To generate a standardised definition for fundamental care and identify the discrete elements that constitute such care.There is poor conceptual clarity surrounding fundamental care. The Fundamentals of Care Framework aims to overcome this problem by outlining three core dimensions underpinning such care. Implementing the Framework requires a standardised definition for fundamental care that reflects the Framework's conceptual understanding, as well as agreement on the elements that comprise such care (i.e., patient needs, such as nutrition, and nurse actions, such as empathy). This study sought to achieve this consensus.Modified Delphi study.Three phases: (i) engaging stakeholders via an interactive workshop; (ii) using workshop findings to develop a preliminary definition for, and identify the discrete elements that constitute, fundamental care; and (iii) gaining consensus on the definition and elements via a two-round Delphi approach (Round 1 n = 38; Round 2 n = 28).Delphi participants perceived both the definition and elements generated from the workshop as comprehensive, but beyond the scope of fundamental care. Participants questioned whether the definition should focus on patient needs and nurse actions, or more broadly on how fundamental care should be delivered (e.g., through a trusting nurse-patient relationship), and the outcomes of this care delivery. There were also mixed opinions whether the definition should be nursing specific.This study has initiated crucial dialogue around how fundamental care is conceptualised and defined. Future work should focus on further refinements of the definition and elements with a larger, international group of practising nurses and service users.The definition and elements, through ongoing refinement, will contribute to a robust evidence base that will underpin policy development and the systematic and effective teaching, delivery, measurement and evaluation of fundamental care.
To explore the accuracy with which nursing students can identify the fundamentals of care.A challenge facing nursing is ensuring the fundamentals of care are provided with compassion and in a timely manner. How students perceive the importance of the fundamentals of care may be influenced by the content and delivery of their nursing curriculum. As the fundamentals of care play a vital role in ensuring patient safety and quality care, it is important to examine how nursing students identify these care needs.Cross-sectional descriptive design.A total of 398 nursing students (pre- and postregistration) from universities in Sweden, England, Japan, Canada and Australia participated. The Fundamentals of Care Framework guided this study. A questionnaire containing three care scenarios was developed and validated. Study participants identified the fundamentals of care for each of the scenarios. All responses were rated and analysed using ANOVA.The data illustrate certain fundamentals of care were identified more frequently, including communication and education; comfort and elimination, whilst respecting choice, privacy and dignity were less frequently identified. The ability to identify all the correct care needs was low overall across the pre- and postregistration nursing programmes in the five universities. Significant differences in the number of correctly identified care needs between some of the groups were identified.Nursing students are not correctly identifying all a patient's fundamental care needs when presented with different care scenarios. Students more frequently identifying physical care needs and less frequently psychosocial and relational needs. The findings suggest educators may need to emphasise and integrate all three dimensions.To promote students' ability to identify the integrated nature of the fundamentals of care, practising clinicians and nurse educators need to role model and incorporate all the fundamental care needs for their patients.
Argon plasma coagulation (APC) and topical formalin have both been shown to be effective in the treatment of radiation proctitis. Aim To compare APC with topical formalin in the treatment of rectal bleeding due to radiation proctitis in a prospective randomised trial. Methods Nineteen treatment‐naive patients (17 M ) with proven radiation proctitis and troublesome rectal bleeding were randomised to receive day‐case APC or 4% topical formalin. A visual analogue scale (VAS) was used to assess rectal bleeding (0–10; 0 = no bleeding, 10 = severe bleeding) and well being (0–10; 0 = very unwell, 10 = very well). Anorectal function (urgency, incontinence) was assessed with the modified Wexner/Cleveland Continence Score (0–24; 0 = normal anorectal function, 24 = complete incontinence with severe urgency). Hemoglobin (Hb) and transfusion requirements were recorded. Treatment was given at 6‐weekly intervals until rectal bleeding had improved to VAS ≤ 2.5. Results [Table, median (range)] The effects of APC and topical formalin were similar, with significant improvement in rectal bleeding after a median of 2 (1–3) treatment sessions. Haemoglobin increased in patients treated with APC. Four patients were transfusion‐dependent before treatment, all of whom did not require transfusions after treatment (three APC, one formalin). Patient well‐being and continence score did not change significantly after either treatment, although a trend was seen in well‐being score after APC. Two patients treated with APC developed minor rectal strictures, which were readily treated with dilatation. Conclusions Argon plasma coagulation and topical formalin are equally effective in reducing rectal bleeding from radiation proctitis. Risk of rectal strictures may be higher after thermocoagulation with APC. APC Pre‐treatment Post‐treatment Formalin Pre‐treatment Post‐treatment Well‐being score 6.8 (5–9.7) 7.5 (5–10) 5.9 (4.9–8.7) 6 (2.5–9.1) Bleeding score 6 (4–7.6) 1.4 (0–2.5) * 5 (4.6–10) 1.5 (0–2.5) * Continence score 7.5 (3–18) 7.5 (0–17) 6 (1–17) 6 (1–13) Haemoglobin (g/L) 120.5 (71–159) 135.5 (82–164) * 143 (82–164) 144 (116–167) Follow‐up (weeks) 45.5 (22–114) 27 (9–100) P < 0.05.
There is no simple, single treatment for schizophrenia and present approaches are based on clinical research and experience. Pharmacotherapy is the most common treatment for schizophrenia; however, unwanted side-effects are often problematic, and medications do not provide important coping skills. These skills are provided through forms of psychotherapy. Psychotherapy has been examined from a range of perspectives, including the effectiveness of group and individual treatments on behaviours and symptoms of schizophrenia. This review reports on the effectiveness of forms of group and individual therapy.The objective of this review was to present the best available information on the use of group therapy and individual therapy in the treatment of schizophrenia. This review summarises the findings of all relevant studies relating to these interventions. This review attempted to answer the question: which is more effective in improving symptoms in patients with schizophrenia, group or individual therapy?The review included adult patients with schizophrenia. Interventions of interest were forms of group and individual therapy aimed at lessening the symptoms of schizophrenia. For the purposes of this review, individual therapy was regarded as a one-to-one interaction between a patient and a therapist, and group therapy excluded family therapy. Studies that examined symptom reduction, including measures of mental state, quality of life and social function, were included in this review. This review attempted to determine the efficacy of group and individual therapy in the treatment of schizophrenia. Therefore, randomised or pseudo-randomised controlled trials that address the use or comparison of these treatment modalities were included. High-quality systematic reviews of evidence of effectiveness were also included.Based on the search terms used, 28 references relating to the use of some form of group or individual therapy, in the treatment of chronic schizophrenia, were identified. Of these, nine were excluded for not meeting the stated inclusion criteria and 19 were included in the analysis (17 trials and two systematic reviews). From these studies numerous treatment types were compared for the management of chronic schizophrenia. Meta-analysis was not possible given the level of heterogeneity in trial methods and measurement scales.The following recommendations are made.
There has been a tremendous growth in day surgery units to meet the demand for cost-effective healthcare. As a result of increased outpatient use of these units, procedures for administrative and clinical management have been developed. The effectiveness of the use of these protocols, however, has not been tested. This article reports on a study that examined nurses' compliance with a protocol for postprocedural vital signs measurement in a gastrointestinal day unit. The protocol's effectiveness in detecting postprocedure complications and the resource implications of the protocol were examined. The rate and type of postprocedure complications detected are also reported. Analysis of the observation data suggests staff are undertaking observations according to the protocol for most patients. Some patients appear, however, to be having their observations done outside the time frame recommended by the protocol. It is possible that staff are exercising their clinical judgement and continuing observations on some patients, though this is speculation and requires further research. Findings from the study raise questions regarding whether postprocedure monitoring is resource efficient.
Background This systematic review updates a previous review published in 2000. The objective of this review was to present the best available evidence relating to the prevention of catheter-associated urinary tract infections (UTI). Selection criteria This review considered randomised controlled trials (RCTs) of adult patients with short-term urethral catheters. In the absence of RCTs, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Interventions of interest were those related to the prevention of catheter-related UTI and included: sterile versus non-sterile insertion technique, special coatings to catheters versus standard non-coated catheters, the use of flush solutions, the use of solutions added to urinary drainage bag, maintenance of a closed urinary drainage circuit, the use of antireflux valves, antibiotic creams applied to the external meatus–catheter interface, meatal care regimens, education programs, and changed care delivery practices. This review was limited to short-term urethral catheters, and so studies evaluating long-term or suprapubic catheters were excluded. The primary outcome of interest was the difference in the rates of UTI between experimental intervention and the control. Search strategy The search included both published and unpublished studies with an initial limited search of MEDLINE and CINAHL databases undertaken to identify key words contained in the title or abstract, and index terms used to describe relevant interventions. A second extensive search used all identified key words and index terms. The third step included a search of the reference lists and bibliographies of relevant articles. The databases searched included: CINAHL, MEDLINE, Current Contents, Cochrane Library, Expanded Academic Index, and Embase. The Dissertation Abstracts International database was searched for unpublished studies. Assessment of methodological quality Methodological quality was assessed using a standardised checklist. Critical appraisal and data extraction were conducted by two independent reviewers; discrepancies were addressed through discussion with a third reviewer as required. Results There was no significant difference in infection rate using either sterile surgical or non-sterile insertion technique. The use of water for cleansing prior to catheter insertion was recommended. There was no additional benefit from specific meatal care other than standard daily personal hygiene and removal of debris. Infection rates were similar for both latex and silicone catheters. Comparisons between silver and Teflon coating clearly favoured the silver alloy coating. The use of a complex closed drainage system in the intensive care environment did not confer any additional benefit. Studies comparing types of junction seals and use of junction seals either prior to or following catheterisation found no clear benefit from using either preconnected sealed systems or sealed systems with the addition of silver releasing devices. Neither the addition of chlorhexidine nor hydrogen peroxide to the drainage bag was found to be effective at reducing UTI rates. The findings indicated there was a higher incidence of bacteriuria associated with Foley catheters compared with intermittent catheterisation (P < 0.025). A single RCT examined the effect on UTI rates of routine bag changes against no routine bag change. Routine bag changes were not advantageous in reducing the risk of infection. Conclusions Current RCT evidence suggests the use of a surgical sterile catheterisation technique is not required, and that tap water is sufficient for cleaning genitalia. Following insertion, daily hygiene around the meatal area is as effective as catheter toilets; and catheters impregnated with silver may reduce the incidence of catheter associated bacteriuria. Sealed (e.g. taped, presealed) drainage systems should not be relied upon as the sole mechanism for prevention of bacteriuria. The addition of antibacterial solutions to drainage bags and the routine change of drainage bags had no effect on catheter associated infection. However, most of the recommendations arising from this review were based on single studies, often with limited numbers of participants. There is an urgent need to replicate these studies in other clinical settings.
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