International reflections on knowledge and use of the mirror in nursing practice

TOPIC

There are no guidelines on the use of the mirror with patients in nursing practice. Nurses have used their experiences, personal preferences, and best-guess practice models when to offer a mirror.

PURPOSE

This international study provides insight into the current knowledge and uses of the mirror in nursing practice and, as such, provides a small foothold toward understanding the mirror as a multidimensional nursing tool.

SOURCE OF INFORMATION

Ten healthcare providers from eight countries (South Africa, Egypt, Japan, the Netherlands, Panama, Russia, Singapore, and the United Kingdom) took part in semistructured questionnaire conversations via email. Thematic analysis was performed on the data.

CONCLUSIONS

The results suggest the use of the mirror has a place in shaping nursing practice and is currently being used in nursing practice. Mirrors appear to be lacking in hospital environments. There is no known research to guide the nurse in the appropriate type of mirror to have in a hospital or any other healthcare environment.

Complexity compression, the tipping point for nurses in the practice environment: an interview with Lynn Jaycox. Interviewed by Alice P. Weydt

A participant in a study of complexity compression conducted by the Minnesota Nurses Association and the University of Minnesota School of Nursing discusses how nurses cope with the increased complexity of client needs and systems of care, and with the increasing demands from both.

Effectiveness of an intervention to improve the documentation required for diagnosis of metabolic syndrome in clinics serving African-American patients

BACKGROUND AND AIMS

The metabolic syndrome (MetS) is a clustering of cardio-metabolic risk factors for cardiovascular disease. It is important to identify individuals with the MetS early and initiate interventions long before adverse conditions occur. Our previous studies found that missing or incomplete data that should be entered into the electronic health record (EHR) by nursing staff could lead to the under-diagnosis of the MetS. This study aimed to determine whether a five-component intervention to improve EHR data entry would increase the completeness of data, particularly height, weight, and blood pressure, needed to diagnose the MetS.

DESIGN

Quasi-experimental design with pre-test, intervention, and post-test sessions.

SETTING

Two family medicine residency training clinics serving mainly African-American patients in Atlanta, Georgia, United States.

SUBJECTS AND METHODS

Four nurses and four certified medical assistants attended pre-test, intervention, and post-test sessions. Data of 279 patients at pre-test and 246 patients at post-test were collected and analysed. The pre-test and post-test data completion rates of data entry were compared using rates and Wald chi(2)-test.

MAIN OUTCOME MEASURES

Rate of patients with information documented in the EHR on blood pressure, weight, and height at pre-test and post-test.

RESULTS

There was a statistically significant increase in the recording of height from pre-test to post-test (46.6% versus 96.7%, P <0.001) and the recording of blood pressure from pre-test to post-test (96.8% versus 99.2%, P <0.05).

CONCLUSIONS

The intervention led to an improvement in the entry of pertinent EHR data among nurses and medical assistants in this primary care setting. This increase improved the ability to identify patients who met the criteria for the MetS.

Reducing the risk of needlestick injury

The increase of incident reporting in hospitals in recent years, and the way these incidents are dealt with, have contributed to patient safety becoming one of the hot topics of the early 21st century. An important and necessary issue to tackle, yes, but has the safety of nurses been cast aside in the pursuit of patient safety?

Successful AV fistula creation does not lead to higher catheter use: the experience by the Northwest Renal Network 16 Vascular Access Quality Improvement Program. Four years follow-up

BACKGROUND

In 2002, the Center for Medicare and Medicaid Services (CMS) required all 18 Renal Networks to participate in a Vascular Access Quality Improvement Program (QIP). The Northwest Renal Network (NWRN 16) chose to increase arteriovenous fistula (AVF) use. NWRN 16 hypothesized that strategies which targeted the improvement of AVF rate and the reduction of catheter use were the same. In December 2001, 44.2% of hemodialysis (HD) patients in the NWRN 16 received HD using an AVF which met the Dialysis Outcome Quality Initiative (K/DOQI) 40% AVF guideline for prevalent patients. However, 43% of HD facilities (2869 patients) had less than 40% of AVF and higher HD catheter rates than the average Network catheter rates (25.0 vs. 20.3%). To address the needs of underperforming facilities, NWRN 16 provided education and tools for their vascular access decision makers to promote AVF creation and catheter reduction.

METHODS

In 2002, NWRN 16 sponsored four regional workshops targeted at nephrologists, vascular surgeons, HD nurses, and interventional radiologists.

RESULTS

Percentage of AVFs in use in invited facilities increased from 31.3% pre-intervention to 56.2% at 4 yrs: 78% increase (99% confidence interval: 77.8% to 81.5%). Percentage of catheters increased from 25% to 25.8%: 3.2% change over 4 yrs (99% confidence interval: 2.5% to 4%).

CONCLUSION

The success of Network 16's AVF interventions demonstrates the effectiveness of Network education promoting multidisciplinary teamwork, and innovative strategies to increase dramatically AVF use without substantial increase in catheter use.

Nurses' stories: discovering essential nursing

Stories help nurses share their nursing culture. They reveal the nature of nursing work, including its challenges, uniqueness, and privileged place. Stories are worth telling and recording, not only to supply material for research but also to help nurses better understand their lives at work.

Mastering the art of politics

As a long-term political relationship matures, the nurse's scope of influence with the legislator generally grows and mutual respect ensues. In the best relationships, legislators seek the opinion of nurses on health care questions and ask them to share their expertise at informal meetings or through formal testimony at a policy committee hearing. When possible, backing friendly legislators from either party during their re-election bids places nurses in a proactive rather than a reactive relationship with legislative policymakers. Alliances-are further developed when nursing organizations endorse legislators who have taken pro-nursing stances on important issues. Nurses or nursing groups that take the initial step toward involvement in the political process are the ones who will influence the future of nursing and health care policy. Visionary nurses throughout the past century helped establish nursing as a professional discipline. They were risk takers with a dream and acted for the betterment of nursing. We should still heed the advice of one of these prominent visionaries, Florence Nightingale, who said: The progressive world is necessarily divided into two classes--those who take the best of what there is and enjoy it--those who wish for something better and try to create it. Without these two classes, the world would be badly off. They are the very conditions of progress, both the one and the other. Were there none who were discontented with what they have, the world would never reach anything better (Nightingale, 1860/1979, p. 29). You need to seize the moment, be risk-takers, become politically-savvy nurses and make a difference in the profession of nursing and, more importantly, the lives of the patients who are entrusted to your care!

Research activity and evidence-based practice within DNA: a survey

In this survey, research awareness and capacity within the Dermatology Nurses' Association (DNA) was investigated to inform the organization's development in both the use of research evidence to improve practice and the capacity to undertake research. The majority of respondents (almost 90%) indicated they were DNA members. Of the remaining respondents who did not answer this question, we could not be clear on their status and so decided not to separate member and non-member responses during analysis.

Operating room management: why, how and by whom?

Operating room (OR) is a cost-intensive environment, and it should be managed efficiently. When improving efficiency, shortening case duration by parallel processing, training of the resident surgeons, the choice of anesthetic methods, effective scheduling, and monitoring of the overall OR performance are important. When redesigning the OR processes, changes should be given a clear target and the achieved results monitored and reported to everyone involved. Advanced, reliable, and easy to use information technology solutions for OR management are under development. Pre-operative clinic and functionally designed facilities support efficiency. OR personnel must be kept motivated by clear management and leadership, supported by superiors.

Nurses' perceived knowledge, beliefs, skills, and needs regarding evidence-based practice: implications for accelerating the paradigm shift

BACKGROUND

The paradigm shift to evidence-based nursing practice in the United States has been slow. Although multiple barriers to evidence-based practice (EBP) have been identified through prior studies, there is a gap in the literature specifically identifying key variables (e.g., belief that EBP produces quality outcomes) that are correlated with the extent to which nurses engage in EBP.

AIM

The primary aims of this study were to (1) describe nurses' knowledge, beliefs, skills, and needs regarding EBP; (2) determine whether relationships exist among these variables; and (3) describe major barriers and facilitators to EBP.

METHODS

A descriptive survey was conducted with a convenience sample of 160 nurses who were attending EBP conferences or workshops in four states located within the Eastern Region of the United States.

RESULTS

Although participant beliefs about the benefit of EBP were high, knowledge of EBP was relatively low. Significant relationships were found between the extent to which the nurses' practice is evidence-based and (1) nurses' knowledge of EBP, (2) nurses' beliefs about the benefits of EBP, (3) having an EBP mentor, and (4) using the Cochrane Database of Systematic Reviews and the National Guideline Clearinghouse.

CONCLUSION AND IMPLICATIONS

Health care systems need to implement interventions that not only increase nurses' EBP knowledge and skills, but also strengthen their beliefs about the benefit of evidence-based care. EBP mentors may be key in accelerating a more rapid shift toward evidence-based nursing practice. Theoretically driven randomized controlled trials are urgently needed to test the effectiveness of interventions on advancing evidence-based care.

Case management by nurses in primary care: analysis of 73 'success stories'

BACKGROUND

There is interest as to whether case management reduces unplanned patient admission to hospital. However, very little is known about how the intervention is delivered and what the most salient outcome measures are.

DESIGN

Qualitative study embedded in a wider evaluation.

SETTING

Primary health care.

METHOD

Analysis of case manager case reports in a service innovation evaluation study.

RESULTS

Case management provides home-based care to frail elderly patients using a process of assessment and medication review. This often leads to new diagnoses, to the co-ordination of further care and the tailoring of services to suit the needs of individuals. The benefits reported are complex and relate to improving a patient's quality of life more than the prevention or otherwise of admission to hospital. The type of attention provided by these roles seems to be absent from current NHS arrangements. The role enables time to be spent assessing the individual needs of patients who live at the margins of independent living.

CONCLUSION

The case managers describe having the time and the skills to assess a mix of clinical and social problems, and then accessing the correct networks to help elderly people with multiple illnesses navigate a complex system of providers. More weight should be given to the ability of this intervention to result in improved quality of life for patients, and to the investigation of costs and benefits.