Defining patient deterioration through acute care and intensive care nurses' perspectives

Aim: To explore variations between acute care and intensive care nurses’ understanding of patient deterioration according to their use of this term in published literature. Background: Evidence suggests that nurses on wards do not always recognize and act upon patient deterioration appropriately. Even if resources exist to call for intensive care nurses’ help, acute care nurses use them infrequently and the problem of unattended patient deterioration remains. Design: Dimensional analysis was used as a framework to analyze papers retrieved in a nursing focused database. Method: A thematic analysis of 34 papers (2002-2012) depicting acute care and intensive care unit nurses’ perspectives on patient deterioration was conducted. Findings: No explicit definition of patient deterioration was retrieved in the papers. There are variations between acute care and intensive care unit nurses’ accounts of this concept, particularly regarding the validity of patient deterioration indicators. Contextual factors, processes and consequences are also explored. Conclusions: From the perspectives of acute care and intensive care nurses, patient deterioration can be defined as an evolving, predictable and symptomatic process of worsening physiology toward critical illness. Contextual factors relating to acute care units appear as barriers to optimal care of the deteriorating patient. This work can be considered as a first effort in modeling the concept of patient deterioration, which could be specific to acute care units. Relevance to Clinical Practice: The findings suggest it might be relevant to include subjective indicators of patient deterioration in track and trigger systems and educational efforts. Contextual factors impacting care for the deteriorating patient could be addressed in further attempts to deal with this issu

Voices That Care: Licensed Practical Nurses and the Emotional Labour Underpinning Their Collaborative Interactions with Registered Nurses

Recognizing the emotional labour underlying interprofessional collaborations (IPCs) could be considered a crucial step towards building a cohesive nursing team. Although IPCs between registered nurses (RNs) and licensed practical nurses (LPNs) have been linked to quality nursing care, little is known about the emotions experienced by LPNs during their interactions with RNs or those factors that influence IPCs. A questionnaire administered to 309 LPNs found that (1) the professional identity of LPNs has evolved into a that of a unique social group; (2) LPNs define IPC as an interpersonal process of exploring similar or dissimilar assessments of a patient's status with RNs and, together, establishing a course of nursing actions; (3) the primary organizational factor facilitating IPCs is inclusive nursing leadership; (4) the interpersonal factor promoting IPCs is the level of trust RNs extend to LPNs; and (5) an LPN's emotional labour (i.e., internal emotional regulation) is most tangible during uncollaborative interactions with RNs

Une intervention en centres d’hébergement et de soins de longue durée visant à réduire les problèmes de santé mentale liés au travail

Une intervention visant la diminution des contraintes de l’environnement psychosocial du travail et de leurs effets sur la santé mentale a été mise en place à l’hiver 2002. Cette intervention se résume en cinq étapes : l’engagement du milieu et la constitution d’une équipe d’intervention, l’identification des contraintes, l’élaboration des plans d’action, l’actualisation des plans d’action et l’évaluation de l’intervention. La recherche se déroule dans douze centres d’hébergement et de soins de longue durée (CHSLD) et inclut l’ensemble du personnel soignant en contact direct avec la clientèle (N = 493). Un devis quasi-expérimental avec quatre groupes expérimentaux, huit groupes témoins et des mesures avant et après l’intervention a été utilisé.La description des phases de développement et d’implantation de la démarche d’intervention est présentée ainsi que l’évaluation à 12 mois des effets de l’intervention sur la prévalence des contraintes psychosociales au travail et des problèmes de santé mentale.An intervention aimed at reducing adverse occupational psychosocial factors and their mental health effects was begun during the winter of 2002. This intervention can be summarized in five steps: commitment of stakeholders and setting up of an intervention team, identification of adverse occupational psychosocial factors, development of an action plan, implementation of the action plans, and evaluation of the intervention. The study was conducted in twelve residential and extended care centres (CHSLD) and included all care-giving staff in direct contact with patients (N= 493). A quasi-experimental design was used with four experimental groups and eight control groups, and with pre- and post-intervention measurements.The description of the intervention’s development and implementation phases and the evaluation at 12 months of the effects of the intervention on the prevalence of occupational psychosocial factors and mental health problems are presented.En el invierno 2002 se ha establecido una intervención con objetivo de disminuir las coacciones del ambiente psicosocial del trabajo y de sus efectos sobre la salud mental. Esta intervención se resume en cinco etapas : la compromisión del medio y la constitución de un equipo de intervención, la identificación de las coacciones, la elaboración de los planes de acción, la actualización de los planes de acción y la evaluación de la intervención. La investigación se desarolla en doce centros de alojamiento y de cuidados a largo plazo (CHSLD) e incluye el conjunto del personal sanitario en contacto directo con la clientela (N= 493). Un presupuesto casi experimental de cuatro grupos experimentales, ocho grupos de control y medidas pre and post-intervención fueron utilizados.La descripción de las fases de desarrollo y de implantación de los trámites de intervención están presentados así como la evaluación después de 12 meses de los efectos de la intervención sobre la prevalencia de las coacciones psicosociales en el trabajo y de los problemas de salud mental

Reconciling autonomy and beneficence in treatment decision-making for animal patients

This article explores how the concept of consent to medical treatment applies in the veterinary context, and aims to evaluate normative justifications for owner consent to treatment of animal patients. We trace the evolution of the test for valid consent in human health decision-making, against a backdrop of increased recognition of the importance of patient rights and a gradual judicial espousal of a doctrine of informed consent grounded in a particular understanding of autonomy. We argue that, notwithstanding the adoption of a similar discourse of informed consent in professional veterinary codes, notions of autonomy and informed consent are not easily transferrable to the veterinary medicine context, given inter alia the tripartite relationship between veterinary professional, owner and animal patient. We suggest that a more appropriate, albeit inexact, analogy may be drawn with paediatric practice which is premised on a similarly tripartite relationship and where decisions must be reached in the best interests of the child. However, acknowledging the legal status of animals as property and how consent to veterinary treatment is predicated on the animal owner’s willingness and ability to pay, we propose that the appropriate response is for veterinary professionals generally to accept the client’s choice, provided this is informed. Yet such client autonomy must be limited where animal welfare concerns exist, so that beneficence continues to play an important role in the veterinary context. We suggest that this ‘middle road’ should be reflected in professional veterinary guidance

The Signal of Regard: William Godwin’s Correspondence Networks

© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group. The letter is a gift of attention, in which the writer seeks to communicate regard by means of a signal crafted uniquely for the recipient. The concept of regard, as developed by the economic historian Avner Offer, indicates both attention and approbation. Adam Smith took it to be the driver of human exchange in emotions as much as in commerce. The exchange of regard captures the logic of a prodigious correspondent like William Godwin. The personalization of the gift signal is an attempt to convey an obligation to reciprocate. Godwin was attuned to this obligation and worked hard to fulfil it—with varying degrees of success. His correspondents encompassed almost every significant literary and political figure on the political left from the era of the French Revolution to the 1832 Reform Act. The children of the Godwin household were nourished by bonds of reciprocity, which they developed and extended when, in adulthood, they dispersed across Europe. The letters of Godwin and his correspondents embody a larger conversation, allowing intimacy to be preserved at a distance. The signals they once created for each other may now be received by us