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This study explored how nurses in acute and nurse-led gynaecology wards prioritised patient caseloads ranging in diversity and number of patient conditions. Statistics show that since the introduction of medical termination of pregnancy (MTOP) procedures into the National Health Service (NHS) in 1991, the number of women having this procedure is increasing year on year. To date very little is known about the impact this procedure may have had on nursing practice. The focus of this study was to explore the nursing care when this included, and did not include, caring for women having MTOP. The study was conducted in two parts. The first qualitative study employed non-participant observation and semi-structured interviews of nurses in gynaecology and surgical wards at two hospital sites to examine the external context in which nursing decisions were made. This found that nurses in gynaecology focused on emotional or psychosocial aspects more so than surgical nurses who focused on physical aspects of patient care. The second quantitative study involved a cross-sectional survey of nurses from both ward types in two hospitals sites in Scotland. Internal constructs were examined using personality and thinking styles measures. Nurses were assessed on their emotionality, that is, the numbers of times an emotional care aspect was prioritised. This found that nurses who prioritised the emotional aspects of the task tended to be more conscientious and elected preference for a ‘people-centred’ thinking style. The context in which women have TOP is also important since the findings suggest women may benefit from being cared for in nurse-led rather than in acute wards. Knowing how a person thinks about emotional and physical aspects of care also has implications for those involved in education, and career planning.

Les dispositifs de santé en France et dans le monde sont en tension. Les déterminants de ces pressions sont en lien avec la démographie des professions, l’économie et l’organisation des soins. Les pathologies chroniques non infectieuses sont en recrudescence. La maladie allergique est emblématique de ces pathologies. Elle concerne 25% d’individus en France (15 millions de personnes). En Europe, 100 millions de personnes souffrent de rhinites allergiques et 70 millions souffrent d’asthme. A l’horizon 2020, c’est 40% de la population mondiale qui sera atteinte d’une maladie allergique. La déclaration de RIO, texte fondateur du développement durable, place la santé comme une préoccupation majeure. Face à ce constat, il est nécessaire de repenser les modes de prise en charge, par des modèles innovants, de nouvelles formations et une répartition des compétences différente à partir de nouveaux périmètres de métier de la santé. L’objectif général de ce travail est d’identifier des modèles novateurs en santé dans une vision pluridisciplinaire systémique et éthique des soins. Les objectifs secondaires sont : définir le concept des pratiques innovantes en santé dans le système de santé français, préciser le cadre réglementaire des pratiques innovantes, déterminer les besoins de formation, la qualification, les nouveaux métiers et nouveaux outils, enfin, l’adéquation de la formation aux déterminants générationnels des étudiants des Sciences de la Santé. La méthode utilisée est une revue de la littérature portant sur le développement durable, la médecine environnementale, la formation des professions de santé. La confrontation au cadre réglementaire de la pratique infirmière à celui d’infirmier de pratiques avancées est réalisée. Le modèle d’étude est l’allergologie. Une enquête par questionnaire en ligne a évalué le niveau de compétences, de formation et de régulation des infirmières spécialisées en Europe. Cette étude a été réalisée en collaboration européenne avec le département de la Haute Ecole de Namur, l’Université de Nottingham, la Haute Ecole de Santé de Fribourg, l’Université de Porto, et l’Ecole des Hautes Etudes en Santé Publique de Rennes. Cette enquête a permis d’identifier 5 compétences de haut niveau d’expertise et de formation selon les descripteurs de Dublin pour les infirmiers de pratique avancée. Un programme de formation de niveau master de pratique avancée en allergologie est élaboré. Enfin, il a été identifié 4 phases constitutives de l’innovation : pilotage, appropriation, généralisation de la pratique et absorption par le système. L’innovation est un processus délibéré nécessitant la transformation des pratiques par l’introduction de nouveautés pédagogiques, organisationnelles et e-santé. L’évolution des outils d’aide à la décision thérapeutique infirmière appelée diagnostic infirmier est mis en lumière. Le diagnostic infirmier portant sur l’adaptation des individus à l’environnement est envisagé Les résultats soulignent la nécessité de développer des programmes de formation s’appuyant sur une pédagogie adaptée aux déterminants sociaux des étudiants en Sciences de la Santé ainsi qu’une révision du cadre réglementaire et juridique des professions de santé dites intermédiaires en France. / Health systems in France and in the world are in tension. The determinants of those pressures are linked to demography, economy and care organization Chronic non-infectious diseases are on the rising. Allergic disease alone respect 25% of individuals in France (15 million people). In Europe, 100 million people suffer from allergic rhinitis and 70 million suffer from asthma. By 2020, it is 40% of the world population will be suffering from an allergic disease. The declaration of RIO, founding text of sustainable development, puts health as a major concern. It is necessary to think of new management models, new training and distribution of different skills from new business perimeters for health caregivers. The primary objective of this research is to identify: innovative models of health in a systematic multidisciplinary vision and ethics of care. .the Secondary objective is to define the concept of innovative practices in health in the French health system, clarify the regulatory framework for innovative practices, identify training needs, qualification of new businesses and new tools and finally review the adequacy of generational training for health science students. The method used is a review of the literature on sustainable development, environmental medicine, training of health professionals. The confrontation with the regulatory framework of practice nurse at the nursing of advanced nursing practices is made. The study design is the allergy disease. An online survey assessed the level of skills, training and policy of nurses in Europe. This study was conducted in collaboration with the European department of Haute Ecole de Namur, the University of Nottingham, and High School of Health of Freiburg, University of Porto, and School of Advanced Studies in Public Health in Rennes. This survey identifies five high levels of expertise that are 5 skills training according to Dublin descriptors for advanced practice nurses. A master level training program for APRN in allergy practice is developed Finally four steps of innovation were identified: management, ownership, widespread practice and absorption by the system.The results highlight that innovation is a deliberate process requiring practice by introducing new pedagogical, organizational and e-Health .Changing nurse’s diagnosis decision and support tools are highlighted. The nursing diagnosis on individual adaptation to environment is also considered. Eventually, two main recommendations are presented, firstly to develop training program according to the new French law in France, and secondly to considered the social determinants of the students in health science to make those training.

Tiriamojo darbo tikslas. Ištirti stacionarioje sveikatos priežiūros įstaigoje dirbančių slaugytojų sveikatą įtakojančius psichosocialinius rizikos veiksnius ir įvertinti jų valdymo galimybę. Uždaviniai: Nustatyti slaugytojų nuomonę apie psichosocialinių rizikos veiksnius ir jų realų valdymą; Tyrimo metodika. 2011 m. rugpjūčio mėn. atliktas kiekybinis ir kokybinis tyrimas. Apklausti 284 VšĮ Respublikinės Šiaulių ligoninės bendrosios praktikos slaugytojai bei interviu metu apklausti 9 informantai. Rezultatai. Nustatyta nepakankamas apsaugos pirštinių naudojimas (p = 0,000). Daug darbo užduočių, nepriklausančių slaugytojo veiklai (p = 0,002), laiko trūkumas užduotims atlikti (p = 0,008), nepakankamai sudaromos sąlygos profesinei kvalifikacijai kelti ( p = 0,050). Organizavimo veiksniai: naktinis darbas (p = 0,035), nepakankamas darbo užmokestis (p = 0,035). Turinio veiksniai: didelė atsakomybė už atliekamus slaugos veiksmus (p = 0,042), įtakos savo darbui trūkumas (p = 0,027). Darbo santykių veiksniai: bloga skyriaus atmosfera (p = 0,018), nėra bendravimo (p = 0,017), paramos iš skyriaus administracijos trūkumas (p = 0,029), paramos iš įstaigos vadovybės trūkumas (p = 0,000), blogas vadovavimas įstaigai (p = 0,001). Visi šie veiksniai yra statistiškai reikšmingai susiję su slaugytojų amžiumi, jų šeimynine padėtimi, slaugytojų darbo stažu dabartinėje darbo vietoje bei bendru medicininiu darbo stažu. Negatyvus elgesį kasdien ir kas savaitę patirdavo: 2,2 % slaugytojų gaudavo... [toliau žr. visą tekstą] / Aim of study: to investigate the psychosocial risk factors for health among nurses working at in-patient health care setting and evaluate the potential for management of such factors. Objectives: to evaluate the attitudes of nurses towards psychosocial risk factors and actual management of such factors. Material and methods: the qualitative and quantitative study was conducted in August 2011. In total, 284 general practice nurses from Siauliai Hospital were enrolled to study, 9 of them underwent the interview. Results. There were following identified risk factors: insufficient use of hospital gloves (p<0.001), abundance of tasks not related with nursing (p=0.002), lack of time for accomplishing the tasks (p=0.008), and scarce conditions for improvement of professional qualification (p=0.050). Organizational factors: work at night (p=0.035) and low salary (p=0.035). Content-related factors: high responsibility for nursing actions (p=0.042) and lack of influence on own work (p=0.027). Relationships at work: poor internal climate at work (p=0.018), lack of communication (p=0.017), lack of support by department authorities (p=0.029), lack of support by hospital authorities (p<0.001), and poor hospital management (p=0.001). All abovementioned factors were statistically significantly associated with nurses ‘age, family status, work experience in current workplace, and general medical work experience. Daily or weekly negative behaviour towards nurses was reported by 2.2 % in form... [to full text]

Heart failure (HF) is a serious public health problem associated with high mortality rates, hospital readmissions, and health care costs. Transitional care has emerged as a disease management model used to reduce readmissions for hospital-discharged patients with HF. However, the efficacy of an advanced practice nurse (APN)-led transitional care program (TCP) in readmission reduction is under debate. The practice question for this project examined the extent to which an APN-led TCP was effective in reducing 30-day all-cause readmissions for hospital-discharged HF patients. The logic model was the framework guiding this program evaluation. An analysis of quality improvement HF data from September 2015 to August 2016 was reviewed for one hospital in southern California. The APN-led TCP included 47 patients and had 7 patients with 30-day readmissions. The physicians' group included 298 patients and had 53 patients with 30-day readmissions. The results of chi-square analysis revealed a nonsignificant association between 30-day readmissions and post-discharge care providers [Ï? 2 (1, N = 345) = 0.236, p = 0.627], and the HF 30-day readmission rates were the same between two groups. The APN-led TCP served a large proportion of Medi-Cal patients (48.94%) who had less primary care access, while the majority of patients in the physicians' group were Medicare (51%) who had primary care providers. This project highlights the positive social changes that advanced practice nurses affect via their critical leadership and clinical roles in increasing care access for the low-income population. Further studies on payer sources and readmissions are recommended on the efficacy of APN-led TCP in readmission reduction.