Journal of advanced nursing
-
The patient and the primary care team: a small-scale critical theory For increasing the understanding of team-based delivery of primary care, ratings of care satisfaction and stimulated-recall interviews were used to compose a small-scale critical theory. Three teams and 24 patients at a community health care centre participated in the study. It was found that the multiprofessional team was vulnerable to discrepancies between the health service policy and the available care resources. ⋯ Simultaneously, when the teams are led to solve the health problems without involving the patients in the process, the team members convert these to their own personal distress when they fail. The conclusion is that the discrepancy between care policy and factual resources is an important cause of imbalance in patient-primary care team interaction. If service strategy and team organization and resources are not continuously adjusted to each other, the effects will continue to obstruct communication during consultations.
-
Interprofessional relations between doctors and nurses: perspectives from South Wales This paper discusses findings from a study of interprofessional relationships between doctors and nurses in medical wards in three provincial general hospitals in south Wales. The aim of the research was to investigate the changing nature of doctor-nurse relations, and in particular, how far the notion of the doctor-nurse game, as developed by Leonard Stein (Stein 1967, 1990), remains relevant to contemporary hospital work. The present paper concentrates on a subset of the findings concerned with doctors' and nurses' accounts of the hospital division of labour and the extent of any overlap in their work activities. ⋯ Inductive analysis of the data indicated that, whilst doctors and nurses perceived their roles in largely traditional terms, there was some recognition of blurring of occupational boundaries, especially when considering work pressures, working at night and differences in practice in more specialized clinical areas. Although nurses were generally reluctant to challenge doctors' authority, some used the notion of patient 'advocacy' to frame and justify their questioning of particular decisions. Whilst doctors valued 'experience' in nurses and saw experienced nurses as the group who might most legitimately move into doctors' territory, nurses valued formal education and saw advanced nursing qualifications as the route to role expansion.
-
The role of nurses in AIDS care regarding voluntary euthanasia and assisted suicide: a call for further dialogue Because of the nature of their work, nurses are directly involved with terminally ill patients and the problems associated with the decision to hasten death through voluntary euthanasia or assisted suicide (VE/AS). An anonymous survey delivered to nurses working in HIV/AIDS settings in Canada was used to analyse nurses' experiences and attitudes regarding VE/AS. An emergent analysis of 22 nurses' responses to an open-ended prompt appearing at the end of the survey reveals that nurses: support death-hastening practices; believe that legislation for these practices needs to be established; are wary of the potential abuse of VE/AS; and believe that further discussion on end-of-life issues is imperative. Their caring role in the health care setting places nurses in key positions to stimulate discussion in this area.
-
Comparative Study
An evaluation of the safety and effectiveness of telephone triage as a method of patient prioritization in an ophthalmic accident and emergency service.
Service changes in the accident and emergency service at Manchester Royal Eye Hospital in England resulted in a telephone triage-based referral service for health care professionals. It became clear that this service needed evaluation in order to assure both providers and users of the service that this referral strategy, based on experienced nurse practitioners making decisions about patient priority, was safe and effective. The evaluation was extended to encompass the other area of the service where telephone referrals tend to be directly from patients. ⋯ The decisions made to deny urgent appointments to a number of patients were safe in all cases. It appears that one of the problem areas in the gathering of information for prioritization purposes is in the nurses' telephone triage discussions with some, but by no means all, doctors. Some general practitioners seemed unwilling to discuss the patient and give accurate information to a nurse and this is an area which appears to need some further work.
-
Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. ⋯ To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.