The journal of nursing research : JNR
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: The U.K. Department of Health recently proposed an international dementia strategy to enhance the quality of dementia care in acute hospital care settings. To implement such a strategy, it is necessary to first assess whether nurses have the knowledge and person-centered approach essential to enhancing hospital-based dementia care quality. ⋯ : Most participants had accurate dementia care knowledge and tended to use a reality-oriented approach. Nurse competency in differentiating delirium from dementia should be enhanced. This study provided initial insight into the dementia care situation at a single hospital in southern Taiwan. Future studies should further explore the relationship between dementia care quality and hospital nurses' knowledge and approaches, respectively.
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Advance directives (ADs) are one of the few means for patients to indicate their end-of-life (EOL) treatment option preference. An effective and consistent solution for increasing the AD completion rate remains elusive. A literature search revealed three studies completed in the United States that employed an identical methodology and focused on registered nurses (RNs). These studies examined a variety of concepts, including nurses' knowledge, attitudes, experience, and confidence with regard to ADs. ⋯ Findings indicated that level of knowledge of nurses was about 60% correct and that nurses reported a moderate level of confidence related to ADs. Nurses stated they were experienced in AD discussions and agreed with attitude statements indicating support of ADs. Advocacy was a theme in the findings of these studies, as most nurses agreed with the statement that nurses should uphold patients' wishes. Time was identified as an impediment to AD completion. Critical care nurses had higher levels of awareness of ADs, as compared with oncology and emergency room nurses, although the cause of this difference is unclear. Although RNs provided AD education and explanations and described the various types of EOL care, these study subjects suggested that discussions of patients' prognoses may be an intervention more appropriate for nurses or other clinicians with advanced education and training. CONCLUSION/LIMITATIONS: The low Cronbach's alpha values in the attitude scales within the survey instrument posed limitations in the original research on the use of attitude scale scores in statistical analysis. The data examined in this study was obtained from published reports, which limited the synthesis and analysis of study findings. Nurses need to refine their role in AD discussions with patients. End-of-life discussions should be an interwoven process between RNs and the multidisciplinary team.
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Multicenter Study
Effects of nurse staffing ratios on patient mortality in Taiwan acute care hospitals: a longitudinal study.
The nurse workload in Taiwan averages two to seven times more than that in the United States and other developed countries. Previous studies have indicated heavy nursing workload as an underlying cause of preventable patient death. No studies have yet explored the relationship between nurse staffing ratio and patient mortality in Taiwan. ⋯ Nurse staffing levels affect patient outcomes. Faced with the problem of inadequate nurses for hospital healthcare needs, Taiwanese policymakers should work to implement a legislatively mandated minimum patient-nurse ratio on a shift-by-shift basis to regulate nurse staffing. In setting guidelines for nurse staffing, policymakers must consider nursing staff characteristics in addition to the number of nurses.
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Randomized Controlled Trial
Brushing teeth with purified water to reduce ventilator-associated pneumonia.
Oral care may decrease the development of ventilator-associated pneumonia (VAP) and improve oral hygiene. However, little evidence is available to guide the development of oral care protocols. The practical effect of toothbrushing on VAP development and oral health and hygiene improvement is inconclusive. ⋯ Patients (N = 53) were predominantly male (64.2%), mean age was 60.6 years old, and most had received emergency surgery (75.5%). After 7 days of toothbrushing with purified water, cumulative VAP rates were significantly lower in the experimental (17%) than in the control (71%; p <.05) group. The experimental group also had significantly better scores for oral health (p <.05) and plaque index (p <.01). CONCLUSION/IMPLICATION FOR PRACTICE: Findings suggest that, as an inexpensive alternative to existing protocols, toothbrushing twice daily with purified water reduces VAP and improves oral health and hygiene.
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Florence Nightingale emphasized the need for nurses to honor the psychological and spiritual aspects of patients to promote patients' health. Whereas study of a public hospital in Singapore presented similar findings, few studies have explored clinical nurses' perceptions of spirituality. ⋯ This study found education to have a positive impact on participants' perception of spirituality and spiritual care. A higher education level and more spiritual care lessons or training courses were found to increase perception level. Study findings provide preliminary insights into nurses' perceptions of spirituality and spiritual care in Taiwan. Findings demonstrate an urgent need for additional education programs or training in spiritual care to improve the ability of nurses in catering to the spiritual needs of patients and guide clinical nurses when conducting spiritual care.