Attitudes of nurses towards care of the dying patient in India.

BACKGROUND: Worldwide, end-of-life care is coming under increasing scrutiny as nurses struggle to balance cultural norms and legal requirements with the desires of patients and families. The purpose of this descriptive pilot study was to examine and describe nurses' attitudes when caring for dying patients in India, and whether participation in an educational conference, which included two scenario-based, low-fidelity simulations increased knowledge of end-of-life care. METHOD: Participants' attitudes were measured with the 30-item Frommelt Attitudes Toward Care of the Dying (FATCOD-B) scale. Knowledge was measured with a researcher-developed 15-item content-focused test before and after the conference. RESULTS: The mean attitude scores of nurses (n=101) were M=101.45 (range 65-143, SD=15.99). Participation in the educational conference and end-of-life care simulations increased the knowledge of most nurses (P<0.05). CONCLUSION: Conferences and low-fidelity simulation are effective methods for improving nurses' knowledge of end-of-life care in India. Improved education surrounding end of life may positively affect attitudes.

Patient-centered care for chronic pain in the emergency department: A qualitative study.

Pain is a common problem for which patients seek care in the emergency department, accounting for up to 42% of all ED visits. The purpose of this study was to explore qualitatively the reasons for use of the emergency department (ED) by those frequenting the ED for treatment of chronic pain. The settings for the study were two sites of a large U.S. Midwestern healthcare system. The sample comprised patients who used the ED four or more times in the 3-month time of data collection. From a total of 85 frequent users identified through retrospective chart reviews, a computer generated random sample of patients was selected to explore their reasons for use of ED for treatment of chronic pain. Content analysis was used to identify themes from the interviews. Four themes emerged from the qualitative data analysis: time of day, pain intensity, barriers to and reasons for using the emergency department for care, and lack of individualized plan of care. Reasons patients use the ED for chronic pain are numerous and complex. Leaders of healthcare organizations must address patient-centered care, with specific alternatives to the emergency department such as individualized care plans, and care transition interventions.

Using SBAR to promote clinical judgment in undergraduate nursing students.

The purpose of this study was to describe how students identify and interpret multiple embedded clinical cues in a case study, and then reflect these using SBAR (Situation, Background, Assessment, and Recommendation). Using Tanner's model of clinical judgment, a descriptive design was used to examine SBAR assignments completed by second-semester nursing students (n = 80). The majority of students (n = 62, 77.5%) in the study were unable to successfully follow all of the clinical judgment phases of the model: noticing, interpreting, responding, and reflecting. Although SBAR is an important tool for communicating clinical information, gaps exist between noticing and interpreting clinical cues, and forming an appropriate course of action.