Nursing & health sciences
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Nursing & health sciences · Mar 2009
Physicians' perceptions of protocol-directed weaning in an intensive care unit in Norway.
The aim of this paper is to identify physicians' perceptions of protocol-directed weaning from mechanical ventilation in an intensive care unit in Norway. Errors occur in the absence of procedures, plans, and a team culture. ⋯ Four themes emerged: (i) acceptance, where the participants perceived the protocol as having a positive influence on the weaning process, although some barriers were identified, such as its failure to facilitate the "difficult-to-wean" patient; (ii) indignant responses, which gave the impression that the protocol was prescribed for the benefit of the nurses; (iii) ambivalence was evident in the two different approaches to the weaning process when problems occurred, which were "directing" and "collaborating"; and (iv) continuity and professional competence were perceived as important aspects of the weaning process. An unclear pattern of responsibility and poor interprofessional collaboration and communication were reported.
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Nursing & health sciences · Mar 2008
Nurse staffing and cost of care in adult intensive care units in a university hospital in Thailand.
Decisions about nurse staffing levels in intensive care units (ICUs) should be guided by research to ensure optimal outcomes. This descriptive correlational study in a large Thai hospital was designed to evaluate the effect of nurse staffing levels on the costs of care, in terms of medical care cost per patient day and health personnel cost per patient day, in ICUs. ⋯ However, a greater number of RNs was associated with improved patient safety and efficiency, thereby reducing the length of stay and the costs of care in the long term. This study provides evidence to support decisions by hospital administrators concerning RN staffing levels.
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Nursing & health sciences · Dec 2007
Delivery life support: a preliminary report on the chain of survival for complicated deliveries in rural Cambodia.
Most programs to reduce maternity deaths focus on hospital performance and general obstetric protocols. In communities where most mothers deliver at home, such strategies will not reduce avoidable deaths. The key concept in the actual intervention is to regard deliveries in poor rural communities as a trauma and to merge midwives and traditional birth attendants (TBAs) with an already existing and successful rural trauma rescue system. ⋯ After completing the training program, the participants themselves rated their skills, confidence, and quality of team work by Visual Analog Scale measurement. The results demonstrate significant improvement, both for the TBAs and the certified midwives. The intervention results so far indicate that delivery life support training to rural careproviders increases their capacity to cope with emergency obstetric cases.
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Action research was used as a method to develop an educational skills training program focusing on the health education aspect of nurses' health-promoting role. The program was based on the theoretical concepts of the Transtheoretical Model and Motivational Interviewing. Interviews were used to collect the data on a purposive sample of nurses working in an acute hospital ward. ⋯ There was evidence, however, that further training was required. This might focus more on helping nurses to use the skills with patients who are very resistant to change and to better recognize health-promoting opportunities. Ways of offering the training program to other health professionals also should be explored.
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An intensive care unit (ICU) is valuable but consumes a disproportionately high amount of health-care resources. Accordingly, cost containment has been deemed a mandatory task. ⋯ The results of this review show that cost reduction can be achieved by using a variety of the following strategies: (i) instituting a closed ICU, where all the patient care is directed by intensivists or full-time critical care trained physicians; (ii) the utilization of interdisciplinary approaches to the care of patients in the ICU; (iii) developing and implementing a program of television-guided remote intensivists; (iv) the use of an alerting and reminding system; and (v) increasing the number of intermediate care beds for patients who require only monitoring and intensive nursing. The conclusion reached is that many of these strategies provide evidence for hospital manager decisions regarding cost containment strategies for the delivery of health care in the ICU.