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Issues in Mental Health Nursing, 32:392–393, 2011Copyright (C) Informa Healthcare USA, Inc.ISSN:
onlineDOI: 10.0.COMMENTS, CRITIQUE, AND INSPIRATION COLUMNThe Importance of Knowing the PatientCindy Zolnierek, MSN, RNUniversity of Texas at Austin, School of Nursing, Austin, Texas, USAEdited by Mona Shattell, PhD, RNUniversity of North Carolina at Greensboro, School of Nursing,Greensboro, North Carolina, USA andTony MacCulloch, MEd, RN, RPN, DipCounsAUT University, School of Nursing, Auckland, New ZealandExpected or unexpected, when it occurs, hospitalization isa major life event for most people—an event that emphasizesone’s illness and vulnerability. Patients hospitalized in generalhospital settings are likely to feel anxious as they deal with aforeign environment that removes personal power and controland imposes unfamiliar routines, structures, and rules. Nursesare the “primary providers” of care in general hospital set-tings and are responsible for determining nursing care needs,managing patient risk, and coordinating care. Hospitalized pa-tients’ outcomes are largely dependent on how well nurses areable to perform these roles. The level of nurse staffing, theeducational preparation of nurses, and the quality of the prac-tice environment contribute to nursing effectiveness and affectnurse-sensitive patient outcomes (Aiken, Clarke, Sloane, Lake,& Cheney, 2008). In addition, patient satisfaction scores are in-creasingly included as important hospitalization outcome mea-sures, and perceptions of nursing care, specifically the qualityof nurse-patient relationships, are strongly related to overall pa-tient satisfaction ratings as well as hospital quality and safetymeasures (Issaac, Zaslavsky, Cleary, & Landon, 2010). Nurseshave a powerful role in influencing the health outcomes of hos-pitalized patients.Yet, in the contemporary acute care hospital, nurses struggleto meet patient care needs within the demands of a complexand rapidly changing environment. Complexity compression,environmental turbulence, and workload stacking are a few ofthe phenomena described in the literature representative of thisdynamism and affecting nurses’ ability to perform their rolessafely and effectively. Add to that, “difficult patients”—thoseAddress correspondence to Cindy Zolnierek, School of Nursing,University of Texas at Austin, 1700 Red River Street, Austin, TX78701. E-mail: who exhibit problematic behaviors, who are difficult to get toknow, who do not conform to expectations of the patient role,who fail to validate the professional role of the nurse, and whoutilize more resources—and the challenge, as well as oppor-tunity, for nurses to positively impact care outcomes becomesevident (Kelly & May, 1997; Macdonald, ).Psychiatric comorbidity alone can cause a patient to be expe-rienced as difficult in a general hospital setting. It is significantthat up to 50% of patients in nonpsychiatric general hospitalsettings have a psychiatric comorbidity (Furlanetto, da Silva, &Bueno, 2003). This patient population experiences poorer out-comes in general hospital settings than patients without psychi-atric comorbidities. When the cormorbidity includes a seriousor severe mental illness (SMI), patients experience increasedadverse events, longer lengths of stay, and greater costs of care(even when controlling for severity of illness) (Zolnierek, 2009).Perhaps this is not surprising. Nonpsychiatric nurses strugglein their attempts to provide care to persons with mental illnesshospitalized in general hospital environments. These nurses feelthey lack the competency and resources to provide appropriatecare (Brinn, 2000). Patients with psychiatric comorbidities mayexhibit unusual behavior, take more time, be difficult to get toknow, and challenge the comfort of nursing staff. Some hospi-tals have implemented psychiatric consultative liaison services,generally provided by psychiatrists and/or nurses, to assist incare management. While such services are well-received byboth staff and patients, there is a paucity of evidence inform-ing the practice—most reports are descriptive or based on casestudies, and improved patient outcome measures have not beenreported (Cullum, Tucker, Todd, & Brayne, 2007). Up to half ofgeneral hospital inpatients may have a psychiatric a more comprehensive approach may be required.Holistic care, individualized care, person-centered care, andculturally competent care all stem from the recognition of theneed to first see the person, not the disorder, and to understandthe person as multifaceted with biological, psychological, social,cultural, and spiritual aspects that must be considered as a uniquewhole. Several recent national reports (e.g., Center for MentalHealth Services, 2010; Institute of Medicine, 2011) overtly chal-lenge providers to rethink and reformulate approaches to care392Issues Ment Health Nurs Downloaded
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COMMENTS, CRITIQUE, AND INSPIRATION 393and treatment by developing integrated person-centered mod-els. Nursing has long claimed a holistic approach as central toits practice. But, is holistic care a reality in the acute care gen-eral hospital environment? Dutton (2010), an RN, posted thefollowing comment on the Future of Nursing website:The report on the future of nursing is great—but there seems tobe a lack of understanding as to the function of a hospital nurse (asmandated by hospitals) and what they do. The function of a hospitalnurse is not a practice—it is a task driven job that has been reducedto the point where there is no relationship between what a nurse istaught his/her function is and what hospitals have them do.If hospital environments place priority on the completion oftasks rather than supporting nurses’ role in determining nursingcare needs, managing patient risk, and coordinating care, re-lationships with patients and purposeful interpersonal encoun-ters will be limited and optimal patient outcomes will not beachieved. If nurses see their role as completing tasks, it is un-likely they will seek to know their patients, making person-centered care impossible.Duffy, Baldwin, and Mastorovich (2007) describe a Quality-Caring Model for organizing care delivery in which caring re-lationships and specific caring practices are emphasized. Careis organized so that nurses plan uninterrupted time with pa-tients for purposeful interaction. As nurses come to know theirpatients, they are able to implement personalized care. Bothpatient and nurse satisfaction rates improved after piloting thismodel in medical-surgical settings.A relationship-based nursing care delivery model that de-liberately prioritizes the nurse-patient relationship may be themissing link for moving inpatient nursing practice from task- toperson-centered care. A relationship-based care delivery modelmay improve effectiveness of psychiatric consultative liaisoninterventions by focusing nurses’ efforts on getting to knowtheir patients so they can personalize their care rather than fo-cusing efforts on eradicating difficult patient behaviors. Suchan approach requires nurses to know their patients—to firstsee the person—and establish a relationship. The quality ofnurse-patient relationships is critical to the outcome of patients’experiences of hospitalization. Patients’ experiences of beingunderstood were found to be characterized by an “interper-sonal connection with listeners who made them feel importantand connected on their level” (Shattell, McAllister, Hogan, &Thomas, 2006, p. 239). Listening takes time and ef as oneparticipant is quoted by Shattell et al. (2006), “A person canlisten without caring, but can’t care without listening” (p. 237).Further, nurses’ ability to get to know their patients is key topositive nurse-patient encounters (Macdonald, 2007).Psychiatric nurses in consultative liaison roles are a valuable,though perhaps insufficient, resource to nonpsychiatric nursesproviding care to persons with psychiatric comorbidities in gen-eral hospital settings. Nurses’ practice environments must sup-port professional practice roles that include purposeful nurse-patient encounters and relationships so that person-centered carecan be provided. Direct care nurses are called upon to refuse toacquiesce their role to task completion and insist, instead, onpractice environments that support their professional role ofdetermining nursing care needs, managing patient risk, and co-ordinating care. Nurse leaders are challenged to develop andprotect care delivery models that support nurse-patient relation-ships and contribute to positive patient outcomes.REFERENCESAiken, L. H., Clarke, S. P., Sloane, D. M., Lake, E. T., & Cheney, T. (2008).Effects of hospital care environment on patient mortality and nurse outcomes.Journal of Nursing Administration, 38, 223–229.Brinn, F. (2000). Patients with mental illness: General nurses’ attitudes andexpectations. Nursing Standard, 22, 32–36.Center for Mental Health Services. (2010). The 10 by 10 Campaign: A NationalAction Plan to Improve Life Expectancy by 10 Years in 10 Years for Peoplewith Mental Illnesses. A Report of the 2007 National Wellness Summit. HHSPublication No. (SMA) 10–4476. Rockville, MD: Center for Mental HealthServices, Substance Abuse and Mental Health Services Administration.Cullum, S., Tucker, S., Todd, C., & Brayne, C. (2007). Effectiveness of liaisonpsychiatric nursing in older medical inpatients with depression: A randomizedcontrolled trial. Age and Ageing, 36, 436–442.Duffy, J. R., Baldwin, J., & Mastorovich, M. J. (2007). Using the quality-caringmodel to organize patient care delivery. Journal of Nursing Administration,17, 546–551.Dutton, V. (2010). Comments on the Future of Nursing. Retrieved fromhttp://www.thefutureofnursing.org/IOM-ReportFurlanetto, L. M., da Silva, R. V., & Bueno, J. R. (2003). The impact of psychi-atric comorbidity on length of stay of medical inpatients. General HospitalPsychiatry, 25, 14–19.Institute of Medicine. (2011). The future of nursing: Leading change, advancinghealth. Washington, DC: The National Academies Press.Isaac, T., Zaslavsky, A. M., Clearly, P. D., & Landon, B. E. (2010). The relation-ship between patients’ perception of care and measures of hospital qualityand safety. Health Services Research, 45, .Kelly, M. P., & May, D. (1982). Good and bad patients: A review of the literatureand a theoretical critique. Journal of Advanced Nursing, 7, 147–156.Macdonald, M. T. (2003). Seeing the cage: Stigma and its potential to in-form the concept of the difficult patient. Clinical Nurse Specialist, 17, 305–310.Macdonald, M. T. (2007). Nurse-patient encounters: Constructing harmony anddifficulty. Advanced Emergency Nursing Journal, 29(1), 73–81.Shattell, M. M., McAllister, S., Hogan, B., & Thomas, S. P. (2006). “She tookthe time to make sure she understood”: Mental health patients’ experiencesof being understood. Archives of Psychiatric Nursing, 20, 234–241.Zolnierek, C. D. (2009). Nonpsychiatric hospitalization of people with mentalillness: Systematic review. Journal of Advanced Nursing. 65, .Issues Ment Health Nurs Downloaded
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&The process of caring for a person with SMI in a medical–surgical hospital environment is complex, and many variables can influence the nurse–patient relationship . Patients with SMI were described as difficult to get to know, yet knowing the patient is key to establishing effective nurse–patient relationships (Zolnierek, 2011). Furthermore, the traditional medical–surgical hospital environment may not be conducive to nurses' knowing their patients and individualizing care. &ABSTRACT: When hospitalized for medical conditions, many people with severe mental illness (SMI) have poor outcomes, yet little is known about contributing factors. Studies exploring the care experience from nurses' perspectives described care processes as &difficult.& None of these studies were conducted in the United States, and sociocultural contexts significantly affect perceptions of SMI.
The purpose of this inquiry was to explore a medical-surgical nurse's perceptions of caring for a hospitalized person with SMI in the United States. Design: A qualitative, descriptive case study was used.
The nurse's experience was characterized by categories of tension, discomfort, lack of professional satisfaction, and difficult.
This case study revealed a negative care experience, similar to conclusions of investigations conducted in other countries. Understanding of nurses' care experiences can inform efforts to improve practice environments, provide resources, or develop models of care that support nurses who care for patients with SMI and improve health outcomes for people with SMI. Full-text · Article · Jun 2012 ABSTRACT: This qualitative study aims to explore the perceptions of nurses in nursing homes about signs of stroke and their experiences with older residents who are at a high risk for stroke. Data were collected through in-depth interviews with 31 nurses from 11 nursing homes in South Korea. Data were analyzed concurrently with data collection through inductive content analysis. The findings consisted of three themes: (1) maximizing experiential knowledge: classifying and com (2) minimizing further severe cerebral damage: detecti and (3) perceiving barriers to caring for older residents with stroke. The nurses used their clinical experience and personal history, and maximized their knowledge to identify high-risk residents and recognize the onset of stroke. Through continuous monitoring, they became aware of subtle changes in the condition of older residents with an underlying illness. After timely recognition, prompt transfer to an emergency department was important to minimize serious damage with evidence-based hyperacute treatment. Nurses highlighted that linking with family members might be important for them to understand nurses’ actions and accept emergency situations. However, the nurses perceived limited resources and lack of authority as barriers to stroke care. Poor knowledge about subtle symptoms was also a substantial barrier to stroke care. Understanding the nurses’ perceptions may be an initial step toward developing well-defined clinical protocols of effective stroke care in nursing homes.Article · May 2015 +1more author...[...]ArticleAugust 2016 · Journal of Advanced Nursing · Impact Factor: 1.74ArticleAugust 2016 · Journal of the American Psychiatric Nurses Association · Impact Factor: 0.98ArticleAugust 2016 · Journal of Psychiatric and Mental Health Nursing · Impact Factor: 0.84ArticleAugust 2016 · Journal of Nursing Scholarship · Impact Factor: 1.64Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.This publication is classified Romeo Yellow.
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The Prediction of Medical Decision Post Operative of the Major Operation using Neural Networks
Anifudin Azis, Nur Rokhman, Praretno Wibowo
The exact handling to the postoperative inpatient of the major operation in the restoration period, became one of the factors that very important for the success of the process of medical treatment on the whole. By paying attention to the development of signs and vital signs from the patient, could be made medical by one decision took the form of the further action for the handling of the patient. Using backpropagation neural networks, could be made by a system that could carry out the prediction (forecast) the medical decision that will be taken to the postoperative patient the major's operation. After trining, by accepting sign input and the vital sign of the patient, the system could determine the action that will be carried out against the patient. From results of the test of the application program showed that the backpropagation neural networks could do the prediction of the medical decision with the success to 80%. Therefore, output from the system could be used as consideration of the doctor to decide the further action for the patient.
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