The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières
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The purpose of this study was to examine the role of the nurse practitioner (NP) within an interdisciplinary model of pain management in long-term care (LTC). In a cross-sectional survey, 16 NPs in the Canadian province of Ontario (89%) indicated whether they currently performed and whether they should be performing 33 activities related to pain management and identified barriers to the fulfilment of their pain-management role. Most NPs (81.3%) reported use of pain-assessment tools, but less than half reported use of pain-management clinical practice guidelines. ⋯ However, most felt that they should be more involved in these activities. Barriers to NP management of pain included time constraints; prescribing restrictions; lack of knowledge; difficulties with assessing pain; MD, staff, resident, and family reservations about use of opioids; and poor collaboration with physicians. The results indicate that NPs are not being used to their full potential in managing pain among elderly LTC residents.
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Advances in information and communication technologies shape consumers' attitudes towards engagement in their own health and their interface with the health-care system. The use of eHealth tools holds promise for supporting and enabling health behaviour change and the prevention and management of chronic diseases. The authors review issues related to study design, treatment implementation, and outcome measurement in eHealth trials, providing examples from the literature and from their own ongoing studies. ⋯ Patient-reported outcomes are common to eHealth studies. Other outcomes, such as the costs associated with new eHealth applications, are equally if not more important for decision-makers. This discussion is intended to inform future trials and thereby serve to advance the science of eHealth.
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Enhanced knowledge regarding the factors that influence and support the self-efficacy of emergency department (ED) registered nurses and their provision of care to women who have experienced abuse is necessary for the promotion of optimal health care. The purpose of this study was to examine the self-efficacy of registered nurses with respect to assessing and responding to woman abuse in the ED. Study hypotheses and research questions were derived from Bandura's theory of self-efficacy. ⋯ Hierarchical multiple regression examined the extent to which self-efficacy information, self-efficacy expectations and outcome expectancies predicted ED registered nurses' clinical responses to woman abuse. Overall, the model explained 40% of the variance in ED registered nurses' clinical responses to woman abuse. Results provide additional support for Bandura's theory and demonstrate that the clinical responses of ED registered nurses are complex and must be understood in terms of self-efficacy and the factors that support its development.
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Multicenter Study Controlled Clinical Trial
Violence prevention in the mental health setting: the New York state experience.
In 1996 the NewYork State Office of Mental Health issued a policy requiring all State-operated psychiatric facilities to develop and implement a proactive violence-prevention program based on guidelines issued by the US Occupational Safety and Health Administration. This presented an opportunity to evaluate the impact of the guidelines on worker health and safety. ⋯ The authors provide evidence for the feasibility and positive impact of a comprehensive violence-prevention program in the in-patient mental health workplace. Staff perception of the quality of management commitment and employee involvement in violence-prevention was significantly improved in all worksites post-implementation.
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Most fall intervention programs consist of 2 components: fall risk prediction instruments to identify the patient who is likely to fall, and fall intervention strategies to prevent the patient from falling or to protect the patient from injury should a fall occur. While critical to the effectiveness of a fall intervention program, many of the fall risk prediction instruments have been criticized for their failure to accurately identify the fall-prone patient. In this article, in the context of the validity assessments conducted on the Morse Fall Scale, the research conducted in the past 2 decades on fall risk assessment is critiqued. ⋯ Many of these instruments have been constructed with inappropriate reliance on face validity, have been evaluated inadequately, or have been tested in the clinical setting using an invalid design. Finally, improper use of fall scales in the clinical area may increase the risk of injury to the patient. The author concludes that much nursing research on patient falls does not contribute to improved patient safety.