Aims and objectivesTo determine the effects of nursing interventions for people's nutrition, elimination, mobility and hygiene needs.BackgroundPatient experience of health care is sensitive to nursing quality. A refocus on fundamental nursing care is undermined by lack of evidence of effectiveness for interventions in core areas such as elimination, nutrition, mobility and hygiene.DesignSystematic review.MethodsWe searched for and included experimental studies on interventions by professionally qualified and unregistered nurses that addressed participants' nutrition, elimination, mobility and hygiene needs. We extracted data on scope, quality and results of studies followed by descriptive narrative synthesis of included study outcomes using a novel form of harvest plots.ResultsWe included 149 studies, 35 nutrition, 56 elimination, 16 mobility, 39 hygiene and three addressing two or more areas simultaneously (67 randomised controlled trials, 32 non‐randomised controlled trials and 50 uncontrolled trials). Studies into interventions on participant self‐management of nutrition (n = 25), oral health (n = 26), catheter care (n = 23) and self‐management of elimination (n = 21) were the most prevalent. Most studies focussed their outcomes on observational or physiological measures, with very few collecting patient‐reported outcomes, such as quality of life, experience or self‐reported symptoms. All but 13 studies were of low quality and at significant risk of bias. The majority of studies did not define primary outcomes, included multiple measures of identical concepts, used inappropriate analyses and did not conform to standard reporting quality criteria.ConclusionsThe current evidence for fundamental nursing care interventions is sparse, of poor quality and unfit to provide evidence‐based guidance to practising nurses.Relevance to clinical practiceResearchers in nursing internationally should now undertake a programme of work to produce evidence for clinical practice in the fundamentals of care that is reliable, replicable and robust.
Aims and objectives: To systematically identify, appraise and synthesise patients', residents' and nurses' experiences of fundamental nursing care for nutrition, elimination, mobility and hygiene. Background: The evidence base for effective nursing behaviours to assist people with their fundamental care needs is sparse, hampering the development of effective interventions. Synthesising data on patients' and nurses' experiences of fundamentals of nursing care could contribute to the development of such an intervention.Methods: Systematic review and synthesis of qualitative data from qualitative studies on patients' and nurses' experiences of fundamental nursing care behaviours addressing peoples' nutrition, elimination, mobility and hygiene needs. We appraised study quality and relevance and used a narrative approach to data synthesis, fulfilling PRISMA criteria (Appendix S2). Results:We identified 22,374 papers, and 47 met our inclusion criteria. Most papers were of low quality. Sixteen papers met our quality and relevance criteria and were included for synthesis. Papers were about nutrition (2) elimination (2), mobility (5), hygiene (5) and multiple care areas (2). We found nurses and patients report that fundamental nursing care practices involve strong leadership, collaborative partnerships with patients and cohesive organisational practices aligned to nursing care objectives and actions. Conclusions: To improve fundamental care and interventions suitable for testing may require attention to leadership, patient-nurse relationships and organisational coherence plus the fundamentals of care nursing interventions themselves. Relevance to clinical practice: More rigorous mixed methods research about fundamental nursing care is needed to inform nursing practice and improve patient's • We have identified preferred nursing practices in four essential care areas, nutrition, elimination, mobility and hygiene.• High-quality and relevant studies have been synthesised, and three conceptual themes were identified: nurse leadership, partnerships with patients and organisational practices.• Nurse leadership and organisational practices need to demonstrate prioritisation of partnerships with patients in delivering essential nursing care in order that nursing care quality and patients experience of care is improved.• We will use the framework from our Amalgamation of Marginal Gains logic model to incorporate this knowledge and design our fundamentals of care nursing intervention to be empirically evaluated.
IntroductionPrescribing antibiotics is an error-prone activity and one of the more challenging responsibilities for doctors in training. The nature and extent of challenges experienced by them at different stages of the antibiotic prescribing process are not well described, meaning that interventions may not target the most problematic areas.ObjectivesOur aim was to explore doctors in training experiences of common problems in the antibiotic prescribing process using cultural–historical activity theory (CHAT). Our research questions were as follows: What are the intended stages in the antibiotic prescribing process? What are the challenges and where in the prescribing process do these occur?MethodsWe developed a process model based on how antibiotic prescribing is intended to occur in a ‘typical’ National Health Service hospital in the UK. The model was first informed by literature and refined through consultation with practising healthcare professionals and medical educators. Then, drawing on CHAT, we analysed 33 doctors in training narratives of their antibiotic prescribing experiences to identify and interpret common problems in the process.ResultsOur analysis revealed five main disturbances commonly occurring during the antibiotic prescribing process: consultation challenges, lack of continuity, process variation, challenges in patient handover and partial loss of object. Our process model, with 31 stages and multiple practitioners, captures the complexity, inconsistency and unpredictability of the process. The model also highlights ‘hot spots’ in the process, which are the stages that doctors in training are most likely to have difficulty navigating.ConclusionsOur study widens the understanding of doctors in training prescribing experiences and development needs regarding the prescribing process. Our process model, identifying the common disturbances and hot spots in the process, can facilitate the development of antibiotic prescribing activities and the optimal design of interventions to support doctors in training.
Our aim with this article is to develop a typology for the analysis of client-caregiver encounters in health care. We first observed client-caregiver interactions in the homes of home care clients and during the care processes of surgical patients. We then conducted a data-driven analysis to identify the clients' initiatives and the degree of engagement in the responses they received. The clients shaped their care by commenting on, questioning, ensuring, and enriching their care. The responses from the caregivers consisted of neutral acceptance, disregard, and shared expansive development of the clients' initiatives. The typology developed from these will be a tool to widen our understanding of the complex interactions in care delivery and of the different conceptualizations of care that actors hold. In future studies this typology will help in the analysis of the organizational dynamics of health care delivery.
Currently English universities are responding to a recent government Green Paper which promises to deliver a raft of radical policy changes which could have a major impact on how excellence in teaching and learning is to be publicly acknowledged and rewarded. A significant, yet controversial proposal is the introduction of a «Teaching Excellence Framework» for universities. This paper examines and contextualises the current important policy debates and then presents some preliminary findings from a recent empirical case study which explored how research-intensive universities have valued, rewarded and supported excellence in teaching through institutional structures and also from the perspectives of academic staff responsible for teaching students. We argue that the reality on the ground for many academics is a sense of confusion and contraction around how their universities value and support high quality teaching and that there may be some way to go before some of the ideas and principles currently being discussed in the context of a national English Teaching Excellence Framework are fully embedded in practice.
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