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Biomedical subjects

J Wilson-Barnett

Publications and source records attributed to J Wilson-Barnett.

At least 37 records · Page 2Linked to original sources
PubMed1998

The effectiveness of 'nursing beds': a review of the literature.

A literature search was conducted to identify 'nursing led in-patient units' where the nurse is the designated leader of the clinical team. The review concentrates on studies which have attempted to measure the impact of nursing-led in-patient units and reviews both the methodology and outcomes. Three major bodies of work were identified. Lydia Hall's evaluation of the Loeb Center for Nursing and Rehabilitation (USA) is reviewed in some detail. This work was the model for 'nursing beds' at the two Oxfordshire Nursing Development Units (UK) in the 1980s. Studies evaluating these centres are reviewed and reports of similar UK units discussed. A third body of work evaluates a nurse-managed critical care environment. Common features include a case mix based on nursing need with nurses having authority to admit and discharge patients. While results are generally favourable, with improved patient independence, fewer readmissions, lower mortality and cost savings reported in some or all of the studies, all studies reviewed demonstrate the difficulties of applying an experimental model to real life clinical services. Methodological limitations render firm conclusions difficult. Techniques adopted from studies in field settings, the so-called 'quasi-experiment', are advocated as a remedy, as is further study of the process of care in investigating this model of care delivery.

England↗
PubMed1998

Fatigue in patients receiving chemotherapy: patterns of change.

Fatigue is reported to be a significant and distressing problem for people receiving chemotherapy, but the phenomenon is poorly understood and little is known about the factors influencing it. Nurses need to understand the dimensions of fatigue in order to provide effective help for individuals with cancer who experience it. This article describes a study that employed a daily diary with the aim of prospectively charting the onset, pattern, duration, intensity, and distress associated with fatigue in 109 patients receiving chemotherapy. The diary comprised four visual analogue scales measuring selected dimensions of fatigue: extent of fatigue, distress caused by fatigue, the influence of fatigue on the ability to engage in social activities, and the impact of fatigue on work-related activities. The patients' diaries produced detailed time series of data that captured the dynamics of their fatigue. Analyses of these data revealed the patterns of fatigue after the administration of chemotherapy, which appear strongly related to both the timing of treatment and the manner in which cytotoxic agents are administered. Furthermore, Kruskal-Wallis tests performed to compare fatigue among subgroups of patients revealed that it is statistically associated with particular types of cancer, specific chemotherapy regimens, and certain methods of drug administration. Fatigue varied throughout the day, more frequently occurring in the afternoon and early evening. These insights, gained during this study about the likely pattern of fatigue in the period after the administration of chemotherapy, and the potential benefits of maintaining a fatigue diary could be utilized by nurses engaged in the care of chemotherapy patients.

Activities of Daily Living↗
PubMed1998

Positioning of stroke patients: evaluation of a teaching intervention with nurses.

BACKGROUND AND PURPOSE: There is agreement, although little evidence, that consistently positioning stroke patients in allegedly reflex-inhibiting positions is therapeutic and will enhance functional recovery. The nursing staff, therefore, needs to know and implement these postures and understand their potential underlying value. We examined nurses' knowledge of and practice in positioning stroke patients before and after a formal teaching intervention. METHODS: In a quasi-experimental study, 38 stroke patients and 59 nursing staff members (44 trained nurses and 15 healthcare assistants) from 6 wards were studied. The wards were randomly allocated to experimental or control status. Patients were assessed on entry into the study by use of a range of measures to establish group equivalence. Nineteen aspects of their position were documented at intervals throughout their stay with a previously developed observational tool. One thousand sets of observations of patient position were made. Using 2 questionnaires, the nurses' knowledge of the terminology used to denote posture and of issues relating to the moving and positioning of stroke patients was assessed before, immediately after, and 3 months after a package of formal teaching was implemented on the experimental wards. Nurse knowledge and patient position were used as the main outcome measures. RESULTS: Immediately after teaching, nurses in the experimental group scored significantly higher than those in the control group on the terminology questionnaire (P < 0.05) and the moving and positioning questionnaire (P < 0.001). Three months later, the experimental group scored higher on the latter questionnaire only (P < 0.005). The positioning of patients in the experimental group was improved overall after the teaching (P < 0.0005), and improvements to specific parts of the body were noted. CONCLUSIONS: It was possible to effect a degree of change in the nurses' knowledge of and practice in the positioning of stroke patients. However, the quality of patient positioning remained variable. More effective ways of improving positioning need to be developed. Only then can the effects of recommended positioning be evaluated.

Aged↗
PubMed1996

Nurses' infection-control practice: hand decontamination, the use of gloves and sharp instruments.

Infection is an acknowledged hospital problem. Micro-organisms are disseminated mainly via hands but there is evidence that hand decontamination, the most important means of prevention, is performed too seldom, and not always after activities likely to result in heavy contamination. Nurses themselves are exposed to risks of infection, chiefly through contact with blood and body fluids, yet it has also been reported that gloves are not always worn during contact with patients' secretions and that the handling and disposal of sharp instruments may be performed unsafely. The study reported in this paper documents nursing behaviour in relation to hand decontamination, the use of gloves and sharps, taking into consideration a number of variables which could influence practice: availability of the expertise afforded by an infection-control nurse, clinical setting, nursing workload, knowledge and the resources available to control infection. Hands were decontaminated after 28.78% of patient contacts. Hands were decontaminated after 49.85% of activities likely to result in heavy contamination. Performance was related to nursing workload and the availability of hand decontaminating agents, especially when the nurses became busy. Use of gloves when they were available also proved good, with little evidence of wasteful use. The handling and disposal of sharps were commendable for most subjects but a few grossly unsafe incidents were nevertheless witnessed, apparently not associated with any of the variables examined.

Analysis of Variance↗
PubMed1995

The impact of perceived medical dominance on the workplace satisfaction of Australian and British nurses.

Current literature on the sociology of health views medical dominance as a structural feature of the health division of labour, and a body of literature has developed exploring the structural components contributing to the subordination of the allied health professions. In this paper, nursing literature describing the nature and source of nurses' perceptions, complaints and dissatisfactions with their profession, and sociological analyses of the position of nurses within the structure of the health care delivery system, were employed to provide a framework for assessing the degree to which structural medical dominance of the nursing profession impinges on nurses' perceptions of dominance and how these perceptions affect nurses' workplace satisfaction. A 69-item questionnaire covering aspects of doctor-nurse, doctor-patient, nurse-patient and nurse-hospital administration relationships was developed. One-hundred and thirty-three Australian nurses and 108 British nurses completed the questionnaire, in which they ranked their own level of professional satisfaction and the level of satisfaction they perceived doctors to experience. Results indicated that Australian and British nurses were not only dissatisfied with many aspects of their work environment, such as their pay and working conditions, but also experienced dissatisfaction with their professional status while perceiving the medical profession to be highly satisfied. British nurses were significantly more dissatisfied with their own profession and perceived the medical profession to be more authoritarian than did Australian nurses. No difference between Australian and British nurses' perceptions of degree of medical autonomy was found. The implications of nurses' perceived discrepancy in workplace satisfaction between nurses and doctors in the delivery of health care are discussed in terms of the structural barriers created by medical dominance. Recommendations for the training of nurses and the implications of the findings for nurse practitioners are made, together with suggestions for further research.

Adult↗
PubMed1995

Clinical support and the Project 2000 nursing student: factors influencing this process.

This paper reports on research commissioned by the English National Board for Nursing, Midwifery and Health Visiting into mentorship and clinical support arrangements for Project 2000 nursing students in the adult and mental health branches. Interviews and observation data were gathered from staff and students in three of the demonstration centres. Findings showed that the terms 'mentorship', 'assessor' and 'supervisor' were used interchangeably and covered diverse roles in both clinical and community settings. Generally there was an impression that staff were willing to help students learn from their experience but felt unprepared for the 'new nursing students'. Several factors emerged which seemed either to promote satisfactory experiences for students or inhibit their learning and enjoyment of the placement. These are discussed under the themes 'supernumerary status', 'team spirit', 'theory and practice', 'diploma level practice' and 'organization of nursing teams'.

Education, Nursing↗
PubMed1995

HIV and AIDS care: consumers' views on needs and services.

Increasing numbers of people suffer from HIV infection, in many sectors of society. However, the extent to which health care services meet their needs is open to question. This study aimed to gather consumer views and assess the extent to which care was adequate, through interviews with 85 clients. Their responses were then compared with those of service providers (published in this journal 2 years ago). Overall there was a general expression of appreciation and satisfaction, although in many cases financial and social deprivation was so extreme that it appeared that established services could not compensate. However, the need for better housing and more confidentiality of records was emphasized. The need for greater security from the consequences of prejudice was felt strongly and many distressing incidents were recounted. The major contrast between consumers' and service providers' views focused on whether separate and specialist provision was required. Providers were aware that care would need to be integrated with other generalist services in the future in order to cope with the scale of need, while consumers were keen to retain specialist clinics and wards to protect their confidentiality and sustain the level of expertise they appreciated. Within this sample, however, minority groups wished to have their particular needs recognized, in particular women with children and heterosexual males resented being grouped with the majority group of consumers with HIV/AIDS.

Activities of Daily Living↗
PubMed1994

Evaluating the clinical nurse specialist. A review.

This paper reviews evaluative studies on the role of clinical nurse specialists and aims to describe and categorise research according to the methods used. By using the structure, process and outcome framework a clear pattern of research development and evidence emerges. It appears that significant benefits accrue for patients from the contribution of nurse specialists, but more experimental studies with combined methods should now be applied to this area.

Cost-Benefit Analysis↗
PubMed1993

Evaluation of services for people with HIV/AIDS in an inner-city health authority: perspectives of key service providers.

This paper reports the findings of the first phase of a study designed to assess the needs of people with HIV and AIDS and the extent to which these needs are being met by services in Camberwell Health Authority in inner London. The study involves collecting information and opinions from key service providers, clients with HIV/AIDS and their informal carers. It is the service provider data which will be presented here. Semi-structured interviews were conducted with 47 key service providers involved in the care and support of people with HIV/AIDS in the Camberwell Health District. Respondents were drawn from the local health services, local social services departments and a number of locally active voluntary organizations. The aim was to gather respondents' views on their individual roles and the roles of the organizations they represented, the health and social needs of people with HIV/AIDS and the extent to which these were being met by current service provision and the co-ordination of services for people with HIV/AIDS. The data showed that a broad range of services were utilized by people with HIV/AIDS, reflecting a wide variety of health and social care needs. The majority of respondents felt that some of the needs of people with HIV/AIDS were similar to those of people living with other chronic illnesses (such as cancer). However, they also identified a number of problems which were either unique or more severe for people with the virus. Services for people with HIV/AIDS were generally felt to be poorly co-ordinated and a number of areas of overlap and gaps in service provision were identified.

Attitude of Health Personnel↗
PubMed1992

The newly registered nurse and the cancer patient: an educational evaluation.

This paper reports a study which aimed to develop an understanding of newly registered nurses' attitudes, knowledge, confidence and educational needs in relation to cancer care. An educational intervention designed to meet these nurses' needs was then developed and evaluated with 127 newly registered nurses from two general hospitals. Nurses attended two different educational interventions; one group of nurses completing a 3 day experiential workshop; and a second group attended a more formal seminar programme. A third group of nurses who were unable to obtain study leave were followed up as a control group. A triangulation strategy was used to collect data from different sources, and included a baseline study, and a study of nurses before, after and 3 months following the educational interventions. Data from the study revealed the perceived need and desire for more education on cancer care, and the strong association of cancer with death amongst newly registered nurses. Significant benefits to those nurses attending the workshop were demonstrated. These differences were however less obvious at 3 months follow-up.

Adult↗