Advice nursing practice: on the quality of the evidence

Self-reported activities and outcomes of ambulatory care staff registered nurses: an exploration

CONTEXT

Ambulatory care is a growing field of nursing practice. As ambulatory registered nurse (RN) practice grows, there has been an ongoing effort to identify the desired role of the staff RN in outpatient care and to provide linkages to preferred outcomes.

OBJECTIVE

This study sought to describe the perceived impact of components of the staff RN role on specific activities and outcomes, as guided by the structures, processes, and outcomes of the Nursing Role Effectiveness Model.

DESIGN

This exploratory research study used a descriptive, self-report survey design.

RESULTS

Survey respondents were ambulatory care staff RNs from various primary and specialty care clinics (n = 187) in an integrated health care organization in Southern California. The most frequently reported activities included patient assessment, nurse advice during message management, and completion of patient triage. Reported patient outcomes most frequently affected by RN activities were patient satisfaction, normalization of laboratory values, receiving the correct level of medical treatment, and prevention of complications. Respondents expressed that "emergency situations" periodically occur in the ambulatory setting.

CONCLUSIONS

This research study supports what ambulatory care RNs say they are doing: daily, diverse, and complex patient care activities that influence multiple relevant patient outcomes. Future research studies could reveal best practices related to message management, in addition to activities and outcomes unique to specialty care populations.

Measuring the dose of nursing intervention

PURPOSE

To increase awareness of the many issues involved in measuring the dose of nursing intervention in nursing interventions effectiveness research.

METHODS

Identify critical issues in measurement of the dose of nursing intervention and discuss decisions regarding dosage measurement made in a study of the effectiveness of nursing interventions.

FINDINGS

A single method can be applied to resolve two critical issues in intervention dosage measurement.

CONCLUSIONS

Those conducting nursing interventions effectiveness research must think explicitly about how intervention dosage will be measured and reported so that dosage can be replicated in research and practice.

PRACTICE IMPLICATIONS

Measuring and reporting the dose of nursing intervention in research is essential to the development of an evidence base adequate to support practice.

Impact of a continuing education activity on the quality of telephone interventions by nurses in an adult asthma client base

The objectives of this study were to evaluate the effect of a continuing education activity on the clinical evaluation and advice provided by nurses working for a telephone triage service with an asthmatic client base, and to measure the number of referrals to Asthma Education Centers (AECs). The results suggest a positive impact on the quality of the telephone intervention in the short term, but this was not sustained over time. Few patients were referred to an AEC.

Use of a community sexual health information line

BACKGROUND

Since 1989 Sydney Sexual Health Centre has provided a community phone information line (PIL). The service aims to educate and promote the sexual health of the community and facilitate efficient use of the centre's resources through the provision of information and advice to the community and health professionals; a referral service; and patient triage. In October 1997 a comprehensive computerised database was developed to collect caller information. In 2003, a 5-year review of the PIL database was undertaken with the express aim of describing the profile of people using the service.

METHODS

We analysed data from the PIL from 16 October 1997 to end 20 December 2002 using SPSS.

RESULTS

A total of 34,013 callers were in the PIL database. Every year the service has seen an increase in demand from 5295 calls in 1998 (first full year of service) to 8401 in 2002. The majority of callers lived in central and southeast Sydney geographical area, however, calls were registered from over 55% of postcodes in NSW and from interstate. The average caller age each year was 32 years with similar standard deviation and the distribution over time has not changed. There were equal numbers of male and female callers each year. Peak times for people to call the PIL were 2-4 pm with a high number of callers at 10 am. In general, calls were between 4 and 6 min duration. Overall, 14,098 (41.4%) of calls in the database were for general sexual health information. The majority of the information callers over the period who have been calling about infections have called about herpes simplex virus.

CONCLUSIONS

As is evident the PIL meets a specific community need. This study did not, however, look at patient outcomes and this area needs investigation to fully evaluate the benefits of a community PIL.