Generalization, which is an act of reasoning that involves drawing broad inferences from particular observations, is widely-acknowledged as a quality standard in quantitative research, but is more ...controversial in qualitative research. The goal of most qualitative studies is not to generalize but rather to provide a rich, contextualized understanding of some aspect of human experience through the intensive study of particular cases. Yet, in an environment where evidence for improving practice is held in high esteem, generalization in relation to knowledge claims merits careful attention by both qualitative and quantitative researchers. Issues relating to generalization are, however, often ignored or misrepresented by both groups of researchers. Three models of generalization, as proposed in a seminal article by Firestone, are discussed in this paper: classic sample-to-population (statistical) generalization, analytic generalization, and case-to-case transfer (transferability). Suggestions for enhancing the capacity for generalization in terms of all three models are offered. The suggestions cover such issues as planned replication, sampling strategies, systematic reviews, reflexivity and higher-order conceptualization, thick description, mixed methods research, and the RE-AIM framework within pragmatic trials.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPUK
Resumen Marco contextual: La teoría del logro de objetivos de Imogene King ha demostrado ser útil para el desarrollo de la enfermería. No obstante, su uso es limitado, lo que releva la necesidad de ...analizar críticamente su aporte a la disciplina. Objetivo: Analizar críticamente la teoría del logro de objetivos de Imogene King, según la propuesta metodológica de Chinn y Kramer. Principales temas en análisis: Se realizó un análisis de acuerdo con los criterios de reflexión teórica propuestos por Chinn y Kramer, que consta de dos fases: 1) descripción de la teoría, considerando el propósito, conceptos y definiciones, relaciones, estructura y supuestos; y 2) reflexión crítica, que incluye claridad, sencillez, generalidad, accesibilidad e importancia. Conclusión: La teoría es clara, sencilla, generalizable, accesible y con importancia para el ejercicio profesional. Sin embargo, presenta limitaciones en su alcance con pacientes que no pueden interactuar, además, no es parsimoniosa debido a la incorporación de muchos conceptos. Se requiere mayor evidencia empírica que demuestre su uso en la práctica.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK, VSZLJ
This study aimed to evaluate the application of community mental health nursing (CMHN) model using an intervention of nursing standard care and cognitive behavioral therapy on life skills and work ...productivity for the adult population with schizophrenia.
This study was an experimental study with an equivalent control group using randomly allocated 193 participants to either the intervention or control group at community health center in Cipayung, Jakarta. The intervention comprised in a 4-month cognitive behavioral therapy that was implemented by 33 community psychiatric nurse staff to improve the life skills and work productivity of people with schizophrenia. The instruments used to evaluate the intervention were the Indonesian version of the life skill profile (LSP) questionnaire and the work productivity and activity impairment scale (WPAI). The data analysis used a paired t-test.
The findings show that there was a significant difference in scores on the LSP before and after the implementation in the intervention group (19.94±1.27 and 38.83±9.32) with p<.001 and the control group (26.93±12.50 and 30.89±12.41) with p=.002. The findings also show that there was a significant difference of WPAI before and after the implementation for the intervention group (2.21±1.12 and 3.82±1.28) with p<.05 compared with the control group (1.91±1.42 and 2.19±1.58) with p=.188.
CMHN models using basic community mental health nursing interventions can be used to improve life skills and work productivity of people with schizophrenia so this could be a skill to strengthen the ability to live in the community in this type of patients.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPUK, ZAGLJ, ZRSKP
Accessible summary
Rates of violence, self‐harm, absconding and other incidents threatening patients and staff safety vary a great deal by hospital ward. Some wards have high rates, other low. The ...same goes for the actions of staff to prevent and contain such incidents, such as manual restraint, coerced medication, etc.
The Safewards Model provides a simple and yet powerful explanation as to why these differences in rates occur.
Six features of the inpatient psychiatric system have the capacity to give rise to flashpoints from which adverse incidents may follow.
The Safewards Model makes it easy to generate ideas for changes that will make psychiatric wards safer for patients and staff.
Conflict (aggression, self‐harm, suicide, absconding, substance/alcohol use and medication refusal) and containment (as required medication, coerced intramuscular medication, seclusion, manual restraint, special observation, etc.) place patients and staff at risk of serious harm. The frequency of these events varies between wards, but there are few explanations as to why this is so, and a coherent model is lacking. This paper proposes a comprehensive explanatory model of these differences, and sketches the implications on methods for reducing risk and coercion in inpatient wards. This Safewards Model depicts six domains of originating factors: the staff team, the physical environment, outside hospital, the patient community, patient characteristics and the regulatory framework. These domains give risk to flashpoints, which have the capacity to trigger conflict and/or containment. Staff interventions can modify these processes by reducing the conflict‐originating factors, preventing flashpoints from arising, cutting the link between flashpoint and conflict, choosing not to use containment, and ensuring that containment use does not lead to further conflict. We describe this model systematically and in detail, and show how this can be used to devise strategies for promoting the safety of patients and staff.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Background
Nurses comprise the largest component of the health workforce worldwide and numerous models of workforce allocation and profile have been implemented. These include changes in skill mix, ...grade mix or qualification mix, staff‐allocation models, staffing levels, nursing shifts, or nurses’ work patterns. This is the first update of our review published in 2011.
Objectives
The purpose of this review was to explore the effect of hospital nurse‐staffing models on patient and staff‐related outcomes in the hospital setting, specifically to identify which staffing model(s) are associated with: 1) better outcomes for patients, 2) better staff‐related outcomes, and, 3) the impact of staffing model(s) on cost outcomes.
Search methods
CENTRAL, MEDLINE, Embase, two other databases and two trials registers were searched on 22 March 2018 together with reference checking, citation searching and contact with study authors to identify additional studies.
Selection criteria
We included randomised trials, non‐randomised trials, controlled before‐after studies and interrupted‐time‐series or repeated‐measures studies of interventions relating to hospital nurse‐staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective reported measure of patient‐, staff‐related, or economic outcome. The most important outcomes included in this review were: nursing‐staff turnover, patient mortality, patient readmissions, patient attendances at the emergency department (ED), length of stay, patients with pressure ulcers, and costs.
Data collection and analysis
We worked independently in pairs to extract data from each potentially relevant study and to assess risk of bias and the certainty of the evidence.
Main results
We included 19 studies, 17 of which were included in the analysis and eight of which we identified for this update. We identified four types of interventions relating to hospital nurse‐staffing models:
‐ introduction of advanced or specialist nurses to the nursing workforce;
‐ introduction of nursing assistive personnel to the hospital workforce;
‐ primary nursing; and
‐ staffing models.
The studies were conducted in the USA, the Netherlands, UK, Australia, and Canada and included patients with cancer, asthma, diabetes and chronic illness, on medical, acute care, intensive care and long‐stay psychiatric units. The risk of bias across studies was high, with limitations mainly related to blinding of patients and personnel, allocation concealment, sequence generation, and blinding of outcome assessment.
The addition of advanced or specialist nurses to hospital nurse staffing may lead to little or no difference in patient mortality (3 studies, 1358 participants). It is uncertain whether this intervention reduces patient readmissions (7 studies, 2995 participants), patient attendances at the ED (6 studies, 2274 participants), length of stay (3 studies, 907 participants), number of patients with pressure ulcers (1 study, 753 participants), or costs (3 studies, 617 participants), as we assessed the evidence for these outcomes as being of very low certainty. It is uncertain whether adding nursing assistive personnel to the hospital workforce reduces costs (1 study, 6769 participants), as we assessed the evidence for this outcome to be of very low certainty. It is uncertain whether primary nursing (3 studies, > 464 participants) or staffing models (1 study, 647 participants) reduces nursing‐staff turnover, or if primary nursing (2 studies, > 138 participants) reduces costs, as we assessed the evidence for these outcomes to be of very low certainty.
Authors' conclusions
The findings of this review should be treated with caution due to the limited amount and quality of the published research that was included. We have most confidence in our finding that the introduction of advanced or specialist nurses may lead to little or no difference in one patient outcome (i.e. mortality) with greater uncertainty about other patient outcomes (i.e. readmissions, ED attendance, length of stay and pressure ulcer rates). The evidence is of insufficient certainty to draw conclusions about the effectiveness of other types of interventions, including new nurse‐staffing models and introduction of nursing assistive personnel, on patient, staff and cost outcomes. Although it has been seven years since the original review was published, the certainty of the evidence about hospital nurse staffing still remains very low.
Critical nursing shortages have required many health care organizations to restructure nursing care delivery models. At a tertiary health care center, 150 registered practical nurses were integrated ...into acute inpatient care settings.
A mechanism to continuously monitor the impact of this staffing change was not available.
Leveraging current literature and consultation with external peers, metrics were compiled and categorized according to Donabedian's Structure Process Outcome Framework. Consultation with internal subject matter experts determined the final metrics.
The Patient care, Utility, Logistics, Systemic Evaluation (PULSE) electronic dashboard was developed, capturing metrics from multiple internal databases and presenting real-time composites of validated indicators.
The PULSE dashboard is a practical means of enabling nursing leadership to evaluate the impact of change and to make evidence-informed decisions about nursing care delivery at our organization.
Nursing professional development practitioners have the responsibility to find creative and innovative ways to teach and provide learners with the education needed to practice safely in the hospital ...setting. This article describes an interactive game-based learning experience as a way to engage and empower both nurse residents and experienced nurses.
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