Perbandingan Model Asuhan Keperawatan Profesional Tim dengan Primary Nursing dalam Peningkatan Kualitas Asuhan Keperawatan di Rumah Sakit Kota Medan

The development of science and technology that continues to progress, especially in the health sector requires changes in terms of service so that in providing more professional services in hospitals, nursing care must be of high quality. Nursing Law Number 38 of 2014 Article 3B states that nursing arrangements aim to improve the quality of nursing services, therefore the provision of quality nursing services is important in today's health services. The model of professional nursing care is divided into several models, namely primary, team and case nursing. Based on the results of a survey of research journals, the researchers concluded that there was no research that compared the professional nursing care team model with primary nursing in improving the quality of nursing care. The purpose of this study was to identify the use of the professional nursing care team model with the primary nursing model in improving the quality of nursing care. This type of research is a quantitative research type with a comparative design. The population in this study were all patients at the Inpatient Hospital where the study was conducted. The sampling technique used was purposive sampling technique. Data collection on the quality of nursing care used a quality scale patient assessment instrument – the acute care version (PAQS-ACV). This instrument was developed to assess the quality of nursing care. Data analysis in this study used an independent t-test. normality test using the Kolmorogov-Smirnov test with a significance value (p > 0.05). The results showed that there was a significant difference between the quality of nursing care in the team group and the quality of nursing care in the primary nursing group where the value of sig (2-tailed) was 0.008 where > 0.05, the results also showed that based on the results of the frequency distribution test the quality of nursing care was using the team model and the primary nursing model has a high majority value of nursing care quality, but there is a difference in the average value (mean) where the quality of nursing care in the nursing care model group in the team method group is 144.86 and the quality of nursing care in the primary nursing model group is 155.83. These results indicate that the quality of nursing care with the primary nursing model has a higher quality of care value than the group nursing care model with the team method. Based on the results of this study, it is recommended that hospitals can apply a professional nursing practice model, especially the primary nursing model to further improve the quality of nursing care provided.

Obtaining an accurate maternal blood pressure: A quality improvement initiative to improve nursing knowledge and confidence

Background: Inaccurate assessment of maternal blood pressure (BP) contributes to misdiagnosis of hypertension, unnecessary or missed interventions, and maternal morbidity. This study examines obstetric nursing knowledge and confidence in proper assessment of maternal BP before and after an institutional quality improvement project.Methods: We implemented an online educational initiative in our women’s health unit based on the American Heart Association’s Blood Pressure Improvement Program. Simultaneously, a standard assessment of BP cuff sizing by arm measurement was implemented. We conducted a pre- and post-intervention assessment of nursing knowledge and confidence of BP measurement. Responses were analyzed using the χ2 test, two-sample t test, ordinary least squares and logistic regression.Results: A total of 145 nurses completed the pre- and 68 completed the post-intervention assessments. Participants answered 62% of pre- and 73% of post-intervention questions correctly (p < .001). Before implementation, 86.9% of participants reported feeling very or extremely confident in obtaining an accurate BP measurement, increasing to 98.5% following (p = .007). 73.8% of pre-intervention respondents reported feeling very or extremely confident in choosing an appropriate BP cuff compared to 96.3% post (p < .001). Following implementation, confidence levels were similar irrespective of years in practice, years of experience at our hospital, and primary nursing unit.Conclusions: A BP educational initiative and standardized BP cuff assessment increased nurses’ knowledge and confidence in selecting the correct cuff size and obtaining accurate readings. Increased knowledge and confidence may lead to greater adherence to standardized BP assessment during peripartum admission, more accurate BP measurements, and improved management of hypertensive disorders in pregnancy.

Exploring hospital compliance with the primary nursing care model: validating an inventory using the Delphi method

Background The primary nursing care model is considered a personalized model of care delivery based on care continuity and on the relationship between the nurse and patient. Primary nursing checklists are not often mentioned in the literature; however, they represent a valid instrument to develop, implement, and evaluate primary nursing. The aim of this study was to create a structured checklist to explore hospital compliance in primary nursing. Methods The Delphi method was used to develop and validate a checklist. The preliminary version was created and sent to three experts for their opinions. Their comments were ultimately used in the first version, which included four components with 19 items regarding primary nursing characteristics. A two-round Delphi process was used to generate consensus items. The Delphi panel consisted of six experts working in primary nursing contexts and/or teaching or studying primary nursing. Data were collected using a structured questionnaire from July 2020 to January 2021. These experts were asked to rate each element for relevance using a 4-point Likert-type scale. Furthermore, the consensus among the panel of experts was set at ≥78%, with selected items being voted “quite relevant” and “highly relevant”. Content validity index (I-CVI) and modified kappa statistic were also calculated. Following expert evaluation, the first version of the checklist was modified, and the new version, constituting 17 items, was sent to the same experts. Results The first version of the checklist demonstrated a main relevance score of 3.34 (SD = 0.83; range = 1.3–4; mean I-CVI = 0.84; range: 0.83–1), but three items did not receive an adequate I-CVI score, that is, lower than 0.78. After the second round, the I-CVIs improved. The main score of relevance was 3.61 (SD: 0.35; range = 2.83–4; mean = I-CVI: 0.93). The S-CVI/UA was 0.58, and the S-CVI/Ave was 0.93. Conclusion Measuring primary nursing compliance should be implemented to provide continuous feedback to nurses. Moreover, utilizing valid checklists could permit comparing different results from others’ research. Future research should be conducted to compare the results from the checklist with nursing outcomes.

More Thoughts About Models of Nursing Practice Delivery

This is the second of two essays about five models of nursing practice delivery—total patient care, functional nursing, team nursing, primary nursing, and the attending nurse. Primary nursing and the attending nurse are discussed in this essay. The other three models were discussed in a previous issue of Nursing Science Quarterly. Each model is described and its connection with nursing discipline-specific knowledge is discussed. The extent to which each model ascribes accountability for practice also is discussed.

Orientações educativas de enfermagem na alta hospitalar de paciente neurosequelado: relato de experiência

Objetivo: Descrever a experiência com as orientações educativas de alta hospitalar sob a perspectiva de uma enfermeira inserida no modelo Primary Nursing. Método: Relato desenvolvido a partir da vivência profissional em uma clínica médica de unidade hospitalar em São Luís, Maranhão, de janeiro a dezembro de 2020. As orientações educativas de enfermagem ocorriam através de treinamentos com os cuidadores e familiares dos pacientes, previamente à alta. Resultados: As informações eram repassadas de forma dialogada, priorizando o familiar e/ou cuidador que seria mais presente no domicílio, enfatizando orientações educativas de enfermagem relacionadas aos cuidados gerais com a pele, cuidados com a traqueostomia, gastrostomia ou jejunostomia, administração de dieta enteral e de medicamentos. Conclusão: O planejamento das orientações educativas na alta hospitalar são atribuições importantes do enfermeiro primário, promovendo a continuidade do cuidado e segurança por parte dos cuidadores em realizar assistência aos pacientes neurosequelados no ambiente domiciliar.

Clinical and functional impact of cognitive fluctuations in dementia

Cognitive fluctuations (CFs) are defined as spontaneous alterations in cognition, attention, and arousal, and are highly prevalent and disabling among people with dementia. CFs occur with a frequency of 80-90% in dementia with Lewy bodies (DLB), 40% in vascular dementia (VaD), and 20% in Alzheimer’s disease (AD). While CFs have been recognized as an important component of dementia, the majority of studies examining them have lacked objective methods of assessing their presence and severity, making it difficult to determine the degree of interference with other clinical features that can be attributable to fluctuations. The present study examined the nature and frequency of CFs in 55 individuals with dementia living in a long-term care facility. Participants underwent neuropsychological assessment to profile their current cognitive functioning. The Dementia Cognitive Fluctuation Scale (DCFS) was used to characterize CFs in this sample. Patients also completed brief cognitive measures on three separate occasions during a one-week period to obtain objective evidence of variability in cognitive performance. This study also assessed the association between CFs and informant based measures of patients’ quality of life, activities of daily living, and formal caregiver burden. Longitudinal cognitive data was analyzed retrospectively to determine patients’ rate of cognitive decline over the past six months. Consistent with the limited research already completed in this area, this study found that increasing severity of CFs predicts lower cognitive performance and reduced ability to complete activities of daily living. Also, this is the first study to demonstrate that CFs predict patients’ overall quality of life and the degree of caregiver burden in primary nursing staff. Results of the current study suggest that CFs exert a broad range of influence over patients’ functional abilities and well being. Identifying which patients experience CFs could play an important role in developing individualized treatment plans best suited for patients specific care needs.

Clinical and functional impact of cognitive fluctuations in dementia

Cognitive fluctuations (CFs) are defined as spontaneous alterations in cognition, attention, and arousal, and are highly prevalent and disabling among people with dementia. CFs occur with a frequency of 80-90% in dementia with Lewy bodies (DLB), 40% in vascular dementia (VaD), and 20% in Alzheimer’s disease (AD). While CFs have been recognized as an important component of dementia, the majority of studies examining them have lacked objective methods of assessing their presence and severity, making it difficult to determine the degree of interference with other clinical features that can be attributable to fluctuations. The present study examined the nature and frequency of CFs in 55 individuals with dementia living in a long-term care facility. Participants underwent neuropsychological assessment to profile their current cognitive functioning. The Dementia Cognitive Fluctuation Scale (DCFS) was used to characterize CFs in this sample. Patients also completed brief cognitive measures on three separate occasions during a one-week period to obtain objective evidence of variability in cognitive performance. This study also assessed the association between CFs and informant based measures of patients’ quality of life, activities of daily living, and formal caregiver burden. Longitudinal cognitive data was analyzed retrospectively to determine patients’ rate of cognitive decline over the past six months. Consistent with the limited research already completed in this area, this study found that increasing severity of CFs predicts lower cognitive performance and reduced ability to complete activities of daily living. Also, this is the first study to demonstrate that CFs predict patients’ overall quality of life and the degree of caregiver burden in primary nursing staff. Results of the current study suggest that CFs exert a broad range of influence over patients’ functional abilities and well being. Identifying which patients experience CFs could play an important role in developing individualized treatment plans best suited for patients specific care needs.

Healthcare in a pure gatekeeping system: utilization of primary, mental and emergency care in the prison population over time

Background This study investigates the prisoner and prison-level factors associated with healthcare utilization (HCU) and the dynamic effects of previous HCU and health events. We analyze administrative data collected on annual adult prisoner-stay HCU (n = 10,136) including physical and mental chronic disease diagnoses, acute health events, penal circumstances and prison-level factors between 2013 and 2017 in 4 prisons of Canton of Vaud, Switzerland. Utilization of four types of health services: primary, nursing, mental and emergency care; are assessed using multivariate and multi-level negative binomial regressions with fixed/random effects and dynamic models conditional on prior HCU and lagged health events. Results In a prison setting with health screening on detention, removal of financial barriers to care and a nurse-led gatekeeping system, we find that health status, socio-demographic characteristics, penal history, and the prison environment are associated with HCU overtime. After controlling for chronic and past acute illnesses, female prisoners have higher HCU, younger adults more emergencies, and prisoners from Africa, Eastern Europe, and the Americas lower HCU. New prisoners, pretrial detainees or repeat offenders utilize more all types of care. Overcrowding increases primary care but reduces utilization of mental and emergency services. Higher expenditure on medical staff resources is associated with more primary care visits and less emergency visits. The dynamics of HCU across types of care shows persistence over time related to emergency use, previous somatic acute illnesses, and acting out events. There is also evidence of substitution between psychiatric and primary care. Conclusions The prison healthcare system provides an opportunity to diagnose and treat unmet health needs for a marginalized population. Access to psychiatric and chronic disease management during incarceration and prevention of emergency or acute events can reduce future demand for care. Prioritization of high-risk patients and continuity of care inside and outside of prisons may reduce public health pressures in the criminal system. The prison environment and prisoners’ penal circumstances impacts healthcare utilization, suggesting better coordination between the criminal justice and prison health systems is required.

Work Methods for Nursing Care Delivery

This article analyzes the work methods based on care design, identification of needs, care organization, planning, delivery, evaluation, continuity, safety, and complexity of care, and discharge preparation. It describes the diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation that contribute to adopting a given work conception and/or method for nursing care delivery. Later, the concepts underlying the several methods—management theories and theoretical nursing concepts—are presented, with reference to relevant authors. The process of analysis and selection of the method is explained, highlighting the importance of diagnosis of the situation, goal setting, strategy selection, implementation, and outcome evaluation. The importance of various elements is highlighted, such as structural aspects, nature of care, target population, resources, and philosophy of the institution, which may condition the adoption of a method. The importance of care conceptualization is also underlined. The work methods are presented with a description of the key characteristics, advantages, and disadvantages of the task-oriented method (functional nursing) and patient-centered methods: individual, team nursing, and primary nursing. A critical and comparative analysis of the methods is then performed, alluding to the combination of person-centered methods.

Primary nursing: a Varese un Progetto sinergico tra infermieri e medici per aumentare l’adesione terapeutica dei pazienti nefropatici

The World Health Organization (WHO) defines therapeutic adherence as “the extent to which a patient’s behavior – in taking medications, following a diet and/or making lifestyle changes – corresponds to the recommendations of health professionals in charge”.Chronic disease is permanent and requires by the patient an active attitude to reach and maintain a state of well-being, and to be often subject to long periods of supervision, observation and care.Trust must therefore be established between patient and healthcare professionals.This is the reason why it is not correct to discuss compliance. The main difference is that therapeutic adherence requires the patient’s agreement with the prescriptions: patients should be an active partner in their own care and communication between the patient and healthcare professionals is required for an efficient clinical practice.