A list of 266 abbreviations from dieticians' notes in patient records was used to extract the same abbreviations from patient records written by three professions: dieticians, nurses and physicians. A context analysis of 40 of the abbreviations showed that ambiguous meanings were common. Abbreviations used by dieticians were found to be used by other professions, but not always with the same meaning. This ambiguity of abbreviations might cause misunderstandings and put patient safety at risk.
This paper is a report of a study to identify the patterns of prescribing by primary health care nurse practitioners for a cohort of older adults.
The older adult population is known to receive complex pharmacotherapy. Monitoring prescribing to older adults can inform quality improvement initiatives. In comparison to other countries, research examining nurse practitioner prescribing in Canada is limited. Nurse practitioner prescribing for older adults is relatively unexplored in the international literature. Although commonly used to study physician prescribing, few studies have used claims data from drug insurance programmes to investigate nurse practitioner prescribing.
Drug claims for prescriptions written by nurse practitioners from fiscal years 2004/05 to 2006/07 for beneficiaries of the Nova Scotia Seniors' Pharmacare programme were analysed. Data were retrieved and analysed in May 2008. Prescribing was described for each drug using the World Health Organization Anatomical Therapeutic Chemical code classification system by usage and costs for each fiscal year.
Antimicrobials and non-steroidal anti-inflammatory drugs consistently represented the top ranked groups for prescription volume and cost. Over the three fiscal years, antimicrobial prescription rates declined relative to rates of other groups of medications. Prescription volume per nurse doubled and cost per prescription increased by approximately 20%.
Prescription claims data can be used to characterize the prescribing trends of nurse practitioners. Research linking patient characteristics, including diagnoses, to prescriptions is needed to assess prescribing quality. Some potential areas of improvement were identified with antimicrobial and non-steroidal antiinflammatory selection.
Department of Social and Welfare Studies, Faculty of Health Sciences, University of Linköping, Campus Norköping, SE 60174 Norrköping, Sweden. evato@isv.liu.se
The aim was to implement and evaluate a standardised nursing record, using patients with leg ulcer as an example, regarding the content of the nursing record and district nurses' experiences of documentation.
This was a prospective, stratified and randomised intervention study, with one intervention group and one control group. A standardised nursing wound care record was designed and implemented in the electronic patient record in the intervention group for a period of 3 months. Pre- and post-intervention audits of nursing records [n=102 and n=92, respectively] were carried out and 126 district nurses answered questionnaires pre-intervention and 83 post-intervention.
The standardised nursing wound care record led to more informative, comprehensive and knowledge-intensive documentation according to the audit and district nurses' opinions. Furthermore, the district nurses' self-reported knowledge of nursing documentation increased in the intervention group. When the standardised nursing wound care record was not used, the documentation was mostly incomplete with a lack of nursing relevance. There were no differences in the district nurses' experiences of documentation in general between the two groups.
Using the standardised nursing wound care record improved nursing documentation meeting legal demands, which should increase the safety of patient. There was however a discrepancy between the nurses stated knowledge and how they carried out the documentation. Regular in-service training together with use of evidence based standardised nursing records, as a link to clinical reasoning about nursing care, could be ways effecting change.
It is well documented that nursing is concerned about the social support needs of older adults and the effects of those needs on health and well-being. Using survey data from the Atlantic Seniors Housing Research Alliance, the authors explore the emotional and informational social support needs of community-dwelling Canadians aged 65 and older living in the Atlantic provinces. The results indicate that these needs are not being met fully and that they increase with age. Also, men and women report different insufficiencies for specific needs; more men than women report having no support across all items. Nurses should be sensitive to specific age and gender support needs of older adults. They should also increase their social assessments and promote healthy social networks, especially for those 80 years and older. Further nursing research is recommended.
In 2000 more than one-quarter of the Alberta RN labour force was older than 50 years of age, while close to one-half was between 36 and 50 years of age. While this age distribution denotes a mature RN cadre, with considerable valuable practice experience, it also signals a need for an increased number of new RN graduates to replace those soon to be retiring. Although possibly age-related, the proportion of Alberta RNs working regular full-time is less than half--only 45 per cent. Concomitantly, more than half of all Alberta RNs are employed casually and part-time. Especially in a time of RN shortage, reasons for such limited full-time employment warrant examination. As in the past, three-quarters of Alberta RNs work in institutional settings--hospitals and nursing homes--while only eight per cent work in community health. The shift to health promotion and disease prevention has yet to happen in Alberta. In 2000, almost 80 per cent of all Alberta RNs were employed in direct care giving, and less than 10 per cent were employed in management, administration and education. In 2000, almost two-thirds of all Alberta RNs held a diploma in nursing. Of the slightly more than 8,000 Alberta RNs with a baccalaureate degree, the overwhelming majority--85 per cent--worked in direct patient care, and only 13 per cent were employed in administration and teaching. Increasingly, we can expect to see more RNs with baccalaureate degrees at the bedside, in part because of the recent significant shift toward new graduates entering practice with a degree. Since 1997, the number of new RNs entering practice with a degree has been four times greater than the number entering with a diploma. Increased government funding of degree nursing programs aimed at alleviating the current nursing shortage means this trend will continue.
BACKGROUND: Developed countries are experiencing a dramatic increase in the proportion of elderly persons, as well as a progressive aging of the elderly population itself. Knowledge regarding the amount of formal and informal care and its interaction at population-based level is limited. OBJECTIVES: To describe the amount of formal and informal care for non-demented and demented persons living at home in a population-based sample. METHODS: The population consisted of all inhabitants, 75 + years, living in a rural community (n = 740). They were clinically examined by physicians and interviewed by nurses. Dementia severity was measured according to Washington University Clinical Dementia Rating Scale (CDR). Informal and formal care was examined with the RUD (Resource Utilization in Dementia) instrument. RESULTS: The amount of informal care was much greater than formal care and also greater among demented than non-demented. There was a relationship between the severity of the cognitive decline and the amount of informal care while this pattern was weaker regarding formal care. Tobit regression analyses showed a clear association between the number of hours of informal and formal care and cognitive decline although this pattern was much stronger for informal than formal care. CONCLUSIONS: Informal care substitutes rather than compliments formal care and highlights the importance of future studies in order to truly estimate the amount of informal and formal care and the interaction between them. This knowledge will be of importance when planning the use of limited resources, and when supporting informal carers in their effort to care for their intimates.
Smoking is still a problem, particularly among diploma student nurses. Strategies aimed at prevention and cessation need to be developed with emphasis on the motivation to quit rather than new cessation techniques. School curricula should address not only knowledge, but also attitudes and skills required to assist in the tobacco reduction effort.
Night work has been reported to be associated with various mental disorders and complaints. We investigated relationships between night work and anxiety, depression, insomnia, sleepiness and fatigue among Norwegian nurses.
The study design was cross-sectional, based on validated self-assessment questionnaires. A total of 5400 nurses were invited to participate in a health survey through the Norwegian Nurses' Organization, whereof 2059 agreed to participate (response rate 38.1%). Nurses completed a questionnaire containing items on demographic variables (gender, age, years of experience as a nurse, marital status and children living at home), work schedule, anxiety/depression (Hospital Anxiety and Depression Scale), insomnia (Bergen Insomnia Scale), sleepiness (Epworth Sleepiness Scale) and fatigue (Fatigue Questionnaire). They were also asked to report number of night shifts in the last 12 months (NNL). First, the parameters were compared between nurses i) never working nights, ii) currently working nights, and iii) previously working nights, using binary logistic regression analyses. Subsequently, a cumulative approach was used investigating associations between NNL with the continuous scores on the same dependent variables in hierarchical multiple regression analyses.
Nurses with current night work were more often categorized with insomnia (OR = 1.48, 95% CI = 1.10-1.99) and chronic fatigue (OR = 1.78, 95% CI = 1.02-3.11) than nurses with no night work experience. Previous night work experience was also associated with insomnia (OR = 1.45, 95% CI = 1.04-2.02). NNL was not associated with any parameters in the regression analyses.
Nurses with current or previous night work reported more insomnia than nurses without any night work experience, and current night work was also associated with chronic fatigue. Anxiety, depression and sleepiness were not associated with night work, and no cumulative effect of night shifts during the last 12 months was found on any parameters.
Notes
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