This second edition, in Open Access, aims to provide a comprehensive and practical overview of the knowledge required for the assessment and management of the older adult with or at risk of fragility ...fracture, with additional focus on those who are frail. It considers this from the perspectives of all the clinical and home care settings in which this group of patients receive care and is relevant to all global locations. The concept of orthogeriatric care is explored in detail. Global estimates suggest that there were 21 million men and 137 million women aged 50 years or more at high fracture risk in 2010. This incidence is expected to double by 2040, with the most significant increase in Asia. Fragility fracture is one of the foremost challenges for health care providers and thehe global demand for nursing care for patients with fragility fractures across the world is immense. Hip fracture is particularly challenging as these significant injuries often occur in frail older people requiring hospitalisation and orthopaedic surgery. Such injuries and associated surgery result in increased frailty, worsening health and wellbeing, pain, disability, reduced quality of life, loss of independence, and decreased life expectancy. Care providers need to understand the experience of fragility fracture from the perspective of patients and families so that direct improvements in care can be based on the perspectives of the users. Expert care of patients following fractures that require hospitalisation and orthopaedic surgery involves skill in the care and treatment of frail older people as we as individuals with an injury and undergoing surgery. Nurses have a significant role in interdisciplinary collaborative care provided through orthogeriatric models of care. There is increasing evidence that such models significantly improve patient outcomes. High quality, evidence-based orthogeriatric care is increasingly shown to have positive impact on outcomes for recovery, rehabilitation, and secondary prevention of further fracture. This book significantly supports the aims and values of the Fragility Fracture Network and, as such, supports the learning needs of nurses and other allied health professionals which will enable a comprehensive approach to nursing practice in orthogeriatric and fragility fracture care. ; Provides a comprehensive discussion of nursing the frail older person with a fragility fracture across Europe Based on a two-day workshop of like-minded specialist and advanced nurses from over 20 countries Acts as the course text/reader for a Europe-wide education programme in all relevant settings (Emergency Department, Fracture Clinic, Trauma Unit, Orthopaedic Ward, Rehabilitation setting) Open Access
To update the European League Against Rheumatism (EULAR) recommendations for the role of the nurse in the management of chronic inflammatory arthritis (CIA) using the most up to date evidence. The ...EULAR standardised operating procedures were followed. A task force of rheumatologists, health professionals and patients, representing 17 European countries updated the recommendations, based on a systematic literature review and expert consensus. Higher level of evidence and new insights into nursing care for patients with CIA were added to the recommendation. Level of agreement was obtained by email voting. The search identified 2609 records, of which 51 (41 papers, 10 abstracts), mostly on rheumatoid arthritis, were included. Based on consensus, the task force formulated three overarching principles and eight recommendations. One recommendation remained unchanged, six were reworded, two were merged and one was reformulated as an overarching principle. Two additional overarching principles were formulated. The overarching principles emphasise the nurse’s role as part of a healthcare team, describe the importance of providing evidence-based care and endorse shared decision-making in the nursing consultation with the patient. The recommendations cover the contribution of rheumatology nursing in needs-based patient education, satisfaction with care, timely access to care, disease management, efficiency of care, psychosocial support and the promotion of self-management. The level of agreement among task force members was high (mean 9.7, range 9.6-10.0). The updated recommendations encompass three overarching principles and eight evidence-based and expert opinion-based recommendations for the role of the nurse in the management of CIA.
Aims and objectives
To assess the quality of the advanced nursing process in nursing documentation in two hospitals.
Background
Various standardised terminologies are employed by nurses worldwide, ...whether for teaching, research or patient care. These systems can improve the quality of nursing records, enable care continuity, consistency in written communication and enhance safety for patients and providers alike.
Design
Cross‐sectional study.
Methods
A total of 138 records from two facilities (69 records from each facility) were analysed, one using the NANDA‐International and Nursing Interventions Classification terminology (Centre 1) and one the International Classification for Nursing Practice (Centre 2), by means of the Quality of Diagnoses, Interventions, and Outcomes instrument. Quality of Diagnoses, Interventions, and Outcomes scores range from 0–58 points. Nursing records were dated 2012–2013 for Centre 1 and 2010–2011 for Centre 2.
Results
Centre 1 had a Quality of Diagnoses, Interventions, and Outcomes score of 35·46 (±6·45), whereas Centre 2 had a Quality of Diagnoses, Interventions, and Outcomes score of 31·72 (±4·62) (p < 0·001). Centre 2 had higher scores in the ‘Nursing Diagnoses as Process’ dimension, whereas in the ‘Nursing Diagnoses as Product’, ‘Nursing Interventions’ and ‘Nursing Outcomes’ dimensions, Centre 1 exhibited superior performance; acceptable reliability values were obtained for both centres, except for the ‘Nursing Interventions’ domain in Centre 1 and the ‘Nursing Diagnoses as Process’ and ‘Nursing Diagnoses as Product’ domains in Centre 2.
Conclusion
The quality of nursing documentation was superior at Centre 1, although both facilities demonstrated moderate scores considering the maximum potential score of 58 points. Reliability analyses showed satisfactory results for both standardised terminologies.
Relevance to clinical practice
Nursing leaders should use a validated instrument to investigate the quality of nursing records after implementation of standardised terminologies.
Nurses make up the largest segment of the health care profession, with 3 million registered nurses in the United States. Nurses work in a wide variety of settings, including hospitals, public health ...centers, schools, and homes, and provide a continuum of services, including direct patient care, health promotion, patient education, and coordination of care. They serve in leadership roles, are researchers, and work to improve health care policy. As the health care system undergoes transformation due in part to the Affordable Care Act (ACA), the nursing profession is making a wide-reaching impact by providing and affecting quality, patient-centered, accessible, and affordable care.
In 2010, the Institute of Medicine (IOM) released the report The Future of Nursing: Leading Change, Advancing Health , which made a series of recommendations pertaining to roles for nurses in the new health care landscape. This current report assesses progress made by the Robert Wood Johnson Foundation/AARP Future of Nursing: Campaign for Action and others in implementing the recommendations from the 2010 report and identifies areas that should be emphasized over the next 5 years to make further progress toward these goals.
Summary Background Austerity measures and health-system redesign to minimise hospital expenditures risk adversely affecting patient outcomes. The RN4CAST study was designed to inform decision making ...about nursing, one of the largest components of hospital operating expenses. We aimed to assess whether differences in patient to nurse ratios and nurses' educational qualifications in nine of the 12 RN4CAST countries with similar patient discharge data were associated with variation in hospital mortality after common surgical procedures. Methods For this observational study, we obtained discharge data for 422 730 patients aged 50 years or older who underwent common surgeries in 300 hospitals in nine European countries. Administrative data were coded with a standard protocol (variants of the ninth or tenth versions of the International Classification of Diseases) to estimate 30 day in-hospital mortality by use of risk adjustment measures including age, sex, admission type, 43 dummy variables suggesting surgery type, and 17 dummy variables suggesting comorbidities present at admission. Surveys of 26 516 nurses practising in study hospitals were used to measure nurse staffing and nurse education. We used generalised estimating equations to assess the effects of nursing factors on the likelihood of surgical patients dying within 30 days of admission, before and after adjusting for other hospital and patient characteristics. Findings An increase in a nurses' workload by one patient increased the likelihood of an inpatient dying within 30 days of admission by 7% (odds ratio 1·068, 95% CI 1·031–1·106), and every 10% increase in bachelor's degree nurses was associated with a decrease in this likelihood by 7% (0·929, 0·886–0·973). These associations imply that patients in hospitals in which 60% of nurses had bachelor's degrees and nurses cared for an average of six patients would have almost 30% lower mortality than patients in hospitals in which only 30% of nurses had bachelor's degrees and nurses cared for an average of eight patients. Interpretation Nurse staffing cuts to save money might adversely affect patient outcomes. An increased emphasis on bachelor's education for nurses could reduce preventable hospital deaths. Funding European Union's Seventh Framework Programme, National Institute of Nursing Research, National Institutes of Health, the Norwegian Nurses Organisation and the Norwegian Knowledge Centre for the Health Services, Swedish Association of Health Professionals, the regional agreement on medical training and clinical research between Stockholm County Council and Karolinska Institutet, Committee for Health and Caring Sciences and Strategic Research Program in Care Sciences at Karolinska Institutet, Spanish Ministry of Science and Innovation.
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