A sampling study of bedside nursing activity in a cardiac surgical intensive care unit. Part 2. The effect of time and shift on the nursing workload.

For a selected group of 17 patients following cardiac surgery, 33 discrete elements of nursing workload have been defined, and the nurse's bedside activities logged at 1 min intervals throughout the 24 h immediately following the patient's return from the operating theatre. It is possible to identify three broad types of activity undertaken by the bedside nurse; technical nursing care (Type 1), intermittent nursing care (Type 2), and the balance of the nurse's time, largely concerned with observation and liaison with other staff--learning activities (Type 3). The time devoted to technical nursing care reduces significantly over the patient's first 24 h in the ward. On the other hand the time devoted to intermittent nursing care and learning activities is shown to be shift dependent. The effect of the efficient utilisation of computer technology is estimated, and it is demonstrated that the implementation of such technology would result in the expansion of the time available for the nurse to observe the patient. The potential benefits and drawbacks of this are discussed.

An integrated system for patient assessment and classification and nurse staff allocation for long term care facilities.

An integrated approach to patient classification and nurse staffing for long term care facilities is constructed, based on the quantification of patient care needs as reflected by formal assessment of a variety of key functioning status items, behavioral status indicators, and medically defined conditions. Nonlinear multiple regression techniques are employed in order to cluster these key assessment indicators in to an easily applied level of care classification method that can be used to determine placement of patients within the long term care system and to indicate the particular nursing care activities called for. Given the classification of patients into the various levels of care required (e.g., Chronic, Skilled Nursing Care, Intermediate A or B) a mixed integer/linear programming model is used to permit presentation of alternative nurse staffing strategies within a long term care facility or program. Extensions to the model portray the effects of changing budgetary, service, and legal restrictions.

Preoperative nursing planning in pediatric tracheotomy.

Tracheotomy may be necessary in the treatment of severe, prolonged illness or airway obstruction. The preoperative nursing care plan is developed to meet the physical needs of the child as well as provide essential information and emotional support to the child and family. Comprehensive attention to all aspects of care needs in the preoperative period assists in the provision of optimum nursing care during the hospital stay and after discharge.

The development of a classification system for nurses' work methods.

This study describes the development of a classification system for the clarification, understanding and measurement of nurses' work methods. The theoretical basis of the classification system is described. The system offered distinguishes between three common work methods: primary, team and task nursing; the strength of opportunity for nurse-patient interaction in each method being determined as either 'strong', 'moderate' or 'weak', according to how effectively they are practised. Preliminary testing of the system on 32 wards in 13 hospitals is described. It is concluded that further testing and possible refinement is required for validation of the system.

Determining the use of physical assessment skills in the clinical setting.

This study examined the clinical application of physical assessment skills by baccalaureate nurses. Fifty-nine pediatric staff nurses practicing in two different hospitals in Southern California completed a questionnaire which surveyed how frequently assessment skills were utilized and what deterrents, if any, inhibit their use. Approximately one-third of the 36 skills listed were utilized daily by at least 74% of the participants, and respondents selected a variety of deterrents to the utilization of other skills. There was no significant difference in the utilization of skills between nurses who had taken a separate course in physical assessment and those from an integrated curriculum.

Nursing's role in health promotion. An overview.

This article presents health promotion as a basic concept for nursing practice. Since the era of Nightingale, health promotion has continued to be a major focus for nursing as is reflected in the American Nurses' Association (ANA) Social Policy Statement. The major focus of this article is nursing's role in health promotion in such areas as assessment, advocacy, case management, promotion of self-care, and client education. Major societal changes that are expected to have an impact on health promotion in the near future are also presented.

Strategies for promoting health protection.

There is a need for nurses to be involved in testing and refinement of conceptual models for health protection. Development and testing of strategies should occur in all age groups and in a variety of cultural and socioeconomic groups in public and private settings. These strategies need to be evaluated and published.

Adult education. The cornerstone of patient teaching.

Patient teaching is necessary for good nursing care. Nurses cannot learn for patients, but they can facilitate learning by incorporating concepts of adult education into their teaching. Both the educational and nursing processes are based on the steps in the problem-solving approach: assessing, planning, implementing, and evaluating. Special attention to assessment and evaluation are necessary to achieve the desired change in behavior.

Nursing diagnoses and interventions with the acute stroke patient.

The multiple and complex needs of the stroke patient may best be managed by thorough nursing assessment, precise interpretation of clinical signs and symptoms, and identification of individualized nursing diagnoses, etiologic factors, desired outcomes, and nursing interventions. A strong knowledge base of neuroanatomy and cerebral blood flow, together with skillful use of the nursing process, will help the nurse meet the challenge of caring for these complex patients in the acute phase.

Elder-family caregiver relationships. Determining appropriate nursing interventions.

Providing excellent care to elders involves more than the nurse's ability to minister to them; it is dependent on nurses' focusing assessment and intervention on the elder-caregiver dyad. Only by planning nursing care within the context of the dyad and considering the needs of the elder, the caregiver, and the unit, is it possible for nursing to realize its potential for improving the care of all elderly clients.

Nursing assessment and nursing diagnosis in patients with peripheral vascular disease.

Effective nursing interventions are determined by the nursing diagnoses and associated etiologies. The diagnoses are derived from a complete data base that results from a thorough assessment. As the nurse proceeds through the process of differentiating among diagnoses, the focused cue search is essential. For the client with PVD, lifestyle changes, symptomatology, chronicity of the disease, and frequent contact with the health care system are the major influences on the diagnoses. These clients are likely to have potential for injury, potential for infection, impaired skin integrity, activity intolerance, alteration in tissue perfusion, alteration in comfort, and knowledge deficit. Other diagnoses are probable but are determined by the unique characteristics of each client.

Nursing diagnosis of depression.

To summarize, based on a sample of six subjects who were depressed, 12 nursing diagnoses were identified. Five of the 12 diagnoses occurred in more than one subject. Criteria for making a diagnosis were specified, and the diagnoses and their defining characteristics were examined for principles of classification.

Balancing workload and staffing in satellite pharmacies by using a patient acuity index.

The assignment of beds to satellite pharmacies is based primarily on proximity. Assignment will usually be by nursing unit to encourage more effective communication among the patient, doctor, nurse, and pharmacist. Usually, an equal number of beds is assigned to each satellite. Recognizing that some nursing units (e.g., Intensive Care Units) place greater demands on pharmacy resources than others makes it obvious that there is a need for a system to measure the consumption of pharmacy resources by patient acuity. This article tells how such a measure was conceived, developed, and applied.

Assessing recurrent abdominal pain in children.

Recurrent abdominal pain is a frequent complaint of school-aged children. In 5-10 percent of the cases, RAP is the result of organic disease. Specific history and physical assessments are needed to detect organic disease. The assessment tool described in this article is a functional adjunct to a nurse practitioner's evaluation of RAP as well as of other recurrent pain. It provides additional information to identify less obvious organic causes and serves as a basis for involving the patient in development of a treatment plan.

Elder abuse screening and intervention.

Elder abuse and neglect are forms of family violence, a growing societal concern. Estimates suggest that 500,000 to 1.5 million cases of abuse and neglect occur annually in this country. This article describes the nurse practitioner's legal liability for reporting suspected cases of elder abuse and neglect. In addition, specific screening guidelines for this problem are outlined. Assessment parameters for evaluating suspected cases of elder abuse are described.

[The nursing care of patients with a behavioral manifestation arising from a withdrawal from reality]. / Assistência de enfermagem a pacientes com manifestação de comportamento decorrente de alheamento da realidade.

With this study the authors want to furnish the nurses with one more reference source to guide their actions in caring for the patient with manifestation of reality withdrawal. Some concepts of withdrawal are presented and, summarily, the clinical manifestation. Nursing care is described considering their problems and general measures to be taken into account for patients individuality.

[Nursing care for the mother-child dyad--the attitude of undergraduate nursing students]. / Assistência de enfermagem ao binômio mãe-filho--opinião de alunos de graduação em enfermagem.

This study was carried out to verify the undergraduate students opinion about their experiences in nursing assistance to new born baby and the postpartum woman in separated and integrated ways. The factors investigated were opportunity for education, interation, teaching value in the fifth semester and its contribution to the community.

[Invasive procedures and complications in patients with craniocerebral trauma hospitalized in an intensive therapy unit]. / Procedimentos invasivos e complicações em pacientes com traumatismo crâneo-encefálico internados em unidade de terapia intensiva.

The present study realized with 50 patients from an Intensive Care Unit, due to head injury and considering that the majority of them presented a score equal or below six (6) in the Glasgow Coma Scale, has shown that the utilization of invasive procedures is high. Regarding complications, there was predominance of fever, upper airway secretions, hematomas at the arterial puncture localization and diarrhea. Proportionally, the patients under a clinical treatment presented a lower number of invasive procedures and problems and the reverse occurred with those under surgery. The analysis of the association of the invasive procedures and problems compared to the level of consciousness has been affected.