Journal of advanced nursing
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This paper uses the experiences of a programme designed to bring about change in performance of public health nurses (health visitors and school nurses) in an inner city primary care trust, to explore the issues of professional and organizational change in health care organizations. ⋯ Using a Complex Adaptive Systems approach was helpful for developing alternative views of change and for understanding why and how some aspects of change were more successful than others. Its use encouraged the confrontation of some long-standing assumptions about change and service delivery patterns in the National Health Service, and the process exposed challenging tensions within the Service. The consequent destabilising of organizational and professional norms resulted in considerable emotional impacts for practitioners, an area which was found to be underplayed within the Complex Adaptive Systems literature. A Complex Adaptive Systems approach can support change, in particular a recognition and understanding of the emergence of unexpected structures, patterns and processes. The approach can support nurses to change their behaviour and innovate, but requires high levels of accountability, individual and professional creativity.
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This paper reports a study describing Chinese nurses' use of non-pharmacological methods for relieving 6- to 12-year-old children's postoperative pain and factors related to this. ⋯ While Chinese nurses used versatile non-pharmacological methods in school-aged children's postoperative pain relief, there remains a need for more education about pain management and for more frequent use of these methods in clinical care.
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This paper reports an experimental study to determine whether giving 100% oxygen for 1 minute before and after closed suctioning is required. ⋯ In patients who did not receive 100% oxygen before and after closed suctioning, no significant falls in partial oxygen pressure and oxygen saturation were seen. A small number of patients were hypoxaemic before suctioning, and not [corrected] giving 100% oxygen might be deleterious for this category.
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This paper reports a study of patients' current practice with continuous subcutaneous insulin infusions, particularly with respect to the management of the pump. ⋯ Patients having long-term continuous subcutaneous insulin infusion should be carefully audited with respect to the management of the insulin pump and its accessories. In patients who frequently experience problems, shorter intervals between changes of infusion sets are strongly advocated and type of insulin preparation may be of importance in some cases.
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This paper reports a study exploring willingness to use home care nursing services among older people and discussing the implications for long-term and home care nursing policies. ⋯ Co-payment guidelines for minimizing unmet needs are required, especially for older people with low incomes. A positive evaluation from those who knew about or had used such services is expected to contribute to the use of home care nursing services by older people.