Journal of advanced nursing
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Increasing attendances in accident and emergency (A and E) departments in the United Kingdom have been attributed to a greater number of patients presenting with minor injuries. A and E staff believe this type of patient is suitable for primary care, and is 'inappropriate' for A and E management. Thus, A and E staff find 'inappropriate' attenders time-consuming and unrewarding, and are less motivated to help them, whilst 'inappropriate' patients believe they have attended the appropriate service for their medical needs and expectations. ⋯ This is exacerbated by the unclear boundaries and roles of minor injury units, nurse practitioners and general practitioners in minor injury care. Therefore research is required into current attendances in minor injury units, A and E departments and general practice, in order to develop clear roles and boundaries for these services. More importantly, research is warranted into the attitudes of all minor injury care providers towards attending patients, and into patient perceptions of the services offered.
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This small-scale study carried out in a Melbourne metropolitan hospital explored patients' and their carers' perceptions of information, adequacy of information, and their utilization of information concerning post-discharge care received from health professionals during their stay in hospital. The research design consisted of two stages. Stage one involved a qualitative approach using focused interviews of five pairs of patients and their carers, 2 weeks after discharge from hospital. ⋯ The carers' health and employment states were often not considered in their patients' discharge plan. Carers who were present with their patients when they received information concerning post-discharge care experienced a decrease in anxiety during their patients' convalescence at home, greater satisfaction with the information they received, and their patients experienced fewer medical problems post-discharge. The implications for nursing practice and research include recommendations for a more effective system of discharge planning, and further research to include a larger population with a more varied group of participants.
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Community mental health nurses have been criticized for failing to prioritize work with people with a severe or enduring mental illness, many of whom have no contact with specialist mental health services and rely entirely on their general practitioner and primary care team. It is important to ensure that those in contact with specialist services actually need this level of input but, conversely, that those in contact with only primary care receive a service that is equipped to meet their needs. This study examines the differences between these two groups of patients. ⋯ However, patients' levels of need, unmet need and quality of life did not differ in relation to their service contact. Whilst the study provides limited evidence that community mental health nurses are targeting people with the most serious disorders, questions remain about the large proportion not receiving specialist care. Because primary care plays a significant role in the care of severely mentally ill people living in the community, the further mental health training of general practitioners and practice nurses is becoming increasingly important.
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Fracture of the neck of femur, or hip, has become common in older females and the resulting pain is often a factor in inhibiting early mobilization following surgical repair. Since the administration of analgesia is dependant upon decision-making of the nurse, this study concentrated on what influences nurses in the administration of analgesia to patients following surgical repair of a fractured hip. A review of the literature identifies the main influencing factors as nurses' lack of knowledge and the drug prescription, and suggests that education is the key enabler. ⋯ The study findings suggest that education alone will not improve the administration of analgesia. It recommends that the voice of patients is heard more clearly, that the administration of analgesia is separated from the routine drug round, that attention is paid to how decision-making by nurses is supported in clinical settings, and that education be organized on a multidisciplinary basis. In addition, further research should be carried out in the clinical setting.