Journal of advanced nursing
-
Comparative Study
Patients' and carers' perceptions of factors influencing recovery after cardiac surgery.
Stress and anxiety experienced by patients following myocardial infarction are well documented. Moreover, partners feel distress when they realize that they must assume responsibility for day-to-day care once the period of hospitalization is over. However, despite the trend towards early hospital discharge and the role which carers appear to be expected to undertake during the recovery of patients who have had cardiac surgery, few studies have been undertaken with this group outside the United States of America. ⋯ Information provided by nurses was consistently rated more highly than information provided by doctors or physiotherapists but there was scope for increasing input with both groups. High levels of satisfaction with the information provided by health professionals were associated with lower scores on the Hospital Anxiety and Depression Scale. More qualitative, in-depth studies to explore the precise needs of patients and their carers are needed to ensure that in future both groups are better prepared.
-
This paper explores the role of nursing interaction within the context of handovers and seeks to identify the clinical discourses used by registered nurses, student nurses and care assistants in acute elderly care wards, to determine their influence on the delivery of patient care. The study design involved an ethnographic approach to data collection which involved: observations of formal nursing end of shift reports (23 handovers) and informal interactions between nurses (146 hours); interviews (n = 34) with registered nurses, student nurses and care assistants; and analysis of written nursing records. A grounded theory analysis was undertaken. ⋯ Doing 'paperwork' was accorded less status and priority than patient care, and was regarded as excessively time consuming. Despite this, there was evidence of repetition in nursing documents. Moreover, the delivery of clinical nursing appeared to be guided by personal records rather than formal records.
-
The objective of this study was to assess the performance of a consensus-derived decision algorithm in determining chest pain patients' suitability for early transfer to a lower dependency ward by predicting complications. The sample comprised 516 patients with chest pain presumed to be cardiac in origin, admitted to a cardiac care unit (CCU) in northern England from the community or from the accident and emergency department. A decision algorithm was designed following a review of the literature and amended to take into account a clinical consensus of consultant physicians. ⋯ The main outcome measures were death or severe complications occurring during hospitalization, and during the first 2 days following CCU admission. While sensitivity of both the algorithm (0.98) and CCU nurses (0.95) was high, specificity was low in both groups (0.11 and 0.21, respectively), making it unlikely that the algorithm would prove useful in clinical practice. Further studies are required to develop the optimal triage tool for the assessment of patients with acute chest pain.
-
Patient survival often depends on decisions by nurses to call emergency assistance. The experiences of nurses calling emergency assistance have not been described. This descriptive study explored the experiences of registered nurses (n=32) using unstructured interviews. ⋯ This association indicates the importance of experience in the development of clinical decision-making skills. Further, nurses calling emergency assistance need to be provided with the opportunity to debrief after calling. Their heavy reliance on subjective data before searching for objective data as outlined in the emergency calling criteria suggests that it is essential that nurses do not devalue or ignore concerns they may have about patients.
-
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.