 2 months later). Theseminar helped normalize the topic of dying for nurses, encouraged discussion, and validated nursesconcerns. It also modeled communication strategies and prompted shared experiences between older andyounger staff.After taking the seminar, nurses felt more confident in their ability to manage pain, shortness of breath, orrespiratory distress in heart failure patients. They also felt more competent to break bad news to patientsabout illness, to manage patients emotional suffering, and to discuss end-of-life issues with patients andfamilies. However, communicating with heart failure patients about end-of-life issues is complicated by aworkforce of relatively young nurses and doctors overly optimistic views about the prognosis of heart failurepatients.Of the 37 nurses who attended the seminar and completed a postseminar test, about one-third had a year orless of nursing experience and 58 percent had 2 to 6 years of experience. One-fifth reported that none oftheir patients had died over the past 6 months. Nurses also found it difficult to approach the topic of end-of-life care with physicians, who may not view heart failure as a terminal illness. Unlike cancer patients, heartfailure patients can have constant periods of stability or erratic functional status, periodic crises, andrecovery, yet the patient and family must cope with the threat of sudden death. The pilot study was supportedby the Agency for Healthcare Research and Quality (HS10871).Study underscores the positive impact of patient-centeredcare delivered by nurses on cancer patient outcomesA new study reveals the positive impact of patient-centered care delivered by nurses on the outcomes ofcancer patients. Desired outcomes such as optimism, a sense of well-being, and trust were more likely forpatients who received patient-centered nursing interventions (PCNIs). Laurel E. Radwin, Ph.D., R.N., ofMassachusetts General Hospital, and colleagues used factor analysis to examine the relationships betweenPCNIs (care individualization, care coordination, responsiveness, and proficiency), hospital systemcharacteristics, and patient characteristics with specific desired health outcomes for 173 hematology-oncology patients at 1 hospital. Nurse responsiveness and proficiency were positively related to patients trustin nurses.Individualization of care was positively related to patients authentic self-representation, optimism, and senseof well-being. Care coordination was positively related to patients authentic self-representation. Two healthcare system characteristics were significantly related to PCNIs and patient outcomes. Oncology nursingcertification was positively related to proficiency and oncology nursing experience was inversely related toproficiency. Both were indirectly related to patients subsequent trust in nurses. Finally, two patientcharacteristics were related to desired health outcomes. The patients rating of general health was positivelyrelated to optimism and a sense of well-being. Patient educational level was positively related to a sense of
    • well-being. Patients perceptions of PCNIs did not vary by age, gender, race, ethnicity, or educational level. Patient- centeredness of care for cancer patients may be enhanced by quality improvement activities that measure and monitor these PCNIs and resulting outcomes, suggest the researchers. Their study was supported by the Agency for Healthcare Research and Quality (HS11625). See "Relationships between patient-centered cancer nursing interventions and desired health outcomes in the context of the health care system," by Dr. Radwin, Howard J. Cabral, Ph.D., M.P.H., and Gail Wilkes, M.S., R.N., in Research in Nursing & Health 32, pp. 4-17, 2009. Hospitals vary greatly in the quality of their trauma care Patients treated in the worst-performing hospital trauma centers have a 50 percent higher chance of dying than those treated at the average-performing trauma centers, even after adjusting for severity of patient injury. Patients treated in the best-performing hospitals had a comparable reduction in risk of death. These findings from a new study suggest that hospitals vary greatly in the quality of their trauma care. Interventions to improve patient outcomes in trauma care need to be developed and tested, suggest Laurent G. Glance, M.D., of the University of Rochester Medical Center, and colleagues. Their study was based on 157,045 trauma patients admitted to 1 of 125 hospitals that contribute patient information to the American College of Surgeons National Trauma Databank (NTDB) and that treat at least 250 trauma patients each year. The NTDB also includes information on hospital characteristics (trauma certification level, number of beds, teaching status, geographic region, and whether nonprofit or for-profit) and patient characteristics (including mechanism of injury). Seventy percent of the hospitals were either Level I or Level II trauma centers, and nearly two-fifths of the hospitals had more than 400 beds. The researchers adjusted mortality outcomes for patient injury severity, age, gender, mechanism of injury, physiologic information, and whether the patient was admitted from another hospital. Topics for a Nursing Research Paper1. Study the basics of nursing in your paper. While training to enter the nursing profession, pre-service nurses are commonly required to write research papers to expand and demonstrate their understanding of topics germane to the nursing field. By selecting a high-interest topic, you can use this research paper requirement as a learning experience and build upon the knowledge of nursing that you already possess, ultimately making you a more effective and skilled nurse. Patient Care Techniques2. The primary job of a nurse is to tend to the physical and emotional needs of patients. Gather information about effective methods of meeting patient needs and report them in your research paper. Research patient care techniques in contemporary nursing journals, paying specific attention to statistics that indicate the effectiveness of each practice. Report details about what each practice entails and discuss
    • which of the options appears to be most beneficial to patients. Nurse Community Building3. Nurses commonly work closely with their peers, sharing information and building a community. Explore the characteristics of a strong nursing community. Research practices that have been proven to produce and maintain a strong community, and discuss ways in which hospitals or otherhealth facilities can integrate these practices into their daily business. Nurse Coping Procedures4. Working as a nurse can be emotionally taxing. Dealing with illness and death is a struggle for many in the healthcare profession. Gather information on ways in which nurses can effectively cope with these stressors. Discuss how nurses can cope individually as well as what hospitals can do to assist their nurses in dealing with the difficulties associated with the job. Technology in Nursing Education5. Technology has changed the process of nursing education. Now, pre-service nurses can practice the techniques as they learn them on computers and robotic simulation machines. Research the various forms of nursing education technology, and discuss how each of these technologies can assist students in better learning the skills necessary to become an effective nurse. Gather statistics that indicate the effectiveness of these technologies and discuss how the use of these technologies increases the quality of patient care. The Future of Nursing6. The practice of nursing is continually evolving. Research advancements that are being made within the field of nursing. Look for contemporary articles outlining new techniques and tools that promise to bring innovation to the field. Discuss ways in which both nurses and patients will benefit from these changes within the profession. Paint a picture of the field of nursing in the future using words, describing things that will be similar to and different from practices currently used.