Journal of advanced nursing
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Older people are an increasing user group at accident and emergency departments and often have complex needs over and above the clinical cause of attendance. Few studies to date appear to have focused specifically on older people's re-attendance at such departments following direct discharge. However, these few studies conclude that incomplete staff assessment of older people's needs in this setting may play a part in reasons for re-attendance and recommend that further research is needed in this area. ⋯ Improving practice in relation to social and functional assessment and raising staff awareness concerning older people's potential needs seem important in accident and emergency departments. With little research identified to date into re-attendance, further research on this issue is recommended.
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The use of protocols during weaning from mechanical ventilation is uncommon in the UK, despite research pointing to their potential benefits. This may be because the research evidence is considered not to apply in different settings. Intensive care unit consultant physicians are the major decision-makers in weaning in the UK and any attempt to introduce protocolized weaning will require consideration of their views. ⋯ Although local physicians were supportive in theory, introduction of protocolized weaning is likely to be difficult because of the breadth of information required for successful decision-making. Consultant views in this study were not consistent with American findings that physicians' caution may unnecessarily prolong weaning.
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Nursing knowledge is a composite of many influences. In an attempt to strengthen nursing knowledge and practice, there have been significant developments in the codification of nursing knowledge as part of the evidence-based practice movement. Using established research techniques; this has the capacity to enhance clinical practice. However, not all knowledge can be incorporated into this type of academic discourse, and there is growing interest in narrative knowledge. This paper contributes to this sometimes implicit and sometimes explicit critique of dominant paradigms. ⋯ These narratives have their own 'truth', which should be incorporated into an understanding of what constitutes the lifeworld of emergency nurses.
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Death in modern societies is often preceded by medical end-of-life decisions. Empirical research on these end-of-life decisions focuses predominantly on the physicians' role. Little is known about the role of other health care workers, especially that of nurses. ⋯ Nurses in Belgium are largely involved in administering lethal drugs in end-of-life decisions, while their participation in the decision-making process is rather limited. To guarantee prudent practice in end-of-life decisions, we need clear guidelines, professionally supported and legally controlled, for the assignment of duties between physicians and nurses regarding the administration of lethal drugs to reflect current working practice. In addition, we need appropriate binding standards governing mutual communication about all end-of-life decisions.
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Evidence indicates that, although nurses are increasingly using clinical guidelines to ensure higher quality of care, there is a wide variance in their adherence to them. The utility of the Theory of Planned Behaviour (TPB) has not been previously investigated in explaining this variance in community nursing. ⋯ Future trials of interventions to increase practice nurses' adherence to clinical guidelines could attempt to address the elements identified in this study as important factors. Further studies are required to examine the utility of the TPB in predicting practice nurses' behaviour.