Older people in the emergency department: a literature review

BACKGROUND

Emergency departments (EDs) play a unique role in healthcare systems throughout the world by providing acute interventions for older patients with acute/emergency and multiple health problems. The aim of this review was to identify studies that focused on older patients admitted to EDs and to determine the reasons for the visits.

DESIGN AND METHODS

The literature review was based on a comprehensive search of electronic databases. Inclusion criteria were original research written in English; published 2002-2012; focused on older people; reasons for ED visit; and factors that affect the discharge process and those associated with a repeat ED visit. Other literature reviews and studies unrelated to the ED context, and studies examining patients aged ≥65 years, were excluded. Content analysis was performed. Twenty-five studies were identified and critically evaluated.

RESULTS

The highest proportion of older people visited the ED because of multiple health conditions. The reasons for the visits were cardiovascular, mental health, musculoskeletal and abdominal conditions; adverse drug reactions; dermatological, neurological and respiratory conditions; poor health status; accidents; and the influence of time factors such as time of day, week or season. Factors that affected the discharge process were unresolved problems, health risk identification, aftercare instructions, medication prescribed at discharge and patient's residence before ED admission. Factors associated with repeat ED visits were sociodemographic characteristics, social problems, health problems, need for systematic health assessment, healthcare service use and inadequacy of care provided.

CONCLUSIONS

The current review showed that older people are the main population visiting EDs; important factors required for planning and providing nursing care for older people in EDs were identified. More research is needed to determine how EDs support older people and their families.

IMPLICATIONS FOR PRACTICE

The findings of the current review identified that older people visit ED quite often because of different reasons. Discharge process and repeat visits may be influenced by various factors. To ensure quality nursing care in ED nurses need to be aware why do older people visit the ED, what factors may influence discharge and what factors are associated with repeat ED visits.

Hospital nurses' working conditions in relation to motivation and patient safety

There is a lack of empirical knowledge about nurses' perceptions of their workplace characteristics and conditions, such as level of autonomy and decision authority, work climate, teamwork, skill exploitation and learning opportunities, and their work motivation in relation to practice outputs such as patient safety. Such knowledge is needed particularly in countries, such as Estonia, where hospital systems for preventing errors and improving patient safety are in the early stages of development. This article reports the findings from a cross-sectional survey of hospital nurses in Estonia that was aimed at determining their perceptions of workplace characteristics, working conditions, work motivation and patient safety, and at exploring the relationship between these. Results suggest that perceptions of personal control over their work can affect nurses' motivation, and that perceptions of work satisfaction might be relevant to patient safety improvement work.

Willingness to take care of HIV positive people: Responses from Russian nursing students

This article is a report of a study on Russian nursing students’ willingness to take care of people living with HIV or AIDS (PLWHA). HIV and AIDS are continuing to spread in Russia. Nursing students’ willingness to care for people living with HIV or AIDS is one aspect that should also be taken in consideration on this transmission situation. In total, 102 nursing students participated in the study (the response rate was 95.3%). The data were collected using the Nurse Willingness Questionnaire (NWQ) and analysed using SPSS version 15 for Windows. The study showed that nursing students’ willingness to care for PLWHA was low when asked with one general question but quite high when asked more specifically related to some nursing activities. Nursing students were more willing to perform clean nursing activities than activities with infectious risk. There is a great need for improving understanding of and proficiency in safety work with HIV-infected patients.

Is the first-line nursing managers’ power congruent with that of the nursing group?

Aim

This research examined the relationship between nursing managers’ power and nursing group power in public health service organizations.

Approach/Methods

A cross-sectional survey of first-line nurse managers ( n = 264) from 11 Finnish hospitals was conducted. The power of nurse managers and nursing groups was examined through two reliable instruments: the Nursing Managers’ Power instrument and the Sieloff-King Assessment of Group Power within Organizations instrument©.

Findings

The power of nurse managers was perceived to be moderate on a 5-point Likert scale. Managers reported that they gained the most power from their role and position as a nursing manager, and lastly, from their resources. The power of nurse managers correlated no more than moderately with nursing group power.

Implications for Nursing Management

Organizations need to ensure that nursing managers have the power and opportunity to influence nursing goals and outcomes.

Russian nursing students' knowledge level and attitudes in the context of human immunodeficiency virus (HIV) - a descriptive study

Background

The purpose of this study was to describe the knowledge of Russian nursing students regarding HIV and Acquired Immuno-Deficiency Syndrome (AIDS), and their attitudes towards caring for people/patients living with HIV or AIDS (PLWHA - People Living With HIV/AIDS) and their possible homophobic attitudes. The HIV epidemic in Russia is substantial and increasing rapidly. Hence this study provides important new information regarding this phenomenon.

Methods

The data was collected by questionnaire from students in three nursing schools (n = 102, response rate 95.3%). The data was analyzed using PASW Statistics version 18. For computing the level of the students’ AIDS knowledge, all correct answers were recorded as equal to (1), while all incorrect and “Don’t know” answers were recorded as equal to (0). Each respondent’s scores were totaled and individual scores were analyzed using regression analysis. The effect of demographic variables on the average scores of attitudes was also subjected to regression analysis.

Results

Overall, students’ knowledge level regarding HIV and AIDS was moderate (range 5–26). Of a maximum score of 33, the mean of correct answers was 19.8 (SD = 3.70). Nursing students’ attitudes were quite negative and they also demonstrated homophobic attitudes. The mean scale score for nursing students’ general attitude was 2.75, and for homophobic attitudes it was 3.3 (min = 1, max = 5). Only the background factor of gender correlated with the homophobic level demonstrated (p = .05, β = −.67). Nursing students’ overall willingness to provide care for PLWHA was associated with their attitudes (p = .003, β = −.534).

Conclusions

Given that the HIV epidemic in Russia is both substantial and increasing, it is essential to improve HIV nursing education to provide sufficient and up-to-date information about HIV and also to prepare nursing students for caring for PLWHA. In doing so, this may help to address both the deficits in student knowledge, and also modify their attitude towards PLWHA.

Leadership styles of nurse managers in ethical dilemmas: Reasons and consequences

Abstract Background: Understanding the reasons and consequences of leadership styles in ethical dilemmas is fundamental to exploring nurse managers' abilities to influence outcomes for patients and nursing personnel.

PURPOSE

To explain the associations between different leadership styles, reasons for their application and its consequences when nurse managers make decisions in ethical dilemmas.

METHODS

The data were collected between 15 October 2011 and 30 April 2012 by statistically validated questionnaire. The respondents (N = 278) were nurse managers. The data were analysed using SPSS 20.0, calculating Spearman's correlations, the Stepwise Regression and ANOVA.

RESULTS

The reasons for applying different leadership styles in ethical dilemmas include personal characteristics, years in work position, institutional factors, and the professional authority of nurse managers. The applied leadership styles in ethical dilemmas are associated with the consequences regarding the satisfaction of patients,' relatives' and nurse managers' needs.

CONCLUSIONS

Nurse managers exhibited leadership styles oriented to maintenance, focussing more on the 'doing the job' than on managing the decision-making in ethical dilemmas.

Parents' experiences of family functioning, health and social support provided by nurses--a pilot study in paediatric intensive care

OBJECTIVES

The objective of this study was to describe parents' experiences of family functioning, health and social support provided by nursing personnel, while their child was in intensive care, and to determine how social support was associated with family functioning and family health.

DESIGN

Cross-sectional study.

SETTING

The data were collected by a self-administered questionnaire from 31 parents of critically ill children from 2010 to 2011. The data were analysed statistically.

MAIN OUTCOME MEASURES

The parents considered their family functioning, health and social support provided by the nursing personnel to be good.

RESULTS

The sub-area of family functioning that rated the lowest was strengths of family, whereas the lowest rated sub-area of family health was ill-being. Child's previous hospital treatments were associated with family health. Parents, whose child had already been in hospital care, reported more well-being and less ill-being than parents with children hospitalised for the first time. Parents' education was associated with family functioning, family health and social support given by the nurses. Weak positive correlation was also found between social support given by nurses and family health experienced by parents.

CONCLUSION

There is a need to discuss how nursing care can further support parental resources.

Stories of management in the future according to young adults and young nurses

Abstract Aim: The aim of this study was to describe the phenomenon of management by way of the ideas of secondary school students and young nurses.

BACKGROUND

Young adults are changing workplaces more than ever before, yet their work expectations and perspectives of management differ to those of previous generations.

METHODS

The data was collected from upper secondary school students and professionally educated nurses (N = 68), some of whom were immigrants (N = 41). Framed essays were used as a research method and emergent data was analyzed using content analysis.

RESULTS

According to the results, good management involves systematic management, equality, appreciation of know-how, and the promotion of wellbeing at work.

CONCLUSION

New perspectives on management were drawn from the study, in particular the multiple dimensions of equality in workplace organization and the manager's role in an employee's professional development process.

IMPLICATIONS FOR NURSING MANAGEMENT

The interactive skills of the manager are emphasized in promoting wellbeing at work. This is especially so in multi-cultural teams, where the manager is expected to be adept at understanding intercultural communication and the values of young employees.

REASONS AND CONSEQUENCES OF APPLIED LEADERSHIP STYLES IN ETHICAL DILEMMAS WHEN NURSE MANAGERS MAKE DECISIONS

Abstract Background: Understanding the reasons and consequences of leadership styles in ethical dilemmas is fundamental to exploring nurse managers' abilities to influence outcomes for patients and nursing personnel. Purpose: To explain the associations between different leadership styles, reasons for their application and its consequences when nurse managers make decisions in ethical dilemmas. Methods: The data were collected between 15 October 2011 and 30 April 2012 by statistically validated questionnaire. The respondents (n=278) were nurse managers. The data were analyzed using SPSS 20.0, calculating Spearman's correlations, the Stepwise Regression and ANOVA. Results: The reasons for applying different leadership styles in ethical dilemmas include personal characteristics, years in work position, institutional factors, and the professional authority of nurse managers. The applied leadership styles in ethical dilemmas are associated with the consequences regarding the satisfaction of patients', relatives' and nurse managers' needs. Conclusions: Nurse managers exhibited leadership styles oriented to maintenance, focusing more on the "doing the job" than on managing the decision-making in ethical dilemmas.

Supporting and Sharing-Home Birth: Fathers' Perspective

The planned home birth has provoked discussion around the world. Home birth has been described as a positive experience, but results regarding the safety of home birth are controversial. To date, the phenomenon has mainly been examined from the mother's point of view, and there is only one previous study reporting fathers' perspective. The purpose of the present phenomenological qualitative interview study was to investigate fathers' experiences of planned home birth. Eleven fathers were interviewed, and the data were analyzed using Colaizzi's phenomenological method. The fathers followed the woman's wish in choosing the birthplace and set aside their own views. Furthermore, hospital birth was not an option for the fathers due to their own prior negative experiences of hospital births such as disturbing the natural progress of birth. The fathers' experience of home birth included sharing the responsibility, supporting the woman, and participating in the home birth process. The experience was challenging; fathers had to take the role of a midwife, and no support or information on organizing home birth was offered by public health services. The fathers felt that the home birth connected them as family, and the experience was empowering. Our study results suggest that the health care professionals need more education and information on home birth and that the families (including fathers) interested in home birth need greater support from health care professionals. There is a need for proper national home birth guidelines, while family-and client-centered care has to be improved in birthing hospitals.

Views of Luba-Kasai Men, Zambia, about Prevention of HIV Transmission to Babies

OBJECTIVE

This study describes the views of Luba-Kasai men (a Congolese tribe living in Lusaka Province, Zambia) about different methods through which they can prevent their babies from being exposed to human immunodeficiency virus (HIV) infection during pregnancy, delivery and feeding.

DESIGN AND SAMPLE

Individual semi-structured interview study with a sample of Luba-Kasai refugee men (n = 21).

MEASURES

Data were translated into English and analyzed using content analysis.

RESULTS

Two methods of prevention emerged: (1) Outside support (pastoral support, e.g., maintaining a spiritual outlook on life, and support from the public health service); and (2) Adopting safe practices around their own and their families' lifestyle.

CONCLUSION

Additional attention to male participation in antenatal clinics may strengthen prevention of mother to child transmission of HIV.

Stories of management in the future by young adults and young nurses

Abstract Aim: The aim of this study was to describe the phenomenon of management by way of the ideas by secondary school students and young nurses. Background: Young adults are changing workplaces more than ever before, yet their work expectations and perspectives of management differ to those of previous generations. Methods: The data was collected from upper secondary school students and professionally educated nurses (n = 68), some of whom were immigrants (n = 41). Framed essays were used as a research method and emergent data was analysed using content analysis. Results: According to the results, good management involves systematic management, equality, appreciation of know-how, and the promotion of wellbeing at work. Conclusion: New perspectives on management were drawn from the study, in particular the multiple dimensions of equality in workplace organization and the manager's role in an employee's professional development process. Implication for nursing management: The interactive skills of the manager are emphasized in promoting wellbeing at work. This is especially so in multi-cultural teams, where the manager is expected to be adept at understanding intercultural communication and the values of young employees.

Luba-Kasai Men and the Prevention of Mother to Child Transmission (PMTCT) of HIV program in Lusaka

Male participation in the prevention of mother-to-child transmission (PMTCT) of HIV has been determined as one of the key factors in sub-Saharan African countries, but its realization is challenging because of male-related and institutional factors. The purpose of this study is two-fold: first, we explored the views of Luba-Kasai men, living in Zambia in the Lusaka Province, on the factors that encourage, inconvenience or inhibit them in accompanying their wives to the antenatal clinic and their ideas to improve their experience. Secondly, the study considered their knowledge of the PMTCT program and how such knowledge conformed to the Zambian National Protocol Guidelines Integrated PMTCT of HIV /: AIDS. Twenty-one interviews were analyzed using qualitative inductive content analysis. The National Protocol Guidelines Integrated PMTCT of HIV/AIDS were analyzed using the deductive content analysis. The encouraging factors that emerged were involvement in the program, the time of delivery, love and care, and also the suspicion of corruption. The inconveniencing factors were the arrangements and working culture of the clinic, together with stigma and guilt. A lack of motivation, fear of death, socioeconomic circumstances and again the arrangements and working culture at the clinic were held as inhibiting factors. The ideas to remove inconvenient factors were maintaining a spiritual outlook on life, education, interaction, a good mood and a sense of meaningfulness. Considering such male views and paying attention to minorities in the development of national PMTCT of HIV Programs may enhance male participation in the process.

Continuity of care in day surgical care - perspective of patients

BACKGROUND

The realisation of continuity in day surgical care is analysed in this study. The term 'continuity of care' is used to refer to healthcare processes that take place in time (time flow) and require coordination (coordination flow), rapport (caring relationship flow) and information (information flow). Patients undergoing laparoscopic cholecystectomy or inguinal hernia day surgery are ideal candidates for studying the continuity of care, as the diseases are very common and the treatment protocol is mainly the same in different institutions, in addition to which the procedure is elective and most patients have a predictable clinical course.

AIM

The aim of the study was to describe, from the day surgery patients' own perspective, how continuity of care was realised at different phases of the treatment, prior to the day of surgery, on the day of surgery and after it.

METHOD

The study population consisted of 203 day surgical patients 10/2009-12/2010 (N = 350, response rate 58%). A questionnaire was developed for this study.

RESULTS

Based on the results, the continuity of care was well realised as a rule. Continuity is improved by the fact that patients know the nurse who will look after them in the hospital before the day of surgery and have a chance to meet the nurse even after the operation. Meeting the surgeon who performed the operation afterwards also improves patients' perception of continuation of care.

CONCLUSIONS

Continuity of care may be improved by ensuring that the patient meets caring staff prior to the day of operation and after the procedure. An important topic for further research would be how continuation of care is realised in the case of other patient groups (e.g. in internal medicine). On the other hand, realisation of continuation of care should also be studied from the viewpoint of those taking part in patient care in order to find similarities/differences between patients' perceptions and professionals' views. Studying interventions aimed to promote continuity of care, for example in patient guidance, would also be of great importance.

Altered expression and splicing of Ca(2+) metabolism genes in myotonic dystrophies DM1 and DM2

AIMS

Myotonic dystrophy types 1 and 2 (DM1 and DM2) are multisystem disorders caused by similar repeat expansion mutations, with similar yet distinct clinical features. Aberrant splicing of multiple effector genes, as well as dysregulation of transcription and translation, has been suggested to underlie different aspects of the complex phenotypes in DM1 and DM2. Ca(2+) plays a central role in both muscle contraction and control of gene expression, and recent expression profiling studies have indicated major perturbations of the Ca(2+) signalling pathways in DM. Here we have further investigated the expression of genes and proteins involved in Ca(2+) metabolism in DM patients, including Ca(2+) channels and Ca(2+) binding proteins.

METHODS

We used patient muscle biopsies to analyse mRNA expression and splicing of genes by microarray expression profiling and RT-PCR. We studied protein expression by immunohistochemistry and immunoblotting.

RESULTS

Most of the genes studied showed mRNA up-regulation in expression profiling. When analysed by immunohistochemistry the Ca(2+) release channel ryanodine receptor was reduced in DM1 and DM2, as was calsequestrin 2, a sarcoplasmic reticulum lumen Ca(2+) storage protein. Abnormal splicing of ATP2A1 was more pronounced in DM2 than DM1.

CONCLUSIONS

We observed abnormal mRNA and protein expression in DM affecting several proteins involved in Ca(2+) metabolism, with some differences between DM1 and DM2. Our protein expression studies are suggestive of a post-transcriptional defect(s) in the myotonic dystrophies.

Male involvement and prevention of mother-to-child transmission of HIV in Sub-Saharan Africa: an integrative review

PURPOSE

The purpose of the study was to describe male involvement in programmes for preventing mother-tochild transmission (PMTCT) in Sub-Saharan Africa. The study questions guiding this review were: how are male partners involved in PMTCT programmes in Sub-Saharan Africa and what are the strategies for improvement of male involvement?

METHODS

An integrative review was conducted based on the data retrieved from the PubMed MEDLINE database. In all, 18 articles were included in this review. Qualitative content analysis was used as a method of data synthesis.

FINDINGS

Based on the findings of this review, some studies suggested that men had positive attitudes towards PMTCT programmes. However, also barriers to male involvement were identified. These barriers included negative attitude, lack of resources, fear of human immunodeficiency virus (HIV) test result, marital difficulties, problems with health care services and cultural barriers. Accepting HIV testing was associated with factors related to both wife and husband. Strategies for improving male involvement included ones that focus on men's and their wives' resources (sensitizing men about antenatal care (ANC) and PMTCT, focusing on the conjugal context and couples counselling), the development of health care services (tailoring the services to male needs, taking care of health care staff's resources, developing health care strategies) and the community (educating the community, testing, safer infant feeding).

IMPLICATIONS

We should highlight the male participation in PMTCT programmes. However, more research is needed in order to evaluate their impact on PMTCT, as well as on broader family health outcomes.

Graduating nursing students' basic competence in intensive and critical care nursing

AIMS AND OBJECTIVES

To describe and evaluate the basic competence of graduating nursing students in intensive and critical care nursing.

BACKGROUND

Intensive and critical care nursing is focused on severely ill patients who benefit from the attention of skilled personnel. More intensive and critical care nurses are needed in Europe. Critical care nursing education is generally postqualification education that builds upon initial generalist nursing education. However, in Europe, new graduates practise in intensive care units. Empirical research on nursing students' competence in intensive and critical care nursing is scarce.

DESIGN

A cross-sectional survey design.

METHODS

A basic competence scale (Intensive and Critical Care Nursing Competence Scale, version 1) and a knowledge test (Basic Knowledge Assessment Tool, version 7) were employed among graduating nursing students (n = 139).

RESULTS

Sixty-nine per cent of the students self-rated their basic competence as good. No association between self-assessed Intensive and Critical Care Nursing-1 and the results of the Basic Knowledge Assessment Tool-7 was found. The strongest factor explaining the students' conception of their competence was their experience of autonomy in nursing after graduation.

CONCLUSION

The students seem to trust their basic competence as they approach graduation. However, a knowledge test or other objective method of evaluation should be used together with a competence scale based on self-evaluation.

RELEVANCE TO CLINICAL PRACTICE

In nursing education and in clinical practice, for example, during orientation programmes, it is important not only to teach broad basic skills and knowledge of intensive and critical care nursing, but also to develop self-evaluation skills through the use of special instruments constructed for this purpose.