Nursing Research

Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia’s mental health services. Whilst legislation, organization and practice changes have all contributed to a reduction in these practices, forensic mental health services continue to report high rates. This paper details the findings of research that examined the experiences of nurses working in the inpatient forensic mental health setting.
The research aimed to (i) document the experiences of nurses working in the forensic mental health setting, (ii) articulate their perceived unique skill set to manage challenging patient behaviours, and (iii) determine how their experiences and skill set can inform practice changes to reduce the use of restrictive practices. Thirty-two nurses were recruited from one Australian forensic mental health service. Data were collected using semi-structured interviews and analysed using inductive content analysis. Four categories were identified that influenced practice experiences: (i) working in a challenging but interesting environment, (ii) specialty expertize, (iii) exposure to aggression and resilience as a protective factor, and (iv) the importance of effective teamwork and leadership. Forensic mental health care is complex, highly specialized, and often delivered in an unpredictable environment. Whilst high rates of restrictive practices may be linked
to the unique characteristics of forensic patients, training, teamwork, and leadership are critical factors influencing their use in this setting. Nurses working in this area need to be educated and supported to work confidently and safely with this high-risk patient cohort.

Women with chronic illnesses face challenges during childbirth and recovery. However, Schizophrenic postpartum women are especially challenged during this period due to inadequate prenatal care, decreased tolerance for pain, and a psychotically distortion of reality 1, 5.  Most of these women experience overwhelming anxiety 1, 2. To handle the clinical needs of these patients, the postpartum nurse must possess excellent clinical skills and utilize all the available resources. The goal is for quality postpartum care and safety for the patient, baby, family, and staff.

RNs make measurable contributions to the health and wellness of individuals living in nursing homes. However, most nursing homes do not employ adequate numbers of professional nurses with specialized training in the nursing care of older adults to positively affect resident outcomes. As a result, many people never receive excellent geriatric nursing while living in a long-term care facility. Nurses have introduced various professional practice models into health care institutions as tools for leading nursing practice, improving client outcomes, and achieving organizational goals. Problematically, few professional practice models have been implemented in nursing homes. This article introduces an evidence-based framework for professional nursing practice in long-term care. The Everyday Excellence framework is based on eight guiding principles: Valuing, Envisioning, Peopling, Securing, Learning, Empowering, Leading, and Advancing Excellence. Future research will evaluate the usefulness...

Since its inception, phenomenological philosophy has exerted an influence on empirical science. But what is the best way to practice, use and apply phenomenology in a non-philosophical context? How deeply rooted in phenomenological philosophy must qualitative research be in order to qualify as phenomenological? How many of the core commitments of phenomenology must it accept? In the following contribution, I will take a closer look at Max van Manen’s work. I will argue that van Manen’s understanding of and presentation of phenomenology is quite problematic and that his book "Phenomenology of Practice" rather than amounting to a clear and accessible presentation of the phenomenological method that would make it do-able to researchers who are not themselves professional philosophers is in fact both abstruse and excessively complicated. I will then turn to nursing, and by taking that as my example, outline a better way to apply and practice phenomenology.

Coping is a cognitive process and behavior that aims at reducing depression while facing stress situation. Treating patient with schizophrenia is a stressor for family and the family will tend to undergo pressure situation from either the environment or the inside part until it can influence family-coping in treating family who suffers mental disorder, such as schizophrenia. Moreover, this research aimed at knowing factors that influenced mechanism of family-coping in treating patient with schizophrenia. Data analysis utilized logistic-regression-test. The result showed that the factors that influenced against family-coping were self-esteem and social-support, meanwhile, the factors that did not influence it were knowledge, stress, and patient's behavior in social-isolation.

Background: Some patients do not receive adequate pain and symptom relief at the end of life, causing distress to patients, families and healthcare professionals. It is unclear whether undertreatment of symptoms occurs, in part, because of nurses’ concerns about legal and/or disciplinary repercussions if the patient dies after medication is administered. Aim: The aim was to explore nurses’ experiences and knowledge of the law relating to the provision of end-of-life pain and symptom relief. Design: Semi-structured interviews with nurses were assessed using a six-stage hybrid thematic analysis technique. Setting/participants: Four face-to-face and 21 telephone interviews were conducted with nurses who routinely prescribed and/or administered pain and symptom relief to patients approaching the end of their lives in Queensland and New South Wales, Australia. Results: While many nurses had no personal experiences with legal or professional repercussions after a patient had died, the fea...

This study examined the extent of adoption by clinical nurses of 14 research-based nursing practices and explored characteristics of the nurses which may have influenced their use of innovations. The relationship between the nurses' adoption of innovative practices and their perception of organizational support in the form of a hospital policy about the practice was also examined. The 14 nursing practices used in the study met the criteria established by the 1982 Conduct and Utilization of Research in Nursing (CURN) Project. The Nursing Practice Questionnaire (NPQ) developed by Brett (1987) to explore nurses' stage of innovation adoption was sent to a random sample of nurses in 10 medium sized hospitals throughout North Carolina; 113 nurses responded. The majority of the sample were aware of 9 of the 14 nursing practices. The percentage who were aware of individual practices ranged from 28% to 93.8%. Eight of the 14 practices were used regularly by more than half of the sample.

Disasters have been increasing through-out time, both natural and man-made, and it’s agreed upon, that disaster can gravely affect communities and countries if they are not prepared for them. One major part of this preparedness is in the healthcare systems, and primarily in the hospital’s Emergency Departments. Finland has disaster preparedness as part of its national laws, and the Ministry of Social Affairs & Health (STM) has also provided guidelines for Healthcare District Municipalities(SHP) and hospitals. International research has been increasing on this subject recently, but no public national research had been found. This thesis explored the current level of disaster preparedness of nurses in working in an Emergency Department (ED) in a middle size hospital in Finland. The research attempted to identify the different types of disasters which the ED nurses are prepared for, and what trainings and education they have. As well as to identify the factors affect the nurse’s preparedness levels. An empirical qualitative research was performed using inductive thematic data analysis. Data was collected by interviews with 4 charge nurses from an ED. Patricia Benner’s theory “From Novice to Expert” was used as framework, along with the STM guidelines. The findings revealed a lack of knowledge in some areas of disaster preparedness, as well as a lack of sufficient training and education, which affected the participants’ confidence in themselves when it came to some specific major events, and in the ED’s level of preparedness, especially since many of the nurses working there currently were new.

ABSTRAK Pendahuluan: Kanker serviks menjadi penyebab utama morbiditas dan mortalitas di seluruh dunia. Program pencegahan kanker serviks yang kurang baik menyebabkan keterlambatan penanganan sehingga sebagian besar responden mengalami kanker serviks stadium lanjut. Penelitian bertujuan untuk mengetahui hubungan faktor personal, self efficacy dengan upaya pencegahan kanker serviks pada wanita usia produktif. Metode: desain penelitian ini adalah deskriptif korelatif dengan pendekatan cross sectional. Populasinya adalah semua wanita usia produktif di wilayah Puskesmas Kenjeran Surabaya. Besar sampelnya adalah 64 responden wanita usia produktif dengan menggunakan Probability Simple Random Sampling. Variabel independen adalah faktor personal dan self efficacy. Variable dependen adalah upaya pencegahan primer dan sekunder. Data dianalisis menggunakan uji statistik Spearman's rho untuk mengetahui variable yang berhubungan dengan upaya pencegahan kanker serviks. Hasil: hasil penelitian menunjukkan hubungan antara faktor personal dan upaya pencegahan kanker serviks menghasilkan p = 0,025 (α ≤ 0,05). Sedangkan variable hubungan self efficacy dengan upaya pencegahan kanker serviks pada wanita usia produktif menghasilkan p = 0,094 (α ≤ 0,05). Diskusi: Faktor personal berhubungan dengan upaya pencegahan kanker serviks pada wanita usia produktif sedangkan self efficacy tidak berhubungan dengan upaya pencegahan kanker serviks pada wanita usia produktif. Untuk peneliti selanjutnya dapat menggunakan variabel lain dari teori Health Promotion Model untuk melakukan upaya pencegahan kanker serviks. ABSTRACT Introduction: Cervical cancer is a major cause of morbidity and mortality worldwide. Bad cervical cancer prevention program cause delays in treatment. Thus, leading most of the respondents had cervical cancer in advance stadium. The study aims to determine the correlation of personal factors, self efficacy in the prevention of cervical cancer in women of childbearing age. Methods: The study design was descriptive correlative with cross sectional approach. The population were all women of childbearing age in Puskesmas Kenjeran Surabaya. Samples were 64 respondents gathered by using simple random sampling. The independent variable were the personal factor and self efficacy. The dependent variable was the primary and secondary prevention efforts. Data were analyzed using Spearman's rho test to determine the variables which associated with the prevention of cervical cancer. Results: The results showed the correlation between personal factors and prevention of cervical cancer with p = 0.025 (α ≤ 0.05). While self efficacy had no correlation with the prevention of cervical cancer with p = 0.094 (α ≤ 0.05). Discussion: Personal factors related to the prevention of cervical cancer in women of childbearing age, while self efficacy is not related to the prevention of cervical cancer in women of childbearing age. For the next researcher to use other variables of the theory Health Promotion Model to take steps to prevent cervical cancer.

Numerous articles describe barriers to nurses conducting research and achieving evidence-based practice as well as strategies for overcoming barriers. The Research Roundtable format is one such strategy. It is an interactive means for providing novice nurse researchers and nursing students with the skill sets required to drive application of existing evidence to nursing practice and conduct outcome studies to derive new evidence. The authors discuss their Research Roundtable series that addressed a number of barriers to research, research utilization, and evidence-based practice and how the series increased nurses knowledge and skills, demystified the research process, provided role models, demonstrated managerial and collegial support, and provided library, fiscal, and other resource support to complete staff projects. The details of the Research Roundtable series will guide others in replicating the process in their own organizations and academic communities.

This research into the concept of support was undertaken because of the recurrent use of the concept in nursing research and especially because of the vital importance of support to family carers of older persons. To inductively develop a definition of support, specifically in the context of family care of frail aged persons. The study followed the evolutionary method of concept analysis. The study was based on data from scientific publications, encyclopaedias and dictionaries. In order to secure a representative sample, highly systematic means of sampling were used. Working with the data underpinning this study, it was possible to put forward a definition of support for family carers who care for a frail aged person at home. The two major dimensions, as described under attributes, were merged into the following definition: "Support entails the provision of general tangibles such as information, education, economic aid, goods and external services. They are prerequisites for fa...

Much of the domestic violence and abuse literature contains reports of quantitative research approaches that quantify the experience, identify those at risk, and recommend interventions. Although important, these approaches often fail to describe the experience and understanding from the perspective of and in the language used by women who have experienced abuse. This article reports a phenomenographic study of six women's understanding of their experiences of domestic violence during their childbearing years, the time period associated with pregnancy and the first twelve months after birth. The women described domestic violence as being experienced as a loss of self, being controlled and destruction. This report presents the women's views of domestic violence as a complex and damaging phenomenon that is experienced by them in a number of qualitatively different ways.

A conclusione dell'intenso percorso formativo sullo human caring in regione, è possibile porsi alcune domande e soprattutto cercare di elaborare alcuni spunti che possano essere sfruttati a livello pratico-operativo. Si deve anzitutto partire dal riconoscimento del particolare momento che stiamo vivendo: da un lato, l'attenzione verso lo human caring mai è stata così alta da parte di tutti gli attori del panorama sanitario, pazienti, operatori e dirigenza/politici; dall'altro, la riflessione filosofica è finalmente uscita dalla proverbiale torre d'avorio e ha preso consapevolezza che specialmente l'etica ha un futuro solo come etica applicata ai casi concreti della vita. Uno dei problemi evidenziati sin dall'inizio nello human caring è che esso per definizione necessita di una formazione permanente. Occorre dunque pensare ad un approccio articolato su più fronti. Anzitutto occorrerebbe iniziare a fare una prima sintesi delle varie riflessioni fatte in ambito etico finora. Dato per acquisito che il fondamento dello HC è l'etica, si tratta di capire quale sia il modello etico migliore. Inoltre nell'elaborarlo si deve tenere conto delle specificità della situazione italiana. Dall'altro lato, si deve iniziare ad affrontare la questione dell'inserimento dello HC nei curricula di studio e formazione (o rendere questi ultimi permanenti) e magari pensare a creare occasioni di formazione post-laurea e post-diploma sul modello di alcuni esempi esteri. Articolo di Claudio Magris sul Corriere del 6 novembre: In questi anni ho avuto occasione di frequentare, per me e soprattutto per persone a me care, medici delle più svariate specialità ed è stata una delle forti e liberatrici esperienze della mia esistenza. Nelle più varie discipline che si confrontano con i mali che assalgono l'uomo — dall'oncologia all'oculistica, dalla dermatologia alla pediatria, dalla cardiologia alla neurologia, alla chirurgia — ho avuto modo di toccare con mano una radicale trasformazione del rapporto fra medico e paziente, che significa un vero passo in avanti dell'umanità. Ho visto clinici di diverse specialità — e ne ho anche scritto, citando nomi e cognomi — capaci di dare serenità dicendo la verità, una verità spesso tutt'altro che allegra. Ho accompagnato di recente una persona a me carissima dalla sua oncologa, tanto inesorabilmente precisa nella sua descrizione dello stato delle cose quanto incredibilmente capace di comunicare queste nozioni neutralizzando il loro potenziale d'ansia, sicché siamo usciti dal colloquio non ossessionati dalla malattia, bensì pervasi da un profondo senso della vita e della sua creatività, che comprende il meglio e il peggio, entrambi guardati chiaramente in faccia. Certo, quando il numero dei pazienti che giustamente fanno ansiose e ripetute domande si fa alto, la necessaria fretta e lo stress a essa legato possono rendere più difficile questo momento di creatività non solo professionale ma umana.

Nursing care dependency and similar terms are frequently used in nursing literature. However, their meanings are still to be adequately defined. This paper seeks to operationalize the concept of dependency for use in long-term nursing care practice. An analysis of the concept of dependency, specifically with regard to nursing care, will present a frame of reference from which a theoretical definition can be stated. Variable dimensions, observable indicators and means for measuring the indicators are presented. The paper concludes with implications for further research.

Cancer and venous access (CAVA) trial has highlighted some issues and problems from the different departments linked to this clinical trial. This clinical service review attempted to reflect on this problems and offered some insights as to how address these problems.

زمينه و هدف: مراقبت از بيماران مبتلا به دمانس و بالاخص آلزايمر از آسيب پذيرترين و چالش برانگيزترين
نوع مراقبتهاست كه مراقبين ممكن است با آن مواجه شده و باعث تجربه استرس زياد در آنها مي گردد. در اين
ميان فقدان آموزشهاي لازم نيز مشكلات آنها را دو چندان نموده است. هدف اين مطالعه تعيين تاثير بحث
گروهي و مشاوره تلفني بر استرس درك شده زنان مراقبت كننده از سالمند مبتلا به آلزايمر بوده است.
روش بررسي: در اين پژوهش تجربي، 150 زن 18 تا 60 سال كه از وابستگان درجه يك سالمند مبتلا به
آلزايمر بوده و مراقبت مستقيم از سالمند مبتلا به آلزايمر را به مدت حداقل 6 ماه به عهده داشتند با روش نمونه
گيري مستمر مبتني بر هدف انتخاب شده و آزمودني ها با روش تصادفي بلوكه شده به تصادف در دو گروه
آزمون و كنترل قرار گرفتند. گروه آزمون در يك برنامه مداخلهاي شامل يك جلسه بحث گروهي، دريافت يك
پمفلت آموزشي و دو مشاوره تلفني شركت نمودند. 6 هفته پس از مداخله، پسآزمون براي هر دو گروه انجام
گرفت. ابزار گردآوري اطلاعات، پرسشنامه اطلاعات دموگرافيك و استرس درك شده بود. براي مقايسه متغيرها
از آزمونهاي آماري تي زوجي، تي مستقل، كاي اسكوئر و آناليز واريانس يك طرفه استفاده شد.
57 % از / 50 % نمونهها در گروه آزمون و 3 / يافتهها: نتايج نشان داد كه قبل از بحث گروهي و مشاوره تلفني 7
نمونهها در گروه كنترل استرس درك شده بالايي داشتند. پس از انجام بحث گروهي و مشاوره تلفني ميانگين
بين استرس .( P< 0/ 22 تقليل يافت ( 001 /45±5/ 28 به 55 /38 ±8/ استرس درك شده در گروه آزمون از 62
از نظر آماري ارتباط ( P=0/ و وضعيت اقتصادي ( 01 (P=0/ درك شده و متغيرهاي وضعيت تحصيلات ( 03
معنيدار وجود داشت.
نتيجهگيري: زنان مراقبتكننده از سالمند مبتلا به آلزايمر به عنوان مهمترين مراقبين غيررسمي، سطوح استرس
بالايي را تجربه ميكنند كه همين امر سلامت آنها و سالمندان تحت مراقبت ايشان را تحت الشعاع قرار ميدهد،
لذا لزوم مداخله براي اين مراقبين به منظور بهبود وضعيت آنها پيشنهاد ميشود.

The use of hospital facilities may greatly improve services to the visiting patients. The standard of good services will lead to positive patient satisfaction resulting in growing patient visit rate. Normally, patients will evaluate the process and physical evidence provided by the hospital. They will assess the actual and the preferred services, as well as the money and time they have spent to get healthcare services from the hospital. If patient satisfaction toward the hospital services is good, the hospital can compete with other hospital in terms of service provision. Regarding this issue, the present study aimed to investigate the correlation between process and physical evidence toward patient satisfaction in private hospital in Medan. It was a quatitative study using cross sectional design with the total number of population was 6.051. Through performing accidental sampling technique, 100 patients were included as samples. The data of this study was collected by administering questionnaire. Data analysis using Chi Square showed that there was a correlation between process and patient satisfaction (p=0,000;p<0.005). It was also found that there was a signifiant correlation between physical evidence and patient satisfaction (p=0,000;p<0.005). Therefore, it is concluded that good process and physical evidence will result in good patient satisfaction. Consequently, the rate of patient visit will also increase. This study suggests to hospital management to improve the process and physical evidence of hospital services to the patients to meet patient satisfaction.

Feed efficiency can be improved by changing diet composition though probiotic supplementation and changing key microbial groups through defaunation. This study assessed probiotic supplementation as a way of optimizing rumen defaunation in goats fed low-quality forage. The following treatments were compared in this study: T 1 (intact without probiotic supplementation), T 2 (intact with probiotic supplementation), T 3 (defaunated without probiotic supplementation), and T 4 (defaunated with probiotic supplementation). Six out of the twelve animals were defaunated using ipil-ipil (Leucaena leucocephala) fed for 9 days; the other 6 were fed Napier grass (Pennisetum purpureum) alone. After defaunation, three of the defaunated goats were given probiotic supplement while the other three were not. The same was done to faunated goats. Probiotic supplementation to defaunated goats was successful in increasing protozoal counts (P<0.01) and bacterial counts (P<0.01) as well as stabilizing the pH (P<0.01) of these animals fed low-quality forage. Probiotic supplementation is recommended as a technique to combat the negative effects of defaunation on microbial counts and pH in animals fed low-quality forage.

ABSTRAK Pendahuluan: Kanker masih menjadi penyakit dengan angka mortalitas yang tinggi. Pelayanan kesehatan berkelanjutan untuk penderita kanker yang bisa bertahan hidup (cancer survivors) sangat diperlukan untuk pencegahan kekambuhan dan meningkatkan kualitas hidup penderita kanker. PCHN (Palliative Community Health Nursing) merupakan paket pelayanan perawatan kesehatan masyarakat (perkesmas) paliatif yang diberikan kepada keluarga dan penderita kanker di rumah, yang berfokus pada kegiatan promotif dan preventif. Tujuan dari penelitian ini adalah menjelaskan pengaruh pengembangan PCHN terhadap peningkatan kemandirian keluarga dalam perawatan penderita kanker di rumah. Metode: Jenis penelitian adalah pra eksperimen. Populasi adalah keluarga penderita kanker pascaperawatan yang tercatat di wilayah kerja Puskesmas Mulyorejo, Kota Surabaya. Sampel diambil dengan teknik purposive sampling. Sejumlah 7 orang memenuhi kriteria inklusi. Variabel independen adalah PCHN. Variabel dependen adalah tingkat kemandirian keluarga, dikumpulkan dengan lembar observasi tingkat kemandirian keluarga. Data kemudian dianalisis dengan Wilcoxon Signed Rank Test, α ≤ 0,05. Hasil: Hasil uji menunjukkan ada perbedaan tingkat kemandirian keluarga penderita kanker sebelum dan sesudah PCHN (p = 0,025). Diskusi: PCHN dapat meningkatkan kemandirian keluarga dalam perawatan penderita kanker di rumah. Pelaksanaan PCHN melalui kunjungan rumah dapat memberikan dukungan informasi terkait kanker dan perawatan di rumah bagi keluarga. PCHN dapat dikembangkan sebagai salah satu metode untuk meningkatkan pelayanan paliatif di masyarakat oleh perawat komunitas, dalam rangka meningkatkan kualitas hidup penderita kanker. Penelitian selanjutnya, diharapkan mengembangkan PCHN dengan melibatkan tim yang multidisiplin, baik dari petugas kesehatan, rohaniawan, maupun sukarelawan. Kata Kunci: perawatan kesehatan masyarakat, paliatif, kemandirian keluarga, kanker ABSTRACT Introduction: Cancer still remains a disease with high mortality rate. Sustainable health services for cancer survivors are important to prevent relapse and improve patient's quality of life. PCHN (Palliative Community Health Nursing) is a packet of community health nursing services given to the family and cancer's patient at home, focused on promotive and preventive activities. The aim of this study was to analyze the infl uence of palliative community health nursing to increase family's autonomy in caring patient with cancer at home. Method: This study was used pre-experiment design. The populations were family who lived with cancer's patient post treatment. Samples were taken by purposive sampling technique; consist of 7 people. Variable independent was PCHN. Variable dependent were family's autonomy in caring patient with cancer at home collected by using observation form. The data were then analyzed by using Wilcoxon Signed Rank Test, with α ≤ 0.05. Results: The results had showed the differences between family's autonomy in caring patient at home before and after PCHN (p = 0.025). Discussion: PCHN can increase family's autonomy in caring cancer's patient at home. The implementation of PCHN through home visit can give informational support about cancer and treatment at home to the families. PCHN can be used as one of method to improve palliative services at community, in order to increase cancer's patient quality of life. Further research, should develop PCHN which involve multidicipline team, such as health care provider, clergy, and health volunteer.

Introduction: Preschool-aged children are not able to manage their nutrition independently. They need help, especially from their mother. Mother's behavior has effect on preschool's nutritional status. The aim of this study was to develop nutrition demand enquiry model for preschool-aged children based on Health Promotion Model. Method: Design used in this research was an observational analytic with cross sectional approach that was conducted in Karangturi Village, Gresik, East Java. The population was mothers of preschool aged children listed on Integrated Health Post for Underfi ves (Posyandu Balita) along April–May 2012. Simple random sampling was used to take the sample. Sample size was 90 respondents. The independent variables were personal factors (age, motivation, and ethnicity), perceived benefi t, perceived barrier, perceived self-effi cacy, and commitment. The dependent variable was mother's behavior on nutrition of preschool children. Data were collected using questionnaire and food recall 24 hour. Data were analyzed using PLS (Partial Least Square) Regression. Result: The result showed that 1) personal factors had correlation with perceived benefi t, perceived barrier, and perceived self-effi cacy; 2) perceived benefi t and perceived barrier had correlation with commitment; 3) commitment had no correlation with mother's behavior on nutrition. Perceived benefi t and perceived barrier had direct correlation with mother's behavior on nutrition. Discussion: It can be concluded that mother's perceived benefi t and perceived barrier was correlated with mother's behavior on nutrition. Nurses are key health care professionals responsible for increasing health education activities about how to manage nutrition of preschool age children. So, mother should have good behavior on preschool age children's nutrition.