Image--the journal of nursing scholarship
-
To examine in 1995 the effects of case management on the context of nursing practice-perceived quality of care delivered, work satisfaction, and control over nursing practice-rather than the commonly studied effect on fiscal outcomes. ⋯ Case management was found to have a primarily positive effect on nurses-staff and case managers alike. There were significant increases in several aspects of the nurses' perceptions of the quality of care delivered. Additionally, case managers were more satisfied with the administration, the respect they received, and their pay and rewards in the institution. Most strikingly, case managers perceived themselves to have more control over their practice. Some negative effects of the program were a decrease in satisfaction with the pay and rewards by the staff who were not case managers.
-
An interpretive phenomenologic study examined the practice of 130 nurses caring for families in critical care units (CCUs) using group interviews and multiple observations of practice. More than 100 examples of care of the family in CCU served as text for interpretation. A range of practice with families was observed, including practice focused on biomedical management of the patient and care that expertly incorporated the family while at the same time addressing the complex, technologic care of the critically ill. Reciprocal clinical knowledge transfer is needed among nurses at the bedside who are working in family practice and nurses who are skilled and knowledgeable about family interventions.
-
Decisions concerning life-sustaining treatments and the congruence in decision-making between patients and potential surrogates were examined. The ability of a patient-chosen surrogate to make decisions reflecting the wishes of that patient was estimated. ⋯ Patients and surrogates made similar decisions on all treatments except cancer chemotherapy, for which surrogates were significantly more likely to choose treatment when patients would have them refuse. The findings can assist patients and clinicians in choosing a surrogate whose decision-making corresponds with patient choices.
-
Delirium or acute confusion increase the likelihood of physical restraint use and subsequent harmful physical and psychological effects. Assessment for delirium is presented as a conceptual framework to guide researchers, administrators, and clinicians in developing strategies to decrease the use of physical restraint and to support quality of life for hospitalized older adults.
-
A review of nursing research into the impairment of sleep in the critically ill is presented. The author asserts that in order to fully explicate the phenomena from a nursing perspective, research is needed that focuses upon the meaning of the phenomenon to the patient.