Clinical decision making of nurses working in hospital settings.

This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.

Effects of a computer-supported interactive tailored patient assessment tool on patient care, symptom distress, and patients' need for symptom management support: a randomized clinical trial.

OBJECTIVE: To examine the effects of a computer-assisted, interactive tailored patient assessment (ITPA) tool in oncology practice on: documented patient care, symptom distress, and patients' need for symptom management support during treatment and rehabilitation. DESIGN AND METHODS: For this repeated measures clinical trial at a university hospital in Norway, 145 patients starting treatment for leukemia or lymphoma were randomly assigned to either an intervention (n=75) or control group (n=70). Both groups used the ITPA for symptom assessments prior to inpatient and outpatient visits for up to one year. The assessment summary, which displayed patients' self-reported symptoms, problems, and distress in rank-order of the patient's need for support, was provided to physicians and nurses in the intervention group only but not in the control group. RESULTS: Significantly more symptoms were addressed in the intervention group patient charts versus those of the control group. Symptom distress in the intervention group decreased significantly over time in 11 (58%) of 19 symptom/problem categories versus 2 (10%) for the control group. Need for symptom management support over time also decreased significantly more for the intervention group than the control group in 13 (68%) symptom categories. CONCLUSION: This is the first study to show that an ITPA used in an interdisciplinary oncology practice can significantly improve patient-centered care and patient outcomes, including reduced symptom distress and reduced need for symptom management support.

The complexity of symptoms and problems experienced in children with cancer: a review of the literature.

To adequately help children with cancer, care providers need to understand the complexity of symptoms and problems associated with the illness that children are experiencing, which can enable them to better tailor patient care individually to each child. In this integrative literature review, we identified the types of symptoms and problems that children with cancer can experience during treatment and rehabilitation; the terms/expressions they use to describe their symptoms and problems; how children's symptoms and problems vary during the course of their illness; and how they vary and co-vary with age, gender or race. Of the 1175 titles identified, 110 articles met the inclusion criteria and were included in the review. Seventy-eight were research-based. A total of 219 distinct symptoms or problems were identified in the literature either as the main problem or a symptom of the main problem. There is significant evidence that children and adolescents experience numerous and complex symptoms, and problems during and after treatment for cancer. Children use many different expressions to talk about their symptom experiences. However, few articles looked at how children's symptoms and problems varied during the course of their illness or the variations in symptom severity and degree of bother, or examined the relationship between children's symptom experience and age, gender, or race. Most instruments that were used to measure symptoms were interviewer-administered questionnaires, often adaptations from adult versions, and in younger children, symptoms were often obtained from adult informants. The insights gained from this review can be helpful to researchers and clinicians who wish to better understand how symptoms and problems are experienced from the children's own perspective. However, more research is needed: to better understand differences in symptom experiences among different age groups; to identify differences among children from distinct cultural, ethnic, or socio-economic backgrounds; to clarify how symptoms and problems interfere with daily life; and to refine assessment methods that allow even younger children to communicate their symptom experiences in an age-adjusted manner.

Long-term effects of implanted cardioverter-defibrillators on health status, quality of life, and psychological state.

BACKGROUND: Living with an implanted cardioverter-defibrillator increases survival, but the effects of the device on health status, quality of life, and psychological state over time are not clear. OBJECTIVES: To investigate changes in health status, quality of life, and psychological state associated with implantation of a cardioverter-defibrillator from implantation to 4 years later. METHODS: A prospective, longitudinal design was used to measure changes in scores on the Short Form 36 of the Medical Outcomes Study, the Quality of Life Index-Cardiac III, and the Profile of Moods States short form at implantation, 6 months, and 1, 2, 3, and 4 years later. RESULTS: A total of 30 men and 11 women (mean age, 60.4 years) completed all 4 years of follow-up. The physical and mental health composite summary scores of the Short Form 36 changed significantly over time; the mental health score improved (F = 2.95; P = .03), and the physical score worsened (F = 3.69; P = .003). Scores on the Quality of Life Index-Cardiac III did not change significantly. Negative moods were significantly fewer, and the total psychological distress score was significantly lower (F = 10.21; P < .001) during the 4 years of follow-up. CONCLUSIONS: Patients had improved mental health and reduced psychological distress by 6 months after implantation. Perception of physical health declined during the 4 years after implantation; the role physical subscore of the Short Form 36 indicated significant improvement in functioning at 6 months and a trend toward reduced functioning at 3 and 4 years after implantation.

Evaluation of clinical ladder participation in Norway.

PURPOSE: To evaluate nurses' reasons for joining a clinical ladder program, their experiences during participation, and how they use their new competence in practice. DESIGN AND METHODS: Cross-sectional survey design. Sample was 541 nurses who participated in clinical ladder programs at four hospitals in Norway. Data were analysed with descriptive and inferential statistics. FINDINGS AND CONCLUSIONS: Internal motivational factors were most important reasons for joining a clinical ladder. Nursing leaders were lacking in their engagement with the clinical ladder project and its participants. Perceived learning effect, use of competence, and intent to stay increased as nurses progressed in the ladder.

Job satisfaction in a Norwegian population of nurses: a questionnaire survey.

BACKGROUND: Although job satisfaction is a factor that influences retention, turnover and quality of nursing care globally, there are few studies exploring these factors in European countries. OBJECTIVES: To describe job satisfaction among hospital nurses in Norway, to explore the relationship between nurses' job satisfaction and participation in a clinical ladder program and to explore relationships between several variables and intent to stay. A secondary purpose was to investigate the use of a job satisfaction instrument in a different culture than its origin. DESIGN: In a survey, 2095 nurses in four different hospitals answered a questionnaire that included demographic data, intent to stay and a job satisfaction instrument covering the importance of and actual satisfaction with different job factors. RESULTS: Interaction, followed by pay and autonomy were the most important job factors for Norwegian nurses. Actual job satisfaction was similar to nurses in other countries. There was no significant difference in job satisfaction between participants and non-participants in a clinical ladder. Nurses intending to stay more than a year were significantly more satisfied in their job. Further education and 1 day or more scheduled for professional development were factors that were positively related to intent to stay in the hospital. CONCLUSIONS: Norwegian nurses' views on the importance of different job factors mirrored views of the importance ascribed to working milieu in the Norwegian society. As such, the instrument used seemed sensitive to cultural differences. Nurses' actual satisfaction with their job was similar to respondents in many other countries and may imply that structures and content defining nurses' working situation are similar in many parts of the world. Participation in a clinical ladder did not increase nurses' overall job satisfaction. However, further education and the opportunity for professional development increased nurses' intention to stay in the organization.

Quality of life in implanted cardioverter defibrillator recipients: the impact of a device shock.

BACKGROUND: The success of the implanted cardioverter defibrillator (ICD) in prolonging the life of patients with arrhythmia suggests a need to assess quality of life (QOL), especially in those who receive an ICD shock. OBJECTIVES: The purpose of this study was to compare QOL in a group who received an ICD shock with a group who did not receive an ICD shock during the first year. METHODS: Fifty-nine subjects, 42 men and 17 women with a mean age 63 years, completed the Medical Outcomes Study Short Form-36, Ferrans and Powers QOL Index, Profile of Mood States at implantation and 1 year, and the Brodsky ICD Questionnaire at 1 year. RESULTS: Thirty-seven percent received an ICD shock. Those in the shock group had worse mental health ( P < or = .04) and vitality scores ( P < or = .03) on the Short Form-36, increased anxiety ( P < or = .015), fatigue ( P < or = .005), and psychologic distress ( P < or = .02), as measured by Profile of Mood States, compared with the no shock group at 1 year. CONCLUSIONS: Shocked ICD recipients demonstrate mental health concerns.

The effects of age on quality of life in implantable cardioverter defibrillator recipients.

BACKGROUND: The implantable cardioverter defibrillator shows superiority over conventional pharmacological therapy. The implantable cardioverter defibrillator has been implanted with increasing frequency in patients who are either at risk for or have experienced a life-threatening dysrhythmia. Implantable cardioverter defibrillator recipients experience a myriad of physical, emotional and social adjustments, with little being known about the impact of age on trajectory. AIMS, OBJECTIVES AND DESIGN: Therefore the purpose of the study is to examine the effects of age on health status, quality of life, and mood states of implantable cardioverter defibrillator recipients during the first year after implantation using a repeated measures design. METHODS: A comparison of implantable cardioverter defibrillator patients' scores with other samples, both ill and well, are discussed to see how the two implantable cardioverter defibrillator age groups compare on the various measures. Human subjects approval was obtained from the institutional review board. RESULTS: Seventy subjects, 51 males and 19 females, were recruited. There were 31 subjects between the ages of 21 and 62 years, mean age of 51 years, that comprised the younger age group, and 39 subjects between the ages of 67 and 84 years, mean age of 74 years, that comprised the older age group. Each subject completed the Medical Outcomes SF-36, the Ferrans and Powers Quality of Life Index, and the Profile of Moods States at time of implantable cardioverter defibrillator implantation, and 6 and 12 months later. CONCLUSIONS: The older age group was as expected less physically active, less satisfied with their physical functioning, and had slightly more anxiety at 6 and 12 months than the younger counterparts. The younger implantable cardioverter defibrillator recipients demonstrated some improvements over time in the perception of their physical adjustment and anxiety. RELEVANCE TO CLINICAL PRACTICE: Comparison of the SF-36 with other populations with or without a medical condition revealed scores below norms in physical health for both groups, and only slightly higher than patients with heart failure for the older group.

Measuring adherence in a hypertension clinical trial.

BACKGROUND: Non-adherence in hypertension is a global problem and promoting adherence is necessary to decrease cardiovascular mortality. AIMS: The purpose of this paper is to examine the measurement of adherence to medication taking in hypertensive patients. Adherence was evaluated primarily by means of MEMS (Medication Event Monitoring System, Aprex Corporation, Fremont, California) an electronic system that records the date and time of opening of the study medication container. Additional measurements such as change in urinary potassium level, capsule count, client self report and physician estimate of adherence were recorded. METHODS: A randomised clinical trial was used to assign patients to receive the study medication (potassium) or placebo. Descriptive statistics were used to answer the research questions. Frequency and percentage of responses to different measures of adherence were carried out as well as correlation between the measures. RESULTS: One hundred and seven subjects between the ages of 26 and 80 participated in the clinical trial. The results showed that adherence measures varied with lowest adherence from two items of self-report related to forgetfulness (46 and 55%) and stringent electronic monitoring with the MEMS (58%) to percentages in the 80-90 range for other self-report items and the general adherence scale. Electronic monitoring correlated best with capsule count at visit 5. Implications for health care providers are discussed.

The value of collaborative governance/staff empowerment.

OBJECTIVE: Collaborative governance is the decision-making process that places the authority, responsibility, and accountability for patient care with the practicing clinician. BACKGROUND: Collaborative governance was introduced as one of nine structures within the patient care services' professional practice model to facilitate communication and optimize staff participation in decision-making across disciplines. The concept of empowerment was used to evaluate the impact of the collaborative governance structure on members. METHODS: The purpose of the current study was to compare empowerment and power scores for both members and nonmembers of collaborative governance over a 3-year period. RESULTS: Initial survey data (baseline) from 136 staff from across disciplines was returned prior to beginning work on a committee. Study results were based on survey returns from 657 staff over a 3.5-year period. There were no significant differences between collaborative governance members and nonmembers on some demographic variables such as age, but there were significant differences on variables such as work status and education. All empowerment scores were significantly higher at the 2nd and 3rd measurement periods for collaborative governance members as compared to nonmembers. CONCLUSIONS: Findings suggest that membership on a collaborative governance committee increased staff sense of empowerment and fostered self-growth and organizational development.

Life situation related to the ICD implantation; self-reported uncertainty and satisfaction in Swedish and US samples.

The aim of the study was to describe changes in the life situation related to the ICD implantation of Swedish and US samples with regard to uncertainty and satisfaction. The life situation was measured by reference to the uncertainty caused by the condition and satisfaction with the life situation. Inferential statistics were used to analyse changes within and between the Swedish and US samples. Uncertainty showed a statistically significant difference between the Swedish and US samples before as well as after the ICD implantation. A higher level of uncertainty was indicated for the US sample prior to the ICD implantation and for the Swedish sample following the implantation. In the Swedish sample, satisfaction with life showed a statistically significant difference within the socio-economic domain, indicating a higher degree of satisfaction 3 months after implantation. Satisfaction within the domains of health and functioning, socio-economics and psychological-spiritual showed a statistically significant difference between the Swedish and US samples both before and after ICD implantation, indicating a higher degree of satisfaction in the US sample. The previous study shows that the ICD-patient's life situation is changed after the implantation and that it is necessary to provide the patient with information and education based on their own preconditions. The fact that US sample was investigated at a later stage after ICD implantation than the Swedish sample may have influenced the results of the study.

Changes in health status, psychological distress, and quality of life in implantable cardioverter defibrillator recipients between 6 months and 1 year after implantation.

BACKGROUND: Living with an implantable cardioverter defibrillator (ICD) has positive health benefits but the impact on well-being and quality of life over a period of time has not been studied in depth. AIM: To follow patients prospectively over the first year and to compare the changes from time of ICD implantation, to 6 months and 1 year. METHODS: Generalized linear models were used to assess changes through examination of health status (SF-36), psychological distress (POMS), and quality of life (QLI) scores. RESULTS: There were 19 females (27%) and 51 males (73%) in the sample with a mean age of 64 years. There were significant improvements over time in 3 of the 8 sub-concepts of health status: role physical (P<0.001), vitality (P<0.013) and social functioning (P<0.001). The Profile of Mood States revealed significantly less total psychological distress at 6 months with a non-significant leveling off or increase at 1 year. The quality of life index revealed no significant changes over time. CONCLUSIONS: The effects of living with an ICD are not well understood. Research should continue to identify the impact over time in this population and sub-groups so that health care providers can address the social and psychological needs of this population.