International journal of nursing studies
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Multicenter Study
Use of physical restraints in acute hospitals in Germany: a multi-centre cross-sectional study.
Physical restraints are contrary to patients' autonomy and freedom. Their justification for controlling psychomotor agitation and risk of falling is being questioned more and more often. Physical restraints are associated with many negative outcomes. The German law is explicit, allowing physical restraints in nursing only as an exception. Data on the use of physical restraints in acute hospitals in Germany are sparse. ⋯ Physical restraints are apparently standard care in German acute hospitals. However, variation between wards indicates that hospital care with only few physical restraints is feasible. Respecting patients' dignity and integrity warrants intervention programmes aimed at decreasing practice variation towards a general reduction of physical restraints in acute hospitals in Germany.
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Randomized Controlled Trial
Intermittent versus indwelling urinary catheterisation in hip surgery patients: a randomised controlled trial with cost-effectiveness analysis.
Hip surgery is associated with the risk of postoperative urinary retention. To avoid urinary retention hip surgery patients undergo urinary catheterisation. Urinary catheterisation, however, is associated with increased risk for urinary tract infection (UTI). At present, there is limited evidence for whether intermittent or indwelling urinary catheterisation is the preferred choice for short-term bladder drainage in patients undergoing hip surgery. ⋯ Both indwelling and intermittent methods could be appropriate in clinical practice. Both methods have advantages and disadvantages but by not using routine indwelling catheterisation, unnecessary catheterisations might be avoided in this patient group.
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Patient handling is a major risk factor for musculoskeletal injuries among nurses. Lifting equipment is a main component of safe patient handling programs that aim to prevent musculoskeletal injury. However, the actual levels of lift availability and usage are far from optimal. ⋯ Greater availability and use of lifts were associated with less musculoskeletal pain among critical-care nurses. These findings suggest that for lift interventions to be effective, lifts must be readily available when needed and barriers against lift use must be removed.
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The older person with dementia has a limited life expectancy and the dying trajectory can be protracted and unpredictable. For good end-of-life care, early communication, exploration of residents' wishes, and identification of someone who can represent them, are important. In care homes the timing of these discussions, and who is involved is variable. Person-centred approaches to dementia care assume that people with dementia can actively participate in decisions about their lives. Less well understood is how this can inform end-of-life care decision making and complement information provided in advance care plans completed prior to, or at the point of admission to a care home. ⋯ For older people living with a diagnosis of dementia, the experience of living and dying in a care home is inextricably linked. End-of-life care planning and decision making by health care professionals, care home staff and family could be enriched by exploring and documenting the preoccupations, key relationships and wishes about everyday care of people with dementia.
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To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as burnout dimensions of emotional exhaustion, depersonalization, and personal accomplishment. ⋯ The study refines understanding of the relationship between aspects of nursing practice in order to achieve favourable nursing outcomes and offers important concepts for managers to track in their daily work. The findings of this study indicate that it is important for clinicians and leaders to consider how nurses are involved in decision-making about care processes and tracking outcomes of care and whether they are able to work with physicians, superiors, peers, and subordinates in a trusting environment based on shared values. The involvement of nurse managers at the unit level is especially critical because of associations with nurse work characteristics such as decision latitude and social capital and outcome variables. Further practice and research initiatives to support nurses' involvement in decision-making process and interdisciplinary teamwork are recommended.