The Nursing clinics of North America
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Nurs. Clin. North Am. · Dec 1988
ReviewSupporting the deliverers of care: strategies to support nurses and prevent burnout.
AIDS, with the number of cases and death toll increasing every day, puts caregivers at great risk for burnout. In order to prevent the detrimental consequences of burnout and to meet the challenge of this catastrophic illness, strategies need to be implemented. This overview not only explores the sources of stress related to AIDS but also presents strategies for the prevention of burnout. It is the author's belief that through solidarity caregivers will be better equipped to overcome the stress of caring for people with AIDS without experiencing burnout in the process.
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Nurses are morally obligated to give quality nursing care to all HIV-infected individuals that respects their dignity as individuals without regard to their differences in values and lifestyle, the nature of their illness, or their own contribution to infection. This obligation is defended by the principle of beneficence which asserts that nurses should act in ways that prevent harm, remove harm, and promote good to others. Minimal personal risk is inherent in the practice of nursing and is a burden all nurses must bear. ⋯ The principle of confidentiality is founded in the patient's right to privacy and the preservation of the nurse-patient relationship. Because HIV-infected individuals may receive great harm from the inadvertent and unwarranted disclosure of sensitive, personal information, nurses need to carefully apply the principle of confidentiality and ethical guidelines to their practice of nursing and to take an active role in the protection of patient confidentiality in all health care systems. Although violation of the principle of confidentiality may be justified when the rights or interests of a third party come into conflict with the duty of confidentiality, the complex issues surrounding HIV infection may make such an argument more difficult to defend, especially in regard to the disclosure of the risk of HIV transmission to sex partners without the permission of the HIV-infected individual.
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The Yale Nursing Intensity Project explored the use of patient classification, done primarily for staffing, as a measurement of nursing resources. Cross-hospital comparisons showed considerable interesting variation, yet to be explained, in minutes of care but there was considerable consistency in the relative nursing intensity of DRGs. Because of differences in staffing and charging practices, intensive care and routine floor care should be separated in any further study of nursing intensity. ⋯ A method for establishing a nationwide data set in which nursing could be included is suggested. The virtue of this approach is to provide cross-hospital evidence on which policy decisions about weighting DRGs for nursing in deciding reimbursement levels could be made. In addition, such a system would require hospitals to account for nursing separately from other hospital costs, with attendant benefits for nursing management.
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Public health nurses reminisce about the days when writing about the care given was a small part of the workday. Third parties certainly were not as interested in what was documented then as they are today. Perhaps the state would admonish an agency about the fact that goals were missing in the charts, but no one talked about documentation being the key to reimbursement and agency survival. ⋯ It is a vehicle for communicating from one professional to another about the status and needs of the patient. In fact, the chart is often the only means to demonstrate that professional standards, state regulations, and the criteria for reimbursement were met. However, to the extent that charting significantly interferes with the amount of time nurses can spend with patients, it must be limited.(ABSTRACT TRUNCATED AT 250 WORDS)
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Nurs. Clin. North Am. · Dec 1987
ReviewFluid and electrolyte concerns in intestinal surgical procedures.
All surgical patients are at risk for fluid and electrolyte imbalances. This risk increases when a patient undergoes intestinal surgery, because of the role of the gastrointestinal system in providing the body with water and electrolytes. ⋯ The nurse who is aware of preoperative factors that contribute to fluid and electrolyte imbalances, including pre-existing patient factors, iatrogenic causes, and the body's response to stress, can help prevent disastrous intraoperative events. Furthermore, postoperative patient assessment can prevent complications such as fluid overload and potassium and sodium imbalances.