看護とケアのジャーナル

Background: The TeamSTEPPS® Performance Observation Tool (TPOT) is an instrument used in the evaluation of team performance: however, no assessment of the tool’s reliability or validity exists among nurse educators. Methods: A convenience sample of 31 nurse educators completed the TPOT to assess the reliability and validity of the instrument. Results: Using Cronbach’s alpha, the TPOT demonstrated a strong internal consistency coefficient. Through cross-group analysis of scoring between undergraduate and graduate nursing faculty, some evidence for convergent validity was confirmed. Conclusion: This pilot study establishes the internal consistency reliability and convergent validity of the TPOT instrument when used by nurse faculty.

This article addressed the pathogenic fungus distributions on the flowers which were placed in the infectious disease ward. 10 strains of flowers were randomly chosen from the visitors from 30th November 2009 to 6th January 2010. Samples were collected from different parts of the flowers on day 1 and day 8 from the collection. 76 samples were divided into 2 groups (38 samples each group) which were collected on Day 1 and Day 8. 66 of 76 (86.8%) were pathogenic fungus positive. Monilia (24.5%), demalaceous fungi (14.5%) and Rhodothece sp (13.2%) were the top 3 pathogenic fungus in the 318 positive colonies. In the 33 comparing samples (day 1 and day 8), 6 samples were consistent and 23 were inconsistent (P<0.01). The rest 4 samples were pending. It is not recommended for visitor to bring flowers in the ID ward as there were high risk of pathogenic fungus in the flowers, especially for those patients who were suffering immunosuppressed in the ward.

The ability for nurses to practice to the fullest level of their education and expertise in order to optimize patient care is an ideal vision for nursing practice. While healthcare quality has improved over the past decades, delays continue in transferring current information from research to patient care. Many nurses are not experienced in transferring research into practice. This paper describes the process for planning, implementing and evaluating the evidence-based practice (EBP) Fellowship that transferred these critical skills to five bedside nurses. All five Fellows implemented evidence in their area of practice with significant positive changes in patient outcomes. The results from the Fellowship indicate that we met and exceeded the goals of transferring the knowledge, skills and attitudes for EBP to bedside nurses. Unexpected outcomes included the development of leadership and presentation skills as all five of the Fellows disseminated the results of their successful projects regionally and nationally. 

The use of continuous subcutaneous insulin infusion (CSII) (i.e. insulin pump) therapy, continues to grow among patients with type 1 and type 2 diabetes increasing the likelihood that these patients will be encountered in the hospital setting. Prior to the development of protocols, guidelines and order sets that standardize the inpatient management of this group of patients, the decision to continue CSII during an inpatient admission was often arbitrary. While many patients wish to continue pump therapy when admitted to the hospital, lack of familiarity with these devices led to therapeutic misadventures, such as abrupt discontinuation of CSII without transition to scheduled subcutaneous (SC) insulin increasing the risk for both hypoglycemia and hyperglycemia. This review provides information regarding the basics of CSII therapy and summarizes the literature describing the current practice standards and recommendations that have been published as a way of guiding the safe use of these devices in the inpatient setting. Proper assessment of patients who are able to safely manage their pump during admission is critical. The availability of hospital personnel who are knowledgeable in CSII therapy allows for ongoing assessment of the continued safety of CSII use and can guide transition to scheduled SC insulin therapy when patients are no longer capable of self-management. For patients who are unable to self-manage their pump therapy in the hospital, guidelines for transition to conventional subcutaneous insulin therapy is provided. We conclude that these devices can be safely used in the hospital provided that there is a standardized approach to patient selection and that there is a process for assessing glycemic control throughout the hospital stay.

The purpose of this study was to compare adverse intra-partum and post-partum outcomes for home deliveries with skilled and unskilled birth assistance. A cross-sectional study examined Indonesia Demographic Health Survey (IDHS 2007) data for 3,811 ever-married women who had had home deliveries in 2006 and 2007. A logistic regression analysis was used to examine associations between type of assistance at delivery and outcomes. This study found that there was a significantly higher probability of adverse outcomes with skilled assistance than with unskilled assistance for complications at birth and for complications after giving birth. Home deliveries with skilled assistance are not free from the risks of maternal morbidity and neonatal death. This finding raises doubts about the impact of skilled birth assistance. These results call for appropriate training to manage complications during and after childbirth by home delivery using skilled birth assistance. Further research is required.

Menstrual cycle has an influence on mind and body of any woman. A collection of symptoms that emerges one or two weeks before menstruation begins is called premenstrual syndrome (PMS), and that involves variety of complex emotional and physical changes. However, aggravation of epileptic attacks during premenstrual period alone has been focused in women with severe motor and intellectual disabilities (SMID). Exacerbation of various symptoms, other than epilepsy, was recognized as PMS in five cases, and these include muscular hypertonia, fever, tachycardia, flushing on face, nausea and vomiting. In these cases, the PMS symptoms were successfully managed with the low-dose oral contraceptive preparations. PMS among patients with SMID are often found to be difficult to diagnose. The use of the low-dose oral contraceptive was effective in women with SMID and improve the quality of their lives (QOL).

Introduction: Ambiguous abbreviations are one the most common and preventable causes of medication errors. Clinicians use many abbreviations as a timesaving convenience; however they can be prone to misinterpretation. Aim: The aim of this practice review evaluation is to identify the top six error-prone abbreviations at a local Hospital and compare those results to previous review conducted at the same facility to detect any improvement in practice. Method: Copies of inpatient medication charts were randomly selected from each ward over a one-week period. A sample size of 100 patients’ charts was included in the audit. Only regular orders on all current medication charts were included in the review (excluding ceased orders). The audit tool used is based on indicator 3.3, “Percentage of medication orders that include error-prone abbreviations” published by the New South Wales, Australia; Therapeutic Advisory Group. Findings: A total of 47 error-prone abbreviations were detected which equates to an overall incidence of 6% (n=784 medication orders) which is higher than the results of the audits of 2008 (5.1%) and 2012 (5.3%). The most common error-prone abbreviation were ‘mcg or ug’ (57.4%), ‘od or OD’ (23.4%) and ‘U or IU’ (19.1%). There were no ‘leading zeros’, ‘trailing zeros’ or ‘qd or QD’ abbreviation in the sample audited. Conclusion: The audit suggests that the possible reasons for the increase in use of unapproved abbreviations may include: 1) junior medical officers were not instructed to use the New South Wales, Australia, Therapeutic Advisory Group guidelines or 2) some medical staff are in the habit of using varying abbreviations due to their previous work experience and practice standards. If these doctors had never received timely or direct feedback on their prescribing practices then they may not be aware that they are utilising error-prone abbreviations.

Albert Einstein defines insanity as doing the same thing over and over again and expecting different results. We have seen the evolution of disposable syringes, bedpans, suture trays and other equipment known to spread germs. However, bedside commode methods have not changed since the practice of Florence Nightingale. Yet, Clostridium difficile and other gastrointestinal pathogens add billions of dollars to United States health care costs annually. Perhaps it is time to reconsider current methods and equipment in bedside toileting.

Objective : Assertiveness is important for effective team building in nursing. This article aims at evaluating the results of the previous studies on nurses’ assertiveness in each decade in order to discuss the possible ways for enhancing nurses’ assertiveness. Methods : Five databases (PubMed, MEDLINE, CINAHL, Web of Science, and the Cochrane Library) were searched for English-language articles published from 1946 to December 2012. Article which described the assertiveness of nurses and relevant factors related to assertiveness in a clinical setting or evaluated assertiveness training. Results : Twenty-five studies in 26 articles were identified. In the 1970s and 1980s, research demonstrated that nurses perceived they are submissive helper and were less assertive. These studies indicated that educational achievement was regarded as a key factor in nurses’ assertiveness. The study in 1990s demonstrated that at least one population of nurses was assertive. The studies after 2000 suggested that nurses behave in a passive way, conforming to the stereotype of a ‘nice’ nurse, and were less likely to disagree with others. A sense of responsibility for patients, managers’ leadership, organisational culture, and relationship between colleagues were reported as influencing factors of nurses’ assertiveness. Conclusion : Recently, the number of nurses who are trained in higher educational institutions has increased. Despite this, nurses still experience some difficulties assessing themselves. Nurses should understand their role at the recent health care environment as a professional. Nurse manages should take a leadership to avoid nurses’ concerns of voicing their opinions in order to improve nurses’ assertiveness.

Aim: The study aims to examine the associations between leader–member exchange (LMX) and psychosocial factors at work.

Methods: A questionnaire-based cross-sectional study was undertaken at four units in two not-for-profit hospitals in southwestern Sweden. The study sample included 240 employees.

Results: Significant correlations were found between LMX items and most of the psychosocial domains and dimensions. The strongest correlations were found between the LMX item affect and rewards/recognition, role clarity and predictability, and the LMX item loyalty and rewards/recognition. In sum, high-quality LMX was associated with good psychosocial work conditions experienced by the employees.

Conclusions: The results support possible ways for managers and employees to strengthen their relationships and this may in turn lead to more sustainable systems in health care.

Aim: To compare the knowledge of practice nurses on principles and concepts of diabetes self-management education (DSME) before and after a DSME training workshop. Methods: All 150 practice nurses currently studying for a bachelor’s degree were invited for a 2-day DSME training workshop. 88 practice nurses (59%) responded. Each participant was requested to complete and return self-assessment questionnaires before and after the training. The pre- and post-workshop knowledge of the nurses were compared using Wilcoxon Signed Rank Test for non-parametric tests in SPSS. Results: The practice nurses were aged between 20 and 62 years and the majority (95.1%) were employed in the public sector. Before the training, 98-100% of the participants knew and agreed with the five articulated princples of DSME and these did not change after the workshop training (all, p>0.05). Similarly, their understanding (96-100%) of the concepts of DSME before and after the training were similar (all, p>0.05). Conclusions: The practice nurses in Trinidad and Tobago have sufficient theoretical knowledge of the principles and concepts of DSME. The transfer of this knowledge to their patients in their care will depend on the educational infrastructure available to facilitate efficient DSME.

56 adults with type 2 diabetes received feedback on their actual risk for five diabetes complications, with half receiving additional goal setting support. Outcome measures were collected at baseline and 9 months. HbA1c and diabetes-related distress both improved, with reductions in distress associated with improvements in glycaemic control (r=0.33, p=0.014).

The role of nursing professionals in taking up anti-stigma activity is of immense importance in the resource poor developing countries. Unfortunately, there is little research exploring the attitude of nurses towards mental disorders and people affected thereof, the possible correlates of such attitude have not been widely studied. The potential role of the nurses in anti-stigma activity is yet unexplored in these countries. This is a short review of literature of the literature available regarding the attitude of nurses towards mentally ill in developing countries and appropriate recommendations.

Aims: The purpose of this study was to develop an evaluation tool for establishing the core competencies of nursing practice programs. The construct validity of the questionnaire design was subsequently analyzed.

Methods: A total of 660 graduating nursing students were recruited. This study included the following four stages: formulation of the questionnaire content, establishing expert validity, pilot test for exploratory factor analysis, and conducting confirmatory factor analysis for confirming factor structure.

Results: After conducting exploratory factor analysis, the following two domains were identified: “advancement of practice competence” and “practice competence evaluation”. Additionally, the analysis results for both structures showed a factor loading of 57%.

Conclusion: The results of this study can be used to evaluate the performance of core competencies in nursing practice programs for prospective graduates.

Objective: The study explored and described the experiences of patients diagnosed with cancer in Vhembe district, Limpopo Province. A qualitative research design which was phenomenological, exploratory, descriptive was used. The aim of the study was to add to the knowledge and understanding of the complex human phenomena. Methods: A purposive theoretical sample of twelve patients who were diagnosed with different cancers within 2-5 years in a regional hospital in Vhembe district of Limpopo Province was obtained. Data was collected through in-depth interviews with eight participants who were in remission phase or undergoing treatment. Data saturation occurred after in-depth interviews with eight participants, field notes were also used during data collection. Results: The findings revealed that cancer patients experienced poor communication and attitudes, experienced body changes, sense of withdrawal and depression and problems with follow-up care. Conclusions: Understanding the cultural perspective of what it is like to have cancer and filling the gaps of patient’s expectations and addressing emotional and physical needs.

Introduction : The world population is aging and it is estimated that the number of older people with cancer will increase in the years ahead. Every patient communication needs are linked and related to their communication goals, in order to manage the cancer. Aim : Of this literature review is to present the importance of meeting communication needs of older people with cancer. Methodology : The present review is a literature review focusing on studies evaluating the communication needs of older people with cancer. Searches were conducted on MEDLINE for 10 years to 2014, using the following search terms: aged, older, people, patient, cancer, and need. Specific inclusion (reviews, research articles) discussing about communication needs of older people diagnosed with cancer have guided our review plan and the reviewed articles chosen were 16 manuscripts. Results : Communication needs differs according to the age of the patients. Older people need their clinicians to recognize, appreciate and take into account the emotional and psychological impact of the diagnosis and treatment as well as being included in the decisions taken. Conclusion : Good communication with older patients requires knowledge of their unmet needs. Nurses should be close to patients, discuss with them, stimulate them, especially older ones, and give them the opportunity to express their needs.