Academic literature on the topic 'Clinical Nursing: Tertiary (Rehabilitative)'
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Journal articles on the topic "Clinical Nursing: Tertiary (Rehabilitative)"
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Stamm, Brian J., Christina M. Lineback, Lesli E. Skolarus, Lewis B. Morgenstern, and Gaurang V. Shah. "Artery of Percheron Infarct: 12 Cases and Their Complex Clinical Courses." Neurohospitalist 8, no. 3 (December 28, 2017): 141–45. http://dx.doi.org/10.1177/1941874417748543.
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Strokes involving the artery of Percheron (AOP), an anatomic variant of thalamic vascular supply, are rare. Little is known about the inpatient hospital course for these patients. We retrospectively identified consecutive patients with AOP in their medical charts from a university-based tertiary care hospital from January 1, 2000, to August 15, 2017. A chart review identified demographics, transfer status, in-hospital versus community onset of stroke, emergency medical services (EMS) use, presenting signs/symptoms, time to radiologic diagnosis (from time of presentation to tertiary care hospital or from time of initial symptom onset in an already hospitalized patient), tissue plasminogen activator (tPA) use, intensive care unit (ICU) stays, intubation, length of stay (LOS), and discharge location. After radiologic inclusion/exclusion criteria were applied, 12 patients were included in the study. There were 7 men and 5 women, and the mean age (SD) was 68 (15). Seven were transfers, and 4 had an in-hospital stroke. Of the 8 community-onset strokes, 7 utilized EMS. Mental status changes occurred in 11 of 12 and ocular disturbances in all patients. Time to radiologic diagnosis averaged 1.9 (median = 1.1) days. One patient received tPA. Eight received care in the ICU. Four were intubated. Average LOS was 8.3 days. Four were discharged home, 3 entered inpatient rehabilitation facilities, and 5 entered skilled nursing facilities. In-hospital stroke status further complicates the already challenging diagnosis of AOP infarct, and clinicians must maintain a high suspicion for this rare stroke in order to quickly diagnose and intervene.
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Noë, Sofie, Ann Goeleven, Hilde Brouwers, Tom Meurrens, Alexander De Cock, Daphne Kos, and Kris Vanhaecht. "Training for Caregivers and Compliance with Dysphagia Recommendations in a Tertiary Multiple Sclerosis Rehabilitation Center." International Journal of MS Care 23, no. 5 (March 19, 2021): 223–28. http://dx.doi.org/10.7224/1537-2073.2020-019.
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Abstract Background: Dysphagia is common in persons with multiple sclerosis (MS). Speech and language therapists give dysphagia recommendations to persons with MS and caregivers. Nonadherence to these recommendations can increase the risk of aspiration. We investigated current compliance with dysphagia recommendations among caregivers and kitchen staff and assessed improvement in compliance by increasing knowledge through tailored training. Methods: An observational cohort study was conducted over 4 weeks during which the compliance of the caregivers and kitchen staff in a rehabilitation center was monitored. A questionnaire was used to assess reasons for noncompliance. A 2-hour training session was provided for all caregivers and kitchen staff to improve their knowledge and skills. The compliance rate was observed again 1 and 6 months after the training. Compliance was defined by whether recommendations were followed. Results: Results showed a significant improvement after training for overall compliance by caregivers (from 58% to >81%, P < .001). This improvement was still observed 6 months later (80%). After training, significant differences were found in compliance with the following recommendations (P ≤ .001): consistency of soup, consistency of liquids, food preparation, alertness, speed, amount, posture, and supervision. Recommendation for utensils did not improve (P = .44). Compliance with diet modifications made by the kitchen staff improved significantly (from 74% to >86%, P = .002), and even more during follow-up (to >95%, P = .009). Conclusions: Dysphagia training tailored to the needs of caregivers to improve knowledge significantly improves compliance with dysphagia recommendations and the quality of care.
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Small, Luke T., Madison Lampkin, Emre Vural, and Mauricio A. Moreno. "American Society of Anesthesiologists Class as Predictor for Perioperative Morbidity in Head and Neck Free Flaps." Otolaryngology–Head and Neck Surgery 161, no. 1 (March 26, 2019): 91–97. http://dx.doi.org/10.1177/0194599819832812.
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ObjectiveTo evaluate outcomes of free flaps in low- versus high-risk American Society of Anesthesiologists (ASA) classes utilizing a standardized perioperative clinical pathway.Study DesignCase series with chart review.SettingSingle tertiary care academic institution.Subjects and MethodsData were collected from 301 patients who underwent 305 free flap reconstructions for head and neck defects from January 2012 to March 2016 by a single surgeon (M.M.). A standardized perioperative clinical pathway was utilized for all patients, aimed at abbreviating hospital stay and minimizing intensive care unit stay. Data included ASA classification, comorbidities, length of hospitalization, intensive care unit stay, 30-day mortality/readmission, discharge disposition, flap survival, and postoperative complications. Low-risk ASA classes were defined as 1 and 2 (n = 53) and high risk as 3 and 4 (n = 248).ResultsTotal medical complication rates ( P = .012) were mildly increased in the high-risk group, as a result of increased minor—not major—medical complication rates ( P = .007). Discharge to a nursing or rehabilitation facility was found to be more common in the high-risk group ( P = .024). All other outcomes were not statistically different between the cohorts.ConclusionThe ASA classification system is a validated tool in determining perioperative risk. We found that minor medical complications and discharge to a rehabilitation/nursing facility were increased in the high-risk ASA classes; otherwise, there were no statistical differences between the groups. These findings suggest that the ASA classification may be helpful for preoperative discharge planning and counseling but should not be used for patient selection or to assess candidacy for the procedure.
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Safaee, Michael M., Ramin A. Morshed, Jordan Spatz, Sujatha Sankaran, Mitchel S. Berger, and Manish K. Aghi. "Interfacility neurosurgical transfers: an analysis of nontraumatic inpatient and emergency department transfers with implications for improvements in care." Journal of Neurosurgery 131, no. 1 (July 2019): 281–89. http://dx.doi.org/10.3171/2018.3.jns173224.
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OBJECTIVEInterfacility neurosurgical transfers to tertiary care centers are driven by a number of variables, including lack of on-site coverage, limited available technology, insurance factors, and patient preference. The authors sought to assess the timing and necessity of surgery and compared transfers to their institution from emergency departments (ED) and inpatient units at other hospitals.METHODSAdult neurosurgical patients who were transferred to a single tertiary care center were analyzed over 12 months. Patients with traumatic injuries or those referred from skilled nursing facilities or rehabilitation centers were excluded.RESULTSA total of 504 transferred patients were included, with mean age 55 years (range 19–92 years); 53% of patients were women. Points of origin were ED in 54% cases and inpatient hospital unit in 46%, with a mean distance traveled for most patients of 119 miles. Broad diagnosis categories included brain tumors (n = 142, 28%), vascular lesions, including spontaneous and hypertensive intracerebral hemorrhage (n = 143, 28%), spinal lesions (n = 126, 25%), hydrocephalus (n = 45, 9%), wound complications (n = 29, 6%), and others (n = 19, 4%). Patients transferred from inpatient units had higher rates of surgical intervention (75% vs 57%, p < 0.001), whereas patients transferred from the ED had higher rates of urgent surgery (20% vs 8%, p < 0.001) and shorter mean time to surgery (3 vs 5 days, p < 0.001). Misdiagnosis rates were higher among ED referrals (11% vs 4%, p = 0.008). Across the same timeframe, patients undergoing elective admission (n = 1986) or admission from the authors’ own ED (n = 248) had significantly shorter lengths of stay (p < 0.001) and ICU days (p < 0.001) than transferred patients, as well as a significantly lower total cost ($44,412, $46,163, and $72,175, respectively; p < 0.001).CONCLUSIONSThe authors present their 12-month experience from a single tertiary care center without Level I trauma designation. In this cohort, 65% of patients required surgery, but the rates were higher among inpatient referrals, and misdiagnosis rates were higher among ED transfers. These data suggest that admitting nonemergency patients to local hospitals may improve diagnostic accuracy of patients requiring urgent care, more precisely identify patients in need of transfer, and reduce costs. Referring facilities may lack necessary resources or expertise, and the Emergency Medical Treatment and Active Labor Act (EMTALA) obligates tertiary care centers to accept these patients under those circumstances. Telemedicine and integration of electronic medical records may help guide referring hospitals to pursue additional workup, which may eliminate the need for unnecessary transfer and provide additional cost savings.
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Vaziri, Sasha, Jacob Wilson, Joseph Abbatematteo, Paul Kubilis, Saptarshi Chakraborty, Khare Kshitij, and Daniel J. Hoh. "Predictive performance of the American College of Surgeons universal risk calculator in neurosurgical patients." Journal of Neurosurgery 128, no. 3 (March 2018): 942–47. http://dx.doi.org/10.3171/2016.11.jns161377.
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OBJECTIVEThe American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) universal Surgical Risk Calculator is an online decision-support tool that uses patient characteristics to estimate the risk of adverse postoperative events. Further validation of this risk calculator in the neurosurgical population is needed; therefore, the object of this study was to assess the predictive performance of the ACS NSQIP Surgical Risk Calculator in neurosurgical patients treated at a tertiary care center.METHODSA single-center retrospective review of 1006 neurosurgical patients treated in the period from September 2011 through December 2014 was performed. Individual patient characteristics were entered into the NSQIP calculator. Predicted complications were compared with actual occurrences identified through chart review and administrative quality coding data. Statistical models were used to assess the predictive performance of risk scores. Traditionally, an ideal risk prediction model demonstrates good calibration and strong discrimination when comparing predicted and observed events.RESULTSThe ACS NSQIP risk calculator demonstrated good calibration between predicted and observed risks of death (p = 0.102), surgical site infection (SSI; p = 0.099), and venous thromboembolism (VTE; p = 0.164) Alternatively, the risk calculator demonstrated a statistically significant lack of calibration between predicted and observed risk of pneumonia (p = 0.044), urinary tract infection (UTI; p < 0.001), return to the operating room (p < 0.001), and discharge to a rehabilitation or nursing facility (p < 0.001). The discriminative performance of the risk calculator was assessed using the c-statistic. Death (c-statistic 0.93), UTI (0.846), and pneumonia (0.862) demonstrated strong discriminative performance. Discharge to a rehabilitation facility or nursing home (c-statistic 0.794) and VTE (0.767) showed adequate discrimination. Return to the operating room (c-statistic 0.452) and SSI (0.556) demonstrated poor discriminative performance. The risk prediction model was both well calibrated and discriminative only for 30-day mortality.CONCLUSIONSThis study illustrates the importance of validating universal risk calculators in specialty-specific surgical populations. The ACS NSQIP Surgical Risk Calculator could be used as a decision-support tool for neurosurgical informed consent with respect to predicted mortality but was poorly predictive of other potential adverse events and clinical outcomes.
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Dikshit, Vishesh, Abhaya Gupta, Prashant Patil, Geeta Kekre, Paras Kothari, and Apoorva Kulkarni. "Follow up of meningomyelocele and associated hydrocephalus, bladder and/or bowel incontinence and foot deformity in a developing country." International Surgery Journal 4, no. 10 (September 27, 2017): 3450. http://dx.doi.org/10.18203/2349-2902.isj20174514.
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Background: Meningomyelocele (MMC) and meningocele (MC) are the two most common types of neural tube defects (NTD) seen. Some of the problems associated with care of these patients are psychological stress is parents, average financial condition of caretakers, ignorance on the part of parents, local physicians for management of this condition, very few dedicated Spina bifida clinics and social stigma associated with this condition. The aim of treatment of meningomyelocele is to the patients with maximum mobility and social continence which is possible through multidisciplinary care involving paediatric surgeon, paediatrician, nursing staff, occupational therapist, physiotherapist, social worker, parents and patients themselves. The aim of this study is to discuss our experience in initial management of meningomyelocele (MMC) and hydrocephalus and long-term management of bladder/bowel incontinence and foot deformity in a tertiary care hospital of a developing country.Methods: A retrospective nonrandomized observational study was conducted in the department of pediatric surgery at a tertiary hospital, from August 2008 to October 2015. Overall 145 patients of meningomyelocele were included in the study. Patients were managed according to our institution protocol.Results: 68.2% MMC patients were repaired primarily. 24.1% of total patients needed Y-V plasty skin advancement flap. 7.5% patients needed synthetic patch for dural closure. 24.1% patients were incontinent since birth. 19.3% patients had decreased lower limb power since birth. 5.5% patients were incontinent after MMC repair. 8.2% patients had decreased lower limb power after MMC repair. 28.9% patients needed VP shunt for gross hydrocephalus before MMC repair. 51.03% patients needed VP shunt after MMC repair. 20% patients did not require VP shunt in the present series. 13.1% patients in the present series had urinary incontinence. 11.03% patients had fecal incontinence. 73.6% patients with urinary incontinence were successfully managed with conservative treatment. 87.5% patients with fecal incontinence responded to conservative treatment. Bladder augmentation was done in 26.3% of neurogenic bladder dysfunction patients. 60% of these patients had dry interval of more than 4 hours. MACE was done in 12.5% of neurogenic bowel dysfunction patients. 2 patients required simultaneous bladder augmentation, Mitrofanoff’s and MACE procedure. One of these patients achieved a dry interval of >4 hour.Conclusions: Successful rehabilitation of children with MMC can be achieved with parental education and support, dedicated clinicians, trained nursing staff, regular follow-up and low threshold for diagnosing clinical deterioration and proactive management to prevent further clinical deterioration.
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Stosor, Valentina, Julie Kruszynski, Terra Suriano, Gary A. Noskin, and Lance R. Peterson. "Molecular Epidemiology of Vancomycin-Resistant Enterococci: A 2-Year Perspective." Infection Control & Hospital Epidemiology 20, no. 10 (October 1999): 653–59. http://dx.doi.org/10.1086/501560.
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AbstractObjective:To determine the molecular epidemiology of vancomycin-resistant enterococci (VRE) at our medical center in order to identify the extent of strain clonality and possible transmission patterns of this pathogen.Design:An important facet of our infection control program includes molecular typing of all clinical and surveillance isolates of VRE to determine transmission patterns in the hospital. Molecular strain typing is performed by restriction endonuclease analysis (REA) of genomic DNA. REA patterns are visually compared to categorize VRE strains into type and subtype designations.Setting:A 588-bed, university-affiliated, tertiary-care hospital and a neighboring 155-bed rehabilitation facility.Results:From January 1995 through December 1996, 379 VRE isolates were collected from 197 patients. Thirty-three genotypes were determined by REA typing; 15 genotypes were implicated in 29 instances of potential nosocomial transmission. Three major clusters of VRE involving patients on multiple nursing units and two adjacent hospitals were identified. The remaining instances of nosocomial transmission occurred in small patient clusters.Conclusions:In conclusion, the VRE epidemic at this medical center is polyclonal. VRE transmission patterns are complex, and, while large clusters do occur, the usual pattern of nosocomial acquisition of this pathogen occurs in the setting of “mini-clusters”.
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Lucet, Jean-Christophe, Karine Grenet, Laurence Armand-Lefevre, Marion Harnal, Elisabeth Bouvet, Bernard Regnier, and Antoine Andremont. "High Prevalence of Carriage of Methicillin-ResistantStaphylococcus aureusat Hospital Admission in Elderly Patients: Implications for Infection Control Strategies." Infection Control & Hospital Epidemiology 26, no. 2 (February 2005): 121–26. http://dx.doi.org/10.1086/502514.
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AbstractBackground:Despite contact isolation precautions for patients with methicillin-resistantStaphylococcus aureus(MRSA), MRSA infections are increasing in many countries.Objective:To evaluate the role of a potential unrecognized reservoir of MRSA carried by patients in acute care wards, we determined the prevalence of MRSA at hospital admission, with special emphasis on screening-specimen yields.Setting:A 1,100-bed teaching hospital in Paris, France.Methods:Nasal screening cultures were performed at admission to a tertiary-care teaching hospital for patients older than 75 years.Results:MRSA was isolated from 63 (7.9%) of 797 patients. On the multivariate analysis, variables significantly associated with MRSA carriage were presence of chronic skin lesions (adjusted odds ratio [AOR], 5.10; 95% confidence interval [CI95], 2.52–10.33); transfer from a nursing home, rehabilitation unit, or long-term-care unit (AOR, 4.52; CI95, 2.23–9.18); and poor chronic health status (AOR, 1.80; CI95, 1.02–3.18). Without admission screening, 84.1% of MRSA carriers would have been missed at hospital admission and 76.2% during their hospital stay. Furthermore, 81.1% of days at risk for MRSA dissemination would have been spent without contact isolation precautions had admission screening not been performed.Conclusions:MRSA carriage at hospital admission is far more prevalent than MRSA-positive clinical specimens. This may contribute to failure of contact isolation programs. Screening cultures at admission help to identify the reservoir of unknown MRSA patients.
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Barnes, Jonathan Aaron, Mark A. Eid, Kayla Moore, Suvekshya Aryal, Eden Gebre, Jennifer Nicole Woodard, Napong Kitpanit, et al. "Use of real-world data and clinical registries to identify new uses of existing vascular endografts: combined use of GORE EXCLUDER Iliac Branch Endoprosthesis and GORE VIABAHN VBX Balloon Expandable Endoprosthesis." BMJ Surgery, Interventions, & Health Technologies 4, no. 1 (July 2022): e000085. http://dx.doi.org/10.1136/bmjsit-2021-000085.
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ObjectiveTo assess the feasibility of collecting, examining and reporting observational, real-world evidence regarding the novel use of the GORE EXCLUDER Iliac Branch Endoprosthesis (IBE) in conjunction with the GORE VIABAHN VBX Balloon Expandable Endoprosthesis (IBE+VBX stent graft).DesignMulticentre retrospective cohort study.SettingFour real-world data sources were used: a national quality improvement registry, a statewide clinical research network, a regional quaternary health system and two tertiary academic medical centres.ParticipantsIn total, 30 patients with 37 IBE+VBX stent graft were identified. Of those, the mean age was 72±10.2 years and 90% were male. The cohort was 77% white, 10% black, 3% Hispanic and 10% other.Main outcome measuresOutcome measures included: proportion of percutaneous vs open surgical access, intensive care admission, intensive care unit (ICU) length-of-stay (LOS), total LOS, postoperative complications, discharge disposition and 30-day mortality.ResultsThe majority (89%) of cases were performed percutaneously, 5% required surgical exposure following failed percutaneous access and 6% required open surgical exposure outright. Nearly half (43%) required intensive care admission with a median ICU LOS of 1 day (range: 1–2). Median total LOS was 1 day (IQR: 1–2). There were zero postoperative myocardial infarctions, zero reported leg embolisations and no reported reinterventions. Access site complications were described in 1 of 28 patients, manifesting as a haematoma or pseudoaneurysm. Ultimately, 97% were discharged to home and one patient was discharged to a nursing home or rehabilitation facility. There were no 30-day perioperative deaths.ConclusionsThis project demonstrates the feasibility of identifying and integrating real-world evidence, as it pertains to an unapproved combination of endovascular devices (IBE+VBX stent graft), for short-term outcomes analysis. This new paradigm of evidence has potential to be used for device monitoring, submission to regulatory agencies, or consideration in indication expansions and approvals with further efforts to systematise data collection and transmission mechanisms.
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Salas-Vega, Sebastian, Vikram B. Chakravarthy, Robert D. Winkelman, Matthew M. Grabowski, Ghaith Habboub, Jason W. Savage, Michael P. Steinmetz, and Thomas E. Mroz. "Late-week surgery and discharge to specialty care associated with higher costs and longer lengths of stay after elective lumbar laminectomy." Journal of Neurosurgery: Spine 34, no. 6 (June 2021): 864–70. http://dx.doi.org/10.3171/2020.11.spine201403.
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OBJECTIVE In a healthcare landscape in which costs increasingly matter, the authors sought to distinguish among the clinical and nonclinical drivers of patient length of stay (LOS) in the hospital following elective lumbar laminectomy—a common spinal surgery that may be reimbursed using bundled payments—and to understand their relationships with patient outcomes and costs. METHODS Patients ≥ 18 years of age undergoing laminectomy surgery for degenerative lumbar spinal stenosis within the Cleveland Clinic health system between March 1, 2016, and February 1, 2019, were included in this analysis. Generalized linear modeling was used to assess the relationships between the day of surgery, patient discharge disposition, and hospital LOS, while adjusting for underlying patient health risks and other nonclinical factors, including the hospital surgery site and health insurance. RESULTS A total of 1359 eligible patients were included in the authors’ analysis. The mean LOS ranged between 2.01 and 2.47 days for Monday and Friday cases, respectively. The LOS was also notably longer for patients who were ultimately discharged to a skilled nursing facility (SNF) or rehabilitation center. A prolonged LOS occurring later in the week was not associated with greater underlying health risks, yet it nevertheless resulted in greater costs of care: the average total surgical costs for lumbar laminectomy were 20% greater for Friday cases than for Monday cases, and 24% greater for late-week cases than for early-week cases ultimately transferred to SNFs or rehabilitation centers. A Poisson generalized linear model fit the data best and showed that the comorbidity burden, surgery at a tertiary care center versus a community hospital, and the incidence of any postoperative complication were associated with significantly longer hospital stays. Discharge to home healthcare, SNFs, or rehabilitation centers, and late-week surgery were significant nonclinical predictors of LOS prolongation, even after adjusting for underlying patient health risks and insurance, with LOSs that were, for instance, 1.55 and 1.61 times longer for patients undergoing their procedure on Thursday and Friday compared to Monday, respectively. CONCLUSIONS Late-week surgeries are associated with a prolonged LOS, particularly when discharge is to an SNF or rehabilitation center. These findings point to opportunities to lower costs and improve outcomes associated with elective surgical care. Interventions to optimize surgical scheduling and perioperative care coordination could help reduce prolonged LOSs, lower costs, and, ultimately, give service line management personnel greater flexibility over how to use existing resources as they remain ahead of healthcare reforms.
Dissertations / Theses on the topic "Clinical Nursing: Tertiary (Rehabilitative)"
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Bettiens, Rosanne, and n/a. "Clinical outcomes of theoretical teaching of the nursing process in a tertiary programme." University of Canberra. Education, 1992. http://erl.canberra.edu.au./public/adt-AUC20061110.094014.
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Problem: While the educational preparation of students
in a tertiary nursing programme was the general focus of the
study, the specific concern was with the degree to which
students in the first and third year of the programme
implemented all aspects of the nursing process in their
delivery of patient care. The study developed out of a need
to evaluate the effectiveness of theoretical teaching in
regard to the students' ability to implement theoretical
principles in clinical practice. The desired outcome of the
study is that the data will be useful in developing more
appropriate and effective teaching approaches that will
result in improved clinical nursing practice.
Methodology A survey of patients receiving nursing
care from students in the first and third year of their
programme was conducted on completion of a one week block of
clinical experience for both groups of students. A
questionnaire was the instrument of data collection.
Factors included in the study were the patients' perceptions
of the students' attention to four of the five phases of the
nursing process: assessment, diagnosis, planning and
evaluation. Questions addressing the degree of patient
involvement in all of these phases were included throughout
the questionnaire. Questionnaires were returned from twenty
nine of the thirty one patients surveyed in the first year
student group and from thirty of the thirty one patients
surveyed in the third year student group; constituting a
93.5 percent and a 96.7 percent response respectively.
Results The scores achieved by each group of students
were compared against scores determined by the researcher to
indicate realistic educational and professional standards of
practice in each specified section and comparisons were also
made between the two students groups to identify development
of practice over the education programme. Scores indicated
that:
1. Within each section of the study both student groups
scored below the expected level on certain items, the
most notable deficiencies being related to the aspects
of patient empowerment through informing and involving.
2. The third year student group scored overall higher
than the first year students in regard to attention
to the more 'technical' aspects of the nursing process,
but did not give the same degree of attention to the
'human' aspects, scoring equal to, or lower than their
less experienced colleagues.
Conclusions:
1. There are apparent philosophical differences between
the graduates of the 'old style' training system and those
involved in the tertiary nursing programme in regard to the
individualization of patient care and the allocation of
priorities within a time frame.
2. Clinical application of theoretical principles relies
heavily on the reinforcement of these principles by the
clinical teacher/supervisor. There is a need for these
clinical supervisors to have:
(a) a better understanding of the educational objectives
for students in the clinical settings, and
(b) assistance towards developing teaching/organizational
strategies that will guide the student towards
objective attainment when such abilities are not
developed.
Recommendations: Among the recommendations presented
were:
1. that the nursing discipline within the university make
formal and informal opportunities to inform all clinicians
of the changes in nursing education and the implications
these changes have on the overall approach to the delivery
of patient care.
2. that there is an increased emphasis on the educational
preparation of the clinical supervisors and that their
commitment to the students' achievement of the clinical
objectives is enhanced through involvement in programme
planning and evaluation.
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Keller, Linda. "Assessment of Evidence-Based Practice Readiness and Plan for Implementation of Clinical Practice Guidelines in a Tertiary Hospital." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5208.
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Using evidence-based practice (EBP) to deliver patient care in a hospital setting improves patients' care and their outcomes. The use of clinical practice guidelines (CPG) enables nurses and other healthcare professionals to translate current evidence into bedside care. However, there continue to be barriers for hospitals in adopting and implementing evidence-based care using CPGs, including a lack of understanding about EBP by nursing staff. The purpose of this project was to explore readiness of registered nurses in a tertiary hospital to use EBP and provide recommendations for a plan to implement CPGs successfully. Melnyk's research identified EBP as an approach to care, and the concept of using CPGs to shape patient care served as a foundation for the project. In addition, Kotter's theory of change was used to guide the recommendations to promote implementation. The Academic Center for Evidence-Based Practice-Readiness Inventory (ACE-ERI) created by Stevens was used to survey nurses' EBP readiness and knowledge at one Florida tertiary hospital. Data were analyzed using descriptive and inferential statistics. Survey results revealed the nurses' overall moderate level of confidence in using EBP, but limited EBP knowledge. Therefore, recommendations to develop education programs for EBP as well as guidance on follow-up assessments were proposed to nursing leadership. Educating the nurses will increase the likelihood of adoption of the CPGs, which will promote positive social change by improving the bedside care delivered by hospital nurses, which will result in better patient outcomes.
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Schwehr, Jamin, and Jolene Tarasiewicz. "An Assessment Of The Impact Of Decentralized Clinical Staff Pharmacists On Nurses At A Tertiary Referral Teaching Hospital." The University of Arizona, 2007. http://hdl.handle.net/10150/624412.
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Class of 2007 AbstractObjectives: To evaluate the impact of decentralized clinical staff pharmacists (CSPs) on nursing staff in a university- affiliated teaching hospital. Areas of interest include perceived quality of patient care, job satisfaction and nursing job retention. Methods: CSP impact was evaluated using a print-based survey utilizing outcomes items and a four-point Likert-type scale with response options ranging from “Agree” to “Disagree.” Nurses also answered demographic questions about experience, time at the institution, education leve and frequency of interaction with a CSP. Analysis of the data included use of descriptive statistics as well as use of Kendall’s tau-b to evaluate differences between groups based frequency of CSP interaction. Results: Respondents included 122 nurses at University Medical Center (UMC) in Tucson, Arizona in positions supported by a CSP during the summer of 2006. Nurses overwhelmingly selected “Agree” or “Somewhat Agree” for all 12 statements about the CSPs indicating that they found their interaction with CSPs valuable. Nurses who interacted more frequently with CSPs were more likely to “Agree” or “Somewhat agree that CSPs were valuable members of the hospital (p=.049), one reason they remained at UMC (p=.007), helpful with medication questions (p=.008) and improved job satisfaction (p=.013), made their job easier (p=<.001) as well as more enjoyable (p=.027)
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Pelser, Anya. "Assessing the knowledge and opinions of registered nurses with reference to quality indicators in clinincal nursing within a tertiary health institution in Saudi Arabia." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/17938.
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Thesis (MCur)--Stellenbosch University, 2011.ENGLISH ABSTRACT: The quality of care nurses provide to patients is done with the expectation that skills and knowledge of each registered nurse will result in quality patient care. Compliance statistics for quality indicators (level of service indicators) or (LSI’s) in the tertiary health care institution in Saudi Arabia varies, raising the following questions: “Do nurses understand the importance of quality indicators in clinical nursing and do they know how to use them to improve patient care?” No studies done on registered nurses’ knowledge and opinions of quality indicators could be found thus indicate the necessity of a research study to determinine the knowledge and opinions of registered nurses on quality indicators in clinical nursing in the tertiary healthcare system in Saudi Arabia. This is the focus of this research. The objectives of the study were: - To determine the current knowledge and opinions of the professional nurses regarding quality indicators in a tertiary hospital in Saudi Arabia - To identify the factors that influence identification of quality indicators in clinical nursing - To identify the need for a training program regarding nurse sensitive quality indicators Data was collected through a questionnaire handed to more than 200 nurses working in general wards and intensive care areas in a single Saudi Arabian hospital. Participants were selected through a randomised list. The registered nurses who have participated in the pilot study’s responses were excluded from the final data analysis. No patients were included or involved in the study. A descriptive design with a quantitative approach was applied to investigate the professional nurses’ knowledge and opinions on quality indicators (level of service indicators) or (LSI’s) in clinical nursing in Saudi Arabia. Research data suggests that the knowledge and opinions of registered nurses in the tertiary health care institution in Saudi Arabia are not supporting the expectations of quality assurance in clinical nursing. Registered nurses have strong opinions of quality indicators in clinical nursing but do not have the knowledge to support those opinions. Improving initial and recurring training on quality indicators provided to nursing staff with diverse backgrounds and high turnover was recommended as an essential component in using quality indicators to drive improvements in patient care.
AFRIKAANSE OPSOMMING: Die kwaliteit verpleegsorg wat verpleegkundiges op ‘n daaglikse basis aan kliente bied gaan gepaard met die verwagting dat hulle oor die kennis en bevoegtheid moet beskik om kwaliteit verpleegsorg aan te wend wat ‘n langdurige positiewe uitkoms met verwysing na pasientsorg kan bied. Die kwaliteits aanwyser statistieke in die tersiere gesondheidsorg sisteem verskil maandeliks en het die navorser geinspireer om ‘n studie te doen om te bepaal of geregistreerde verpleegkundiges verstaan wat die belangrikheid van kwaliteits aanwysers is en of hulle die kennis het oor die gebruik daarvan, in watter opsigte dit gebruik kan word en wat die voordele inhou wanneer kennis en applikasie daarvan vir kliniese verpleging toegepas word. Literatuur met betrekking tot vorige studies omtrent kennis en opinies van geregistreerde verpleegkundiges tot kwaliteits aanwysers in kliniese verpleeging kon nie deur die navorser gevind word wat gebruik kon word as agtergrond of ondersteuning tot die studie nie. Die fokus van die navorsings studie was om geregistreerde verpleegkundiges se kennis en opinies te bepaal met betrekking tot kwaliteits aanwysers in kliniese verpleging in die tersiere gesondheidsorg sisteem in Saudi Arabie. Die doelwitte van die studie was om: - Die huidige kennis en opinies van geregistreerde verpleegkundiges met betrekking tot kwaliteits aanwysers in die tersiere gesondheidsorg sisteem in Saudi Arabie te bepaal - Om faktore wat ‘n invloed op identifikasie van kwaliteits aanwysers het te identifiseer - Om die nodigheid van ‘n opleidings program met betrekking tot kwaliteits aanwysers te bepaal Die data van die studie was ingesamel deur middel van ‘n vraelys wat aan die geregistreerde verpleegkundiges meesal werksaam is in algemene sale of intensiewe sorgeenhede. Deelnemers was gekies deur middel van ‘n alternatiewe lys. Die deelnemers aan die loots studie was ge-ellimineer van die finale data analise. Geen pasiente was betrokke by die studie nie. ‘n Beskrywende ontwerp met ‘n kwantitatiewe benadering was toegepas om geregistreerde verpleegkundiges se kennis en opinies omtrent kwaliteits aanwysers in kliniese verpleging in die tersiere gesondheidsorg sisteem in Saudi Arabie te toets. Die navorsing het bewys dat die kennis en opinies van geregistreerde verpleegkundiges in die tersiere gesondheidsorg sisteem in Saudi Arabie nie op ‘n aanvaarbare standard kan geklassifiseer word nie asook nie die nodige kwaliteits versekering in kliniese verpleging ondersteun nie. Die studie bewys dat geregistreerde verpleegkundiges beskik oor genoegsame opinies omtrent kwaliteitaanwysers maar nie noodwendig oor die kennis om hulle opinies daaroor te ondersteun nie. Die studie is ook uitkoms gebaseerd omtrent die nodigheid van ‘n opleidings program met betrekking tot kwaliteits versekering in kliniese verpleegkunde te implimenteer, insluitend die vakgebied van kwaliteits aanwysers in kliniese verpleeging.
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Nadalin, Penno Letitia. "Understanding the motivation of nurses toward the continued use of an evidence-based practice in a tertiary clinical practice setting: An application of planned behaviour theory." Thesis, University of Ottawa (Canada), 2008. http://hdl.handle.net/10393/28007.
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Introduction. In the last two to three decades, research findings have gradually been permeating the culture of nursing. Increasingly, nurses are expected to integrate evidence-based practices into specific nursing policy/protocols and patient care decisions (Polit and Beck, 2004; Rogers, 2004). In truth, research utilization is dependent on nurses' actual direct or indirect use of evidence in the clinical setting (Estabrooks, 1999). To date, researchers have been able to conclude that the more positive a nurse's attitude the more likely the nurse will use research findings (Ehrenfeld & Eckering, 1991; Camiah, 1997; Estabrooks, 1999; Olade, 20203, 2004). The nursing literature reveals a dearth of studies examining nurses' "actual ongoing use" of research and the related factors/challenges affecting their continued use of research findings in clinical practice.
Purpose. Why do some nurses continue to use research while others do not where organizational policy supports the ongoing use of evidence-based practice? The purposes of this study are to validate whether nurses' are continuing to use the RNAO's Falls Risk Prevention Best Practice Guidelines (BPG) policy/protocol in 2 units of a tertiary clinical care setting, to examine practicing nurse's attitudes, beliefs and perceptions related to their intention continue to use the policy/protocol; to examine the importance of each variable (beliefs, subjective norms, perceived behavioural controls) related to their intention to continue to use the policy/protocol; and to examine nurses' perceptions and experiences regarding the facilitators, barriers and organizational structures that impact their continued use of research in their practice setting.
Methods. This survey correlation design study used Ajzen's Theory of Planned Behaviour (Godin & Kok, 1996) as a theoretical framework to examine practicing nurse's attitudes, beliefs, perceptions related to their intention to continue to use the Registered Nurse's of Ontario Association (RNAO)'s Falls Risk Prevention Best Practice Guideline (BPG) in their clinical practice.
Findings. Sixty four percent of surveyed nurses (n=22/44) report using the Falls protocol (a direct type of research) always (18%) and/or often (46%) in their clinical practice. They also reported using the Falls Protocol on their previous shift an average of 2.6 patients per nurse. The main sources of falls research education where nurses first learnt about the RNAO's BPG were during their nursing practice (46%), a form of continuing education (27%), or in a conference/seminar setting (18%). Composite mean scores related to surveyed nurses attitudes, social norm and control beliefs ranged from 1.71 to 2.43 indicating strong positive attitudes, a strong sense of social pressure and greater level of control over their ongoing use of the Falls Protocol in their daily practice. Nurses' attitudes, social and control beliefs explained 46% of the variance in intention related to its ongoing use every 3 months and 73% of ongoing use after a patient fall incidence. Surveyed nurses identified 9 facilitators and 4 potential barriers related to the ongoing use of the Falls Protocol in their clinical practice.
Conclusions. Findings reveal nurses in a tertiary care facility demonstrate 'strong generalized intentions' towards the ongoing use of the direct form of research, the Falls Risk Prevention BPG on admission, on a quarterly basis and after a patient fall incident. The 'ongoing utilization of research' in practice is definitely of interest and viewed positively by nurses in this setting despite their educational profile, limited research education and minimal exposure to in-house continuing education. This result indicates exposure to research is necessary in developing favourable attitudes towards RU. Furthermore, nurses' intention to 'continue to use' the Falls Protocol in this tertiary care facility is significantly influenced by the social expectations of referent persons and by their perceived behavioural control (PBC) beliefs. Surveyed nurses also report that three factors facilitate their 'ongoing use' of the Falls Protocol in their setting; these are congruent with those found in the literature relating to the initial adoption of research. These facilitators include: (1) providing research in a usable form; (2) attending conferences or seminars to remain current with new research related to their clinical setting; and (3) engagement in research activities such as the development, updating and implementation of the Falls BPG for use on their units.
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(9874655), L. Jamieson. "Exploration of a potential advanced nursing practice role for adult critical care settings." Thesis, 2000. https://figshare.com/articles/thesis/Exploration_of_a_potential_advanced_nursing_practice_role_for_adult_critical_care_settings/13424189.
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(9875192), S. Crane. "Participatory action research : nurses and elderly people." Thesis, 1997. https://figshare.com/articles/thesis/Participatory_action_research_nurses_and_elderly_people/13425266.
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Project "theorises the engagement in an educational participatory action research project from the localised site of a nursing home for elderly people in Victoria".. This thesis presents the theoretical and practical development of a participatory action research project from the perspective of a localised site of action, a nursing home. The research design is inductively developed by participating staff of the nursing home, both nurses and non-nurses; the design and the range of participation are both unusual features of a nursing action research project in comparison with those conducted internationally to date. The role of the 'outsider' researcher, a nursing academic and a clinical nurse, was concurrently theorised and practically developed with the changing dynamics of this research project. A process of on-going theoretical and practical analysis of the research process and action in the nursing home was achieved through the use of 'critical incidents'. 'Critical incidents' arising during this participatory action research project have been theorised through a Foucauldian view of the history of institutions and the nature of modern power (Foucault, 1977). They gave rise to new understandings of the nature of nursing in a nursing home, and paid attention to issues of power, gender and ethics within this context. Social actions within the nursing home and the research process are explored, described and considered in the change process as being gendered in production. A focus on ethics, both of self ethics within the research process and of the development of situated, negotiated ethics in relation to others' daily actions in the nursing home, is explored and theorised through some of the critical incidents. Examples of the fourteen critical incidents include the exploration of aromatherapy which formed a way of interrupting the dominant production of medical interests in social actions of the nursing home, and the challenge to new staffing and catering decisions which interrupted managerial interests. A theoretical shift in this participatory action research project, and this thesis, is to see that undertaking new action rather than reflection may be the first step in liberatory processes and that these involve altering the boundaries of self.
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Kearney, Penelope. "Reconfiguring the future : stories of post-stroke transition." 2009. http://arrow.unisa.edu.au:8081/1959.8/92288.
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Stroke recovery is complex and poorly understood. As a legacy of pervasive pessimism in the face of limited treatment, it is conceptualised and researched from biomedical and psychosocial perspectives that address impairment, problems of performance, quality of life, burden and disruption. Little stroke research is conducted once professional input has ceased, and yet considerable change occurs after this period with evidence that post-stroke wellbeing is independent of impairment and function -- many people do well in the face of poor prognoses, while others remain miserable despite 'good recovery'. Current advances in acute stroke management are generating increasing optimism, but lack of understanding about individuals' post-stroke experiences and long-term outcomes continues. While it is recognised that the impact of stroke on the lives of survivors and families is profound, rehabilitation focuses on recovery as task achievement and measured functional outcomes. For many survivors and their families 'recovery' is contested, ambiguous and extended. For some, it becomes a lifetime marathon because stroke represents an assault, not only to the body, but to the self and the lifeworld -- it is a 'life' event. This narrative inquiry into life after stroke explores recovery as a process taking place over time and conceptualised as a life transition. The work is grounded in narrative theory with the concept of transition providing the lens and focus for the research, its processes and analyses. Individuals' stories remain intact enabling evocation of diverse stroke meanings and the mapping of individual experience. Bringing these whole stories into conversation with each other elucidates post-stroke transition which is interpreted in light of theories of response to traumatic loss and informed by narrative theory. The thesis presents stories of trauma, loss and grief, situated in past lives and selves where assumptions about selves and future lives are shattered. The future makes no sense in terms of participants' past and present lives; life plots are lost and stroke therefore represents 'lost futures'. Stories of moving on to new lives are focused on being and doing in the present and have an expectant view of life. Although mindful of past lives and enduring losses, survivors actively engage in processes to reconfigure their lives with hope for a meaningful future. Transition is interpreted as 'reconfiguring the future'. The life tasks of reconfiguration are embedded in dynamic models of traumatic loss where grief is conceptualised as recursive movement between loss and meaning reconstruction evident in narratives that slowly move towards wellbeing. Despite broad recognition that loss and grief are part of the stroke experience, they are rarely addressed; where attention is paid it is likely embedded in explanatory models of staged response that oversimplify human experience. This thesis offers a new framework. It represents a fresh interpretation that highlights the ongoing traumatic impact of stroke. The post-stroke journeys of survivors and families are affected by individual circumstances and meanings. Although their stories are permeated with loss, many people move forward towards lives worth living. This interpretation suggests ways of reconfiguring lives in the face of devastation and ongoing traumatic loss. The work identifies a complex interaction of individual, emotional and social factors contributing to transitions to wellbeing following stroke and thus adds to a prospective vision of post-stroke life that can inform rehabilitation, discharge and stroke support strategies. Post-stroke transition will be enhanced when we use narrative framing and understanding to guide rehabilitative practice that uses meaning-centred models to prepare survivors and their families for a return to the lifeworld.Thesis (PhD)--University of South Australia, 2009
Book chapters on the topic "Clinical Nursing: Tertiary (Rehabilitative)"
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Furmedge, Dan. "Geriatric Medicine." In Oxford Assess and Progress: Clinical Medicine. Oxford University Press, 2019. http://dx.doi.org/10.1093/oso/9780198812968.003.0023.
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Geriatric medicine is the largest ‘medical’ specialty in the United Kingdom, with the number of geriatricians expanding at a huge rate with significant demand. Pragmatic specialists in frailty and complex co- morbidity, the work of geriatricians reaches across geriatric medicine wards, the acute medical unit, emergency departments and acute frailty units, surgical wards, and tertiary medical wards and in the community from inner city London to rural Scotland. They can be found in residential and nursing care homes, rehabilitation teams, and hospital at home teams. Frailty, falls, delirium, dementia, continence, immobility, rehabilitation, polypharmacy, nutrition, end- of- life care, advanced care planning, community medicine, and legal and ethical medicine are all core features of a geriatrician’s day. In this chapter, the questions give a taste of some of these concepts and will also demonstrate how geriatric medicine crosses almost every specialty.
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Lloyd, Marjorie. "Mental health nursing in a rehabilitation and recovery context." In Fundamentals of Mental Health Nursing. Oxford University Press, 2009. http://dx.doi.org/10.1093/oso/9780199547746.003.0012.
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In this chapter we return to the story of Anthony and his brother David, who we originally met in Chapter 4, and Joyce, who first appears in Chapter 5. Previously we considered the role of the mental health nurse in working with people experiencing acute mental health crisis. This chapter seeks to consider how as mental health nurses we might go on to work with these people to support their rehabilitation and reintegration into the community. The chapter opens by outlining some key principles of recovery and proceeds to demonstrate how these ideas might be implemented in working with both Anthony and Joyce. “The way I was feeling my sadness was mine. When I was in hospital staff rarely took time to find out what this was like for me. Not taking the time often fuelled what I was thinking: ‘I’m not worth finding out about.’ Nigel Short (2007: 23)” This service user describes how it feels to live with mental illness continuously throughout their lives, not just while they are in hospital. Professional staff may contribute to this feeling if care planning becomes too focused upon symptoms and treatment rather than person-centred care and recovery. In this context, recovery should not be seen as a new concept; rather it can be traced back at least 200 years to one of the earliest asylums, the Tuke Retreat in Yorkshire. “For it was a critical appraisal of psychiatric practice that inspired the Tuke at York to establish a clinical philosophy and therapeutic practice based on kindness, compassion, respect and hope of recovery. Roberts and Wolfson (2004: 37).” Later, during the 1960s, The Vermont Project (an American psychiatric facility) also published research on successful rehabilitative practice that was based upon ‘faith, hope and love’ (Eldred et al. 1962: 45). However, much of the current focus upon recovery practices is based on longitudinal studies in America, services in Ohio, service users were asked to identify what was important to them. This resulted in the Emerging Best Practices document that is recommended guidance in the UK today (NIMHE 2004).
Conference papers on the topic "Clinical Nursing: Tertiary (Rehabilitative)"
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Freitas, Alexandre Villela de, Arnaldo Pereira Cortez Junior, Marília Silva de Souza Takimoto, Vanessa Radavelli de Araujo, and Carolina Rosa de Araujo. "EFFECT OF THE COVID-19 PANDEMIC IN A MASTOLOGY SERVICE AT A TERTIARY HOSPITAL." In Scientifc papers of XXIII Brazilian Breast Congress - 2021. Mastology, 2021. http://dx.doi.org/10.29289/259453942021v31s1089.
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Introduction: The measures of social isolation and campaigns to combat the COVID-19 pandemic released after March 2020 and the risk of severe respiratory disease in the population older than 65 years determined a decrease in the performance of preventive tests and demand to outpatient clinics, as well as the removal of professionals in risk groups reducing the supply of care. The delay in diagnosis and initiation of treatment is considered a problem in health systems worldwide, directly impacting mortality from the disease. In force since 2012, Lawn. 12732 of the Brazilian Department of Health establishes that the first cancer treatment for SUS (Brazilian Unified Health System) patients must begin within a maximum of 60 days from the signature of the pathological report that confirms malignant neoplasia. Objectives: To evaluate the effects of the pandemic in a mastology service at a tertiary hospital of the Unified Health System (SUS) from the measurement of the interval between diagnosis and initiation of treatment, first proposed oncological, surgical (CT) or systemic (TS) treatment and the justifications pointed out when the beginning of treatment occurred in a period of more than sixty days. Methods: Cross-sectional cohort study of patients diagnosed with breast cancer between March 2019 and January 2021, divided into two groups – prepandemic and pandemic from the evaluation of data in the hospital management system (Stratec) and comparison of information between the two groups. Results: In group 1, prepandemic, from March 2019 to March 2020, 82 patients admitted, mean of 6.3 patients per month, 62 started treatment before 60 days (59TC and 3TS) and 20 after (13TC and 7TS). In group 2, pandemic, from April 2020 to January 2021, 65 patients, mean of 7.2 patients per month, 51 started treatment before 60 days (37TC and 14TS) and 14 after (11TC and 3TS), 32.3 and 27.5%, respectively. Regarding the indication of initial treatment, surgical treatment predominated in both groups, however there was an increase in the indication of systemic treatment in group 2 (17/65 vs 10/82). Among the main justifications for delay in the beginning of treatment, we identified clinical conditions of the patients, the need for a plastic surgery team and unavailability of a vacancy in the operating room in the first group, and clinical conditions of the patients and indecision to accept the therapeutic proposal in the second group. Conclusions: The reception by the nursing team to the patients at the time of diagnosis guiding the performance of preoperative examinations and consultations, availability of the operating room exclusively for emergencies, cardiac or oncological surgeries and replacement of professionals when the absence was necessary were effective measures in the maintenance of care and quality of service.