International journal of nursing studies
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Ever-growing demands on care systems have increased reliance on healthcare support workers. In the UK, their training has been variable, but organisation-wide failures in care have prompted questions about how this crucial section of the workforce should be developed. Their training, support and assessment has become a policy priority. ⋯ With the current and unprecedented policy focus on training, support and assessment of healthcare support workers, our study suggests improved training would be welcomed by them and their managers. Provision of training, support and assessment could be improved by organisational policy that promotes and protects healthcare support worker training; formalising the provision and availability of on-ward support; and training and IT support provided on a drop-in basis. Challenges in implementation are likely to be faced in all international settings where there is increased reliance on a support workforce. While recent policies in the UK offers scope to overcome some of these challenges there is a risk that some will be exacerbated.
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Review Comparative Study
What is the impact of professional nursing on patients' outcomes globally? An overview of research evidence.
Nursing is an integral part of all healthcare services, and has the potential of having a wide and enduring impact on health outcomes for a global ageing population. Over time nurses have developed new roles and assumed greater responsibilities. It is increasingly important to demonstrate the safety and overall impact of nurses' practice through research, to support the case for greater investment and development of nursing services around the world. ⋯ There is evidence that adequate numbers of well-educated nurses working in acute care areas can reduce the risk of patient mortality, although the evidence for this is confined to studies in high income countries and the evidence is not sufficiently robust to draw up definitive nurse: patient ratios. There is also moderate evidence that well trained nurses can produce health outcomes that are equivalent to those of doctors for patients with a range of chronic health problems, particularly for those patients managed in primary care, and that nurse-led care may be more effective than medical care in promoting patient adherence to treatment and patient satisfaction. There is low to moderate evidence for the benefits of parenting support programmes delivered by nurses on a range of health outcomes; and for the impact of home visiting on improving function and other health service outcomes for older people. The wider societal benefits of home visiting by nurses and the impact of this on long term outcomes and related cost-effectiveness of home visiting has not been established. There is limited available information regarding the wider global impact of increasing the numbers of nurses and their contribution to healthcare through improved education. Moreover there is very little evidence for the cost-effectiveness of changing care providers from doctors to nurses and as the majority of cost data available has tended to come from studies based in higher income countries, their external validity in terms of applicability to settings in low and middle income countries is questionable. In addition to effectiveness, cost and safety, future research needs to address how implementing expanded nursing roles and task shifting impacts on the morale, retention, and professional development of nurses and the other workforces, and the longer term implications of these developments both locally and internationally.
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Randomized Controlled Trial
Nurse-led immunotreatment DEcision Coaching In people with Multiple Sclerosis (DECIMS) - Feasibility testing, pilot randomised controlled trial and mixed methods process evaluation.
Treatment decision-making is complex for people with multiple sclerosis. Profound information on available options is virtually not possible in regular neurologist encounters. The "nurse decision coach model" was developed to redistribute health professionals' tasks in supporting immunotreatment decision-making following the principles of informed shared decision-making. ⋯ The pilot-phase showed promising results concerning acceptability and feasibility of the intervention, which was well perceived by people with multiple sclerosis, most nurses and physicians. Delegating parts of the immunotreatment decision-making process to trained nurses has the potential to increase informed choice and participation as well as effectiveness of patient-physician consultations.
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Numerous reviews of nursing handover have been undertaken, but none have focused on the patients' role. ⋯ Using research and QI projects allowed diverse findings to expand each other and identify gaps between research and heuristic knowledge. Our review showed the tension between standardising handovers and making them predictable for patient participation, while promoting tailored and flexible handovers. Further investigation of this issue is required, to understand how to train nurses and patient views. Many barriers and strategies identified were from QI projects and the nurse perspective, thus caution interpreting results is required. We recommend steps be taken in the future to ensure high quality QI projects.
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Death and dying is a reality of the clinical context of the intensive care unit. Death often follows a decision to withdraw life-sustaining treatments. Critical care nurses, are the primary care providers to patients and families at the end-of-life in the intensive care unit. ⋯ Thirteen studies were included in the review, 12 qualitative and one mixed-methods. Four key themes were identified from the original research: Navigating Complexity and Conflict; Focusing on the Patient; Working with Families; and Dealing with Emotions Related to Treatment Withdrawal. Critical care nurses provide care to patients and families during the process of withdrawal of life-sustaining treatment which is described as complex and challenging. Despite the inherent challenges, nurses strive towards doing their utmost for patients and families.