No description available.

No description available.

Ineffective pain management in the post anesthesia care unit (PACU) increases patients' risk of adverse effects including decreased mobility, infection, chronic pain, depression, cardiopulmonary complications, increased length of stay, insomnia, fatigue, and overall decrease in quality of life. The PACU in a community hospital did not provide an evidence-based pain management guideline for nurses treating postoperative patients, resulting in nurses' concerns about providing pain management. The purpose of this project was to translate evidence on pain management into an evidence-based guideline for improved nursing practice in a PACU. Evidence was obtained from a detailed literature search using multiple databases and professional organizations' guidelines. Nursing practice guidelines were developed and evaluated by 3 expert panelists using the Agree II guidelines. The panelists selected included; Two anesthesiologists, one who is trained in pain management and is also a pharmacist. The third expert is a practicing nurse practitioner in an acute setting who is also a surgical first assist and the associate director of robotics. The panel endorsed the guidelines for advancement through the hospital's review committees. Implementation of the evidence-based pain management guideline in the PACU might provide nurses with tools to guide their interventions and improve patient outcomes. Social changes resulting from the use of evidence-based pain management guidelines include decreased time to opiate administration, decreased adverse effects, improved assessment of pain, and an increase in the number of patients who receive proper pain management.

In occupational therapy (OT), there is a push to encourage the entry-level doctorate (eOTD) over the master's of OT (MOT), without having identified which degree develops therapists who can best meet the needs of clients, while providing the fewest negative consequences for stakeholders. This collective case study assessed whether there are differences between OTs with MOT and with eOTD. Each supervisor's experiences with the two degree groups represented a separate case, then all were collectively considered. The central research question was whether OT supervisors, who have observational knowledge of clinical performance, perceived differences between MOTs and eOTDs in factors that impact the stakeholders of OT services, as identified using Freeman's stakeholder theory. Ten supervisors who geographically represented the five eOTD programs and diverse areas of OT practice were selected for initial interviews, with four others added to achieve saturation. Fourteen semi-structured interviews were conducted to begin to identify perceived similarities and differences between OTs with the different degrees. These data were inductively coded and then analyzed using a thematic analysis procedure. The results of this small, exploratory study indicate that eOTDs do not have higher skills and abilities; desire higher compensation, but do not receive it; sometimes bring attitudes of superiority; are not more respected because of their degree; and are negatively affected by higher debt load. Positive social change implications stemming from this study suggest that stakeholder theory can be used to guide policy discussions in professional healthcare associations and that policy makers in the profession of OT should exercise caution in adopting the eOTD as the required entry-level degree until further evidence on the efficacy of the eOTD degree is clear.

Assessment of left ventricular (LV) function is one of the most common requests made to cardiac imaging services. This demand stems from a large body of evidence that shows abnormal LV systolic and, more recently, diastolic function has important prognostic and treatment related implications for patients with a wide range of cardiovascular diseases. The vast majority of information supporting the use of conventional measures of LV function, such as ejection fraction, originates from population studies and large clinical trials. However, the application of these measurements to individual patients is far less defined, especially when used for serial evaluation. Central to these concerns is the relative paucity of data surrounding the test-retest reliability of conventional measures in clinical settings. Newer measures of LV function have been developed over recent years, with several techniques becoming widely used in clinical practice (i.e. tissue Doppler imaging) and others remaining largely research tools (i.e. 3D echocardiography, tissue strain/strain rate). Possible benefits of new technologies include improved identification and early detection of myocardial disease, improved reliability for monitoring progression of disease, and the development of novel methods to assess response to therapy. Despite this potential, the application and clinical utility of these techniques above and beyond more conventional measures remains in many cases to be adequately characterized. This thesis addresses several of these issues: from variability of novel and conventional measures of LV function in clinical practice, to new applications of novel functional measures in clinical settings.

Bakgrund: Sjuksköterskestudenter kan känna sig sårbara i början av sin verksamhetsförlagda utbildning (VFU) och kan påverkas både positivt och negativt av bemötandet från både handledare och övrig personalgrupp. Syfte: Att undersöka sjuksköterskestudenters upplevelser av bemötande från handledare och övrig personalgrupp och hur detta påverkar förmågan att utföra omvårdnad, samt studenternas upplevelse av studentrollen. Metod: Kvalitativ forskningsdesign med fem semistrukturerade intervjuer. Resultat: Resultatet delades in i tre huvudkategorier: Bemötande från handledare; Bemötande från övrig personalgrupp och Studentroll. Ett bra bemötande karaktäriserades av vänlighet, involvering i arbetet och förmedlande av trygghet. Ett dåligt bemötande kunde bestå av försummelse, att känna sig i vägen och dålig struktur. Studenterna hade haft skiftande roller under VFU och samtliga hade positiva aspekter. Studenterna upplevde att de hade utvecklats i sin förmåga att utföra omvårdnad. Slutsats: Studien påvisar att det är viktigt för studenter hur de blir bemötta på sin VFU, och vilken roll de får på arbetsplatsen. Den visar även att det är betydelsefullt att samtliga ur personalgruppen visar studenten ett bra bemötande. En undersköterskeroll kan vara utvecklande för sjuksköterskestudenter i termin två. Det förekommer dock negativa aspekter i bemötande från handledare och personalgrupp, vilket tyder på att studentens roll på VFU bör förtydligas. / Background: Nursing students may feel vulnerable in the beginning of a clinical practice placement. The relationship and interaction with their preceptors and other staff members can have a positive as well as a negative effect on the nursing student. Aim: To investigate nursing students’ experiences of the relationship and interaction with their preceptors and other staff members and the influence these factors have on their ability to perform nursing care, and also how the students experienced the student role. Method: Qualitative design with five semi-structured interviews. Result: The result was divided into three main categories: Relationship and interaction from preceptors; Relationship and interaction from other staff members and Student role. A good relationship and interaction was characterised by kindness, involvement in tasks and a sensation of safety. A bad relationship and interaction would consist of neglect, the sensation of being in the way and a bad structure. The students had a variety of roles that emerged during their clinical practice which all had positive aspects on their ability to perform nursing care. Conclusion: The study presented how important the relationship and interaction with the preceptors and other staff members are for nursing students during their clinical practice placement. As important is the role the student acquires. The study presents the importance of a good relationship with all staff members. A health care assistant role can be of value for nursing students during their first clinical practice placement. Certain negative aspects emerged indicating that clarifying information about the student role during clinical practice placement is needed.

Background Evidence-based practice has increasingly been recognized as a priority by professional physiotherapy organizations and influential researchers and clinicians in the field. Numerous studies in the past decade have documented that physiotherapists hold generally favorable attitudes to evidence-based practice and recognize the importance of using research to guide their clinical practice. Research has predominantly investigated barriers to research use. Less is known about the circumstances that actually support use of research by physiotherapists. This study explores the conditions at different system levels that physiotherapists in Sweden perceive to be supportive of their use of research in clinical practice. Methods Patients in Sweden do not need a referral from a physician to consult a physiotherapist and physiotherapists are entitled to choose and perform any assessment and treatment technique they find suitable for each patient. Eleven focus group interviews were conducted with 45 physiotherapists, each lasting between 90 and 110 minutes. An inductive approach was applied, using topics rather than questions to allow the participants to generate their own questions and pursue their own priorities within the framework of the aim. The data were analyzed using qualitative content analysis. Results Analysis of the data yielded nine favorable conditions at three system levels supporting the participant’s use of research in clinical practice: two at the individual level (attitudes and motivation concerning research use; research-related knowledge and skills), four at the workplace level (leadership support; organizational culture; research-related resources; knowledge exchange) and three at the extra-organizational level (evidence-based practice guidelines; external meetings, networks, and conferences; academic research and education). Conclusions Supportive conditions for physiotherapists’ use of research exist at multiple interdependent levels, including the individual, workplace, and extra-organizational levels. Research use in physiotherapy appears to be an interactive and interpretative social process that involves a great deal of interaction with various people, including colleagues and patients.

No description available.

The purpose of this study was to explore how physiotherapists working in stroke care understand their role(s) in the context of clinical practice and how this is mediated by their post-licensure educational experiences. Specifically the study focused on their experiences with the Bobath Concept, a well-developed post-licensure neurology physiotherapy program. This study was oriented within sociocultural theory as a way to understand how the experiences and interactions of physiotherapists mediate their professional practice and their sense of professional identity in a way not previously studied in physiotherapy literature. In order to honour the voices of the participants, this study drew on hermeneutic phenomenology and used a principled data analysis tool to present an understanding of the interrelationships involved in stroke care from their perspectives. Four physiotherapists participated in this study by responding in writing and orally to a clinical case and participating in an in-depth interview regarding their professional roles and experiences. The findings suggest that these physiotherapists understand the Bobath Concept as a professional stance which informs their practice and contributes to an ethos of caring, which is reflected in the ways they understand their roles in clinical practice.

The objective of the thesis was to evaluate the quality of diabetes care in the Canadian Forces by determining the extent to which physicians adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines. In addition, the effect of patient age, sex, rank and size of base on quality of care was assessed and the accuracy of a diagnosis of diabetes in an extract of the electronic medical record (EMR) was evaluated. Fourteen bases within the Canadian Forces were selected for investigation, representing roughly half of the Canadian Forces population. Cases of diabetes were ascertained based on laboratory criteria following a chart review. Twenty-one CDA guideline recommendations were considered. The Canadian Forces demonstrated greater than 75% adherence with each of 9 recommendations, 50-75% adherence with each of 7 recommendations and less than 50% adherence with each of 5 recommendations. The overall adherence with all applicable recommendations per patient was 60.3% (SE 0.66). Age, sex, rank and size of base were not important factors influencing guideline adherence. The sensitivity of a diabetes diagnosis in an extract of the EMR was 84.5%, the specificity was 99.8%, the positive predictive value was 85.1% and the negative predictive value was 99.8%. This is similar to the performance of provincial and national diabetes registries. The quality of diabetes care in the Canadian Forces compared favourably with that of the civilian population within Canada and internationally. The creation of a diabetes registry is expected to lead to further improvements in diabetes care.