RESUMEN
This paper demonstrates the value of participatory action research (PAR) and promotes its use by nurses in clinical practice. PAR has gained popularity in nursing and health-care research, offering a way of developing practice-based knowledge that can improve nursing care. PAR is described in detail: what PAR is, how to use PAR in clinical practice, and the steps in the PAR cycle as applied during an exemplar study in which nurses used PAR to address their concerns and develop, implement and evaluate a model of care in an acute medical ward. The authors advocate PAR as a collaborative means to improve the nursing care for patients in varied clinical practice settings.
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Enfermeras y Enfermeros/psicología , Investigación en Enfermería , Enfermería , Humanos , Poder PsicológicoRESUMEN
BACKGROUND: There is a lack of research investigating models of nursing care for older hospitalised patients that address the nursing needs of this group. OBJECTIVES: The objective of this study is to evaluate the efficacy of models of care for acutely older patients tailored to two contexts: an aged care specific ward and a medical ward. DESIGN: This is a repeated measures design. Efficacy of the models was evaluated in terms of: patient and nurses' satisfaction with care provided; increased activities of daily living; reduced unplanned hospital readmissions; and medication knowledge. SETTINGS: An aged care specific ward and a medical ward in two Sydney teaching hospitals. PARTICIPANTS: There were two groups of patients aged 65 years or older who were admitted to hospital for an acute illness: those admitted prior to model implementation (n=232) and those admitted during model implementation (n=116). Patients with moderate or severe dementia were excluded. The two groups of nurses were the pre-model group (n=90) who were working on the medical and aged care wards for the study prior to model implementation, and the post-model group (n=22), who were the nurses working on the wards during model implementation. METHODS: Action research was used to develop the models of care in two wards: one for an aged care specific ward and another for a general medical ward where older patients were admitted. The models developed were based on empirical data gathered in an earlier phase of this study. RESULTS: The models were successful in both wards in terms of increasing satisfaction levels in patients and nurses (p<0.001), increasing functional independence as measured by activities of daily living (p<0.01), and increasing medication knowledge (p<0.001). CONCLUSIONS: Findings indicate that models of care developed by nurses using an evidence-based action research strategy can enhance both satisfaction and health outcomes in older patients.
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Enfermedad Aguda/enfermería , Enfermería Geriátrica/organización & administración , Unidades Hospitalarias/organización & administración , Modelos de Enfermería , Planificación de Atención al Paciente/organización & administración , Atención Dirigida al Paciente/organización & administración , Actividades Cotidianas , Enfermedad Aguda/psicología , Anciano/psicología , Anciano de 80 o más Años , Análisis de Varianza , Actitud del Personal de Salud , Evaluación Geriátrica , Necesidades y Demandas de Servicios de Salud , Humanos , Satisfacción en el Trabajo , Nueva Gales del Sur , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Evaluación de Resultado en la Atención de Salud , Satisfacción del Paciente , Evaluación de Programas y Proyectos de Salud , Gestión de la Calidad Total/organización & administraciónRESUMEN
AIMS AND OBJECTIVES: The main aim of this study was to improve the quality of nursing care for older acutely ill hospitalized medical patients through developing, implementing and evaluating a new model of care using a participatory action research process. BACKGROUND: One of the challenges of nursing today is to meet the health-care needs of the growing older population. It is important to consider what quality of nursing care means to older patients if nurses are to address gaps between their own perceptions and those of older patients themselves and to consider conceptual models of care appropriate for older patients care in order to improve the quality of care provided. DESIGN: This study is a mixed method triangulated study, involving the use of both quantitative and qualitative methods through participatory action research methodology to establish an evidence-base for an evolving model of care. METHODS: The model was tested on 60 acutely ill patients aged at least 65 years. The medical ward nurses selected a key reference group including the researcher to facilitate the participatory action research process to develop, implement and evaluate a new model of care based on Orem's self-care model incorporating the Nurses Improving Care to Health System Elders Faculty (Am J Nurs 1994; 94:21) medication protocol to improve the nursing care provided for acutely ill older patients. RESULTS: The participatory action research process resulted in improved heath-care outcomes for the patients, such as significant improvements in activities of daily living capabilities between admission to discharge, significant improvements in knowledge levels regarding their medication regimes, as well as increased satisfaction with nursing care activities as perceived by older patients and nursing staff. The implementation of educational sessions during the model of care improved the older patient's functional activities and knowledge levels of their medication regime prior to discharge. In addition, by repeatedly explaining procedures, nurses became more involved with their individual patient's care, developing a patient-centred care relationship based on Orem's self-care model. CONCLUSIONS: This study demonstrates the efficacy of a new model of nursing care in improving the quality of nursing care for older patients in the acute medical ward setting. RELEVANCE TO CLINICAL PRACTICE: This study is significant because of its evidence-base and demonstrates how the participatory action research process empowered nurses to make sustainable changes to their practice. The nurses in the study wanted to affect change. The planned change was not dictated by management, but was driven by the clinical nursing staff at the 'grass roots' level. Therefore, being involved in the decision-making process provided an incentive to actively implement change.
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Enfermedad Aguda/enfermería , Enfermería Geriátrica/organización & administración , Investigación sobre Servicios de Salud/organización & administración , Modelos de Enfermería , Investigación Metodológica en Enfermería/organización & administración , Gestión de la Calidad Total/organización & administración , Enfermedad Aguda/psicología , Anciano/psicología , Actitud del Personal de Salud , Toma de Decisiones en la Organización , Medicina Basada en la Evidencia , Unidades Hospitalarias , Hospitales Públicos , Humanos , Medicina Interna , Nueva Gales del Sur , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Innovación Organizacional , Evaluación de Resultado en la Atención de Salud , Satisfacción del Paciente , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa , Proyectos de Investigación , AutocuidadoRESUMEN
This article reports on a study designed to determine whether demographic characteristics of patients such as age, gender and cultural background were associated with different perceptions of the importance of and satisfaction with various aspects of nursing care. In addition, patients, their family/carer and nurses from wards specializing in aged care were compared with general medical wards to determine if there were differences in these perceptions. Results demonstrated that patients who were older (aged > 80 years), female and from aged care wards perceived that physical aspects of nursing care were more important than did patients who were younger (aged 65-80 years), male and from medical wards. Older patients and those from aged care wards were more satisfied with physical care. Nurses need to be aware of these differences and focus on physical aspects of care to ensure patient satisfaction better health outcomes.