Journal of Nursing & Care

Diabetic foot infections are a frequent clinical problem. About 50% of diabetic foot infections who have foot amputations die within five years. Properly managed most can be cured, but many patients needlessly undergo amputations because of improper diagnostic and therapeutic approaches. This approach along with vascular assessment help clinical decisions about which patients to hospitalize, which to send for imaging procedures or for whom to recommend surgical interventions. This paper reviewed the natural history of the diabetic foot and assessed the surgical impact of the Infectious Diseases Society of America clinical practice guideline- based care of diabetic foot infections.

Sleep disturbances are extremely common among dialysis patients. Subjective sleep complaints are reported in up to 80% of patients. This study was assess the effectiveness of nursing intervention guidelines in improving sleep pattern and quality in ESRD patients undergoing hemodialysis in morning and afternoon shift. A controlled quasi-experimental design with pre-post-follow-up assessment was used in this study. All patients (60) undergoing hemodialysis were age 18-75 years, either in the morning (6:30 to 10:30 AM) or afternoon (3:30 to 7:30 PM) sessions, for at least three months. The study was conducted at the Nephrology Hemodialysis Units at the Zagazig University Hospital. The researchers developed an interview questionnaire to collect data regarding patient's socio-demographic characteristics, physical health problems, psychosocial factors, feeling and biochemical factors, in addition to Pittsburgh Sleep Quality Index (PSQI) and the Epworth Sleepiness Scale (ESS). Nursing intervention guidelines based on identified factors affecting sleep disorders can improve the sleep pattern and quality of the patients with ESRD on hemodialysis through acting on their physical, psychosocial factors and patient feelings. However, it seems to be more effective among patients having morning dialysis sessions compared with afternoon ones. Therefore, it is essential that the nurses identify the factors that may adversely affect the quality of sleep of these patients and develop strategies to reduce their sleep disorders. The findings should be further confirmed through randomized clinical trials to avoid the limitations of confounding factors. The effect of biochemical parameters on sleep quality and pattern needs further investigation.

Contemporary healthcare has a patient-centered approach, integrates health/mental health care, emphasizes interdisciplinary teamwork, and adopts innovations such as communications technology. Telemedicine (including telepsychiatry) adds versatility to service delivery by improving access to care, leveraging expertise of key disciplines to the point-of-service, and tele-education. Key disciplines in integrated care, wherein psychiatric and other mental health services are provided in a primary care platform, are the psychiatrist, other mental health professionals (i.e., psychologists, social workers, marriage and family therapists), mid-level professionals, and nurses. These clinicians provide clinical, administrative, and care coordination expertise or oversight. Overall, telemedicine, cross-training, stepped care roles, and use of clinically “versatile” clinicians help to fill “holes” in services for patients. Evidence-based treatment becomes more accessible, better disseminated, and in “real-time” with use of technology.

There is a growing need for a system change towards more patient-centred and health literate healthcare systems. One valuable approach for change on the system-level is the redesign of health organizations to health literate healthcare organizations (HLHO). This process requires sufficient efforts in teamwork, committed leadership and outcome monitoring. Nurses could make major contributions to the overall system change by integrating their expertise in the redesign of health care organizations in health literate ones.

A point prevalence survey among 125 patients in two units of a rehabilitation facility showed that the physical restraint rate was 12.8% (n=16). The survey examined the reason(s) for restraint use, whether its use had been explained, consent obtained and documented, whether the restraint had been appropriately applied and patients monitored during the period when restraint was applied, and whether alternatives had been attempted. Interestingly, six patients were found to have had their restraints removed either before or after the survey. A slightly less restrictive form of restraint, boxing gloves, was used for seven patients instead of limbs holders. Three patients remained restrained. The results of this study revealed that there was room for improvement in practice of restraints, and that measures to reduce the use of restraints were not necessarily very costly. Applying physical restraints is counter-productive to rehabilitative care. Nurses and other health disciplines need to be better informed regarding restraint reduction programs.

Background: Pregnancy can be physically and emotionally stressful for the parents, which means they need adequate professional support. Easy-to-use, validated scales are important in order to develop professional support in Antenatal care as well as in research. The aim: Our aim was to illuminate pregnant women’s experience of professional support at the Antenatal care, in relation to the Mother-Perceived-Professionals-Support (MoPPS) scale. Method: A qualitative study design using the method “Think aloud” with both inductive and deductive approaches, was used. Five first-time mothers were interviewed with open questions followed by questions related to the MoPPS scale items. Data was analyzed using inductive and deductive qualitative content analyses. Results: The inductive analysis resulted in one theme: “Professional support from midwives made women created a feeling of security and unique or rejected and lonely during pregnancy” and three categories: “Continuity and competence”, “Perceiving trust or not” and “Parental groups or individual visits”. The deductive analysis described the mothers’ understanding of each item. However, coherence between the inductive and deductive analyses varied and the MoPPS-scale needs development. Conclusion: The result shows that women's experience of professional support affects their sense of feeling safe or lonely during pregnancy. Important for midwives were to meet the women’s unique individual needs. The MoPPS scale was considered to be relevant and easy to understand, but it needs development to include questions about continuity, parental groups and the perception of midwives’ competence, which all were important for the women during their pregnancies. Clinical implications: To offer adequate professional support for women during pregnancy, midwives need to meet the women’s unique individual needs with both medical and supportive knowledge.

Physical restraint (PR) is a widespread practice in many countries, and that nurses play a key role in the decisionmaking and practicing PR with a substantial psychological conflicts. Although little is understood how the conflicts should be controlled and integrated into a safe and ethical management of patients, several aspects of PR are becoming clearer which may aid dealing with its use.

Recent theoretical developments and findings in basic research suggest that, self-control demands are a unique job stressor. A series of studies among healthcare workers are reported corroborating this view. The results of literature review show that different forms of self-control demands such as impulse control, resisting distractions, overcoming inner resistances contribute significant portions of unique variance to the prediction of various indicators of job strain and interact with other forms of self-control demands. Furthermore, the relationship between self-control demands and strain is moderated by various resources like self-control capacity, affective organizational commitment, and job control. The identification of those resources offers promising starting points for the development of preventive interventions.

This article describes the development of an instrument to measure and explore the identities of nurses, nursing students and applicants to Nursing programmes. In particular the instrument focuses on the values held by respondents regarding Nursing. The current concern that standards in nursing may be falling and the need for methods to identify suitable candidates are described briefly. The instrument has been developed using the wellestablished ISA/Ipseus theory and psychometric technology to offer an in depth measure of professional identity and values in Nursing. The instrument is called Nurse Match since it allows for comparison and match between the profiles of applicants to Nursing programmes and experienced and well regarded nurses. The article locates the instrument in theoretical and empirical approaches to identity and concentrates on three key theorists, Erikson; Kelly and Festinger. The use of Weinreich’s Identity Structure Analysis and its associated measuring methodology Ipseus are justified as the approach adopted for the development of Nurse Match. The key characteristics of ISA are described together with those of Ipseus, the flexible open-ended measuring technology for the development, administration, response recording, analysis and reporting functions of a dedicated instrument. Ipseus instruments are made up of constructs which are bi polar dimensions of thought and entities which are key elements in the social domain and include aspects of self as well as key others. Completion of the instrument requires all the constructs to be applied to the entities. Responses are recorded and analysed by the Ipseus software which produces a report including indications of the way the values inherent in the constructs are construed and used by the respondent. The instrument thus gives an in depth analysis of, in this case, the respondents position regarding key nursing values. The article describes the steps followed to determine the constructs in the Nurse Match instrument and these included a literature review; ethnographic data gathering; and the use of expert judgements. Initial results from the use of the first version of the instrument demonstrate its power to identify the value orientations of individuals and groups. In particular the instrument reveals which constructs/values are of most importance to a respondent and their preferred pole of each construct. The article concludes with indications of the next steps that will be followed in the development, standardisation, and refinement of the instrument including investigations of concurrent and predictive validity.