Rosemary Ford

Interpersonal Challenges as a Constraint on Care: The Experience of Nurses' Care of Patients Who Use Illicit Drugs

Abstract Men and women who use illicit drugs have a heavy reliance on health care in emergency departments and acute care wards. Nurses’ care however, is known to be constrained by inadequate dru education and policy and practice standards. This paper describes an additional constraint on care, namely, patients’ behaviour. The findings are part of a broader mixed-methods study of nurses’ therapeutic attitude to this patient group. The themes of violence, manipulation and irresponsibility emerged from the data analysis of written reports provided by a sub-sample (N = 311) of the main study sample. Recommendations are made for assisting nurses to reconceptualise their role with this patient group, and importantly, for an increase in violence management education and organisational role support, safety and security measures. Finally, further research in the field is recommended so that a comprehensive analysis of the difficulties faced by nurses and patients can be made.

A meta‐synthesis of factors influencing nursing home staff decisions to transfer residents to hospital

AIM To report a meta-synthesis of qualitative research studies exploring the role of nursing home staff in decisions to transfer residents to hospital. BACKGROUND Nurses and nurse assistants provide the majority of care to residents living in nursing homes and may be the only health workers present when a resident deteriorates. To inform future strategies, it is vital to understand the role of nursing home staff in decisions to transfer to hospital. DESIGN AND REVIEW METHODS A systematic review identified 17 studies to be included. The process of meta-synthesis was undertaken using the Joanna Briggs Institutes guidelines. DATA SOURCES Qualitative research papers published between January 1989-October 2012 were identified in key databases including Cinahl, Embase, Medline and PsycInfo. RESULTS Nursing home staff members play a key role in decision-making at the time of a residents deterioration. Multiple factors influence decisions to transfer to hospital including an unclear expectation of the nursing home role; limited staffing capacity; fear of working outside their scope of practice; poor access to multidisciplinary support and difficulties communicating with other decision-makers. CONCLUSIONS There is a lack of consensus regarding the role of the nursing home when a residents health deteriorates. Nursing home staff would benefit from a clear prescription of their expected minimum clinical skill set; a staffing capacity that allows for the increased requirements to manage residents on-site, greater consistency in access to outside resources and further confidence and skills to optimize their role in resident advocacy.

A systematic review of the effect of telephone, internet or combined support for carers of people living with Alzheimer's, vascular or mixed dementia in the community

BACKGROUND The objective of this review was to assess the effectiveness of interventions delivered by telephone, internet or combined formats to support carers of community dwelling people living with Alzheimers Disease, vascular dementia or mixed dementia. METHOD English language literature published up to 2016 was searched. The initial search included: MEDLINE, Cumulative Index to Nursing and Allied Health (CINAHL), and PsycINFO. A second search was conducted using Medical Subject Headings (MeSH) and keywords for eight databases. The review included randomised controlled trials, non-randomised controlled trials, quasi-experimental and pre-post studies from published and grey literature. Studies selected for retrieval were assessed by three independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments. RESULTS Twenty-two studies were included in the review of which 13 were studies of telephone-delivered interventions, five were internet-delivered interventions and four were delivered in a combination of telephone and internet formats. In this review the successful outcomes from the combined telephone and internet delivery exceeded that of telephone alone and internet alone. Very few studies addressed programs for specific types of dementia. CONCLUSION When considering the ratio of number of studies to successful outcomes, combined telephone and internet delivery of multicomponent interventions demonstrated relatively more positive outcomes in reducing depression, burden and increasing self-efficacy than telephone alone or internet alone. Further studies are necessary to evaluate the effectiveness of interventions targeted at specific types of dementia and to understand which components of interventions are most effective.

Care in the home for seriously ill children with complex needs A narrative literature review

This article reviews contemporary literature on home care of the seriously ill child with complex care needs and the sick child/parent dyad. The literature search revealed three major themes, namely the increasing acuity of child illness, the evolving role of the parent as care provider, and the health professional as care provider. While there is much known about the complexity of care of children and the role of family in that care, little is known about what families require in terms of support and sustenance during the long years of care provision.

A systematic review on the experiences of Residential Aged Care Facility staff decision making regarding the transfer of residents to Emergency Departments

Review question/objective The objective of this review is to synthesise the best available evidence on experiences of RACF staff decision making regarding the transfer of residents to the Emergency Department. Specifically, the review question is: what are the experiences of RACF staff who have been involved the decision to transfer residents to an emergency department? Inclusion criteria Types of participants This review will consider international publications that focus on RACF staff involved in decisions regarding the transfer of residents from the RACF to the ED. All RACF nursing and care staff will be considered including, Registered Nurses RN, Enrolled Nurses EN, Personal Care Attendants PCA and Licensed Practice Nurses LPN. However, due to the ambiguity in nomenclature, no terms for RACF staff will be used in the search criteria and instead the reviewers will identify whether the sample focuses on RACF staff in the sifting phase. Phenomena of interest The phenomena of interest for this review are the experiences of RACF staff decision making regarding the transfer of residents to the Emergency Department including the experiences of the facilitators and barriers to providing care for residents within the RACF when a resident’s health deteriorates. These experiences may refer to the following issues described already in the existing literature: limited access to medical review, the influence of family and resident preferences, the requirement to follow facility transfer protocols, fear of litigation, difficulties identifying the cause of the resident’s deterioration, communication difficulties and the influence of a skill mix. Context The context for this systematic review is the RACF, which are defined as facilities that provide both permanent accommodation and the provision of personal care and nursing services. 3 Studies referring to nursing homes, long-term care settings and skilled nursing facilities will be included. Studies that are undertaken in the community or the acute care setting will be excluded because the focus in on decision-making within the RACF setting. Studies using other descriptions of RACF such as low care facilities, assisted living facilities, homes for the elderly will be critiqued to establish whether they met our definition for inclusion.