Nursing Care Interventions Paper

Nursing Care Interventions Paper

Instructions

For this paper, you are required to write a 1000 words using one nursing care intevention to compare two case studies. This means you will use one nursing care intervention for each of the case studies provided. This is a comparative essay. See comparative essay example in blue font. 

Fundamental nursing care: A systematic review of the evidence on the effect of nursing care interventions for nutrition, elimination, mobility and hygiene

Aims and objectives

To determine the effects of nursing interventions for people’s nutrition, elimination, mobility and hygiene needs.
Background

Patient experience of health care is sensitive to nursing quality. A refocus on fundamental nursing care is undermined by lack of evidence of effectiveness for interventions in core areas such as elimination, nutrition, mobility and hygiene.
Design

Systematic review.
Methods

We searched for and included experimental studies on interventions by professionally qualified and unregistered nurses that addressed participants’ nutrition, elimination, mobility and hygiene needs. We extracted data on scope, quality and results of studies followed by descriptive narrative synthesis of included study outcomes using a novel form of harvest plots.
Results

We included 149 studies, 35 nutrition, 56 elimination, 16 mobility, 39 hygiene and three addressing two or more areas simultaneously (67 randomised controlled trials, 32 non‐randomised controlled trials and 50 uncontrolled trials). Studies into interventions on participant self‐management of nutrition (n = 25), oral health (n = 26), catheter care (n = 23) and self‐management of elimination (n = 21) were the most prevalent. Most studies focussed their outcomes on observational or physiological measures, with very few collecting patient‐reported outcomes, such as quality of life, experience or self‐reported symptoms. All but 13 studies were of low quality and at significant risk of bias. The majority of studies did not define primary outcomes, included multiple measures of identical concepts, used inappropriate analyses and did not conform to standard reporting quality criteria.
Conclusions

The current evidence for fundamental nursing care interventions is sparse, of poor quality and unfit to provide evidence‐based guidance to practising nurses.
Relevance to clinical practice

Researchers in nursing internationally should now undertake a programme of work to produce evidence for clinical practice in the fundamentals of care that is reliable, replicable and robust.
1 BACKGROUND

When nursing care is sub‐optimal, patients experience health care negatively (Rathert, Wyrwich, & Boren, 2013; Suhonen, Leino‐Kilpi, & Valimaki, 2005). Failure to assure the quality of nursing care leads not only to distress and dissatisfaction, but also to wider patient safety failures. Studies internationally (Bureau of Health Information, 2014, Garling, 2008; Kalisch, 2006) have highlighted the prevalence and potentially catastrophic consequences of poor nursing care (Department of Health, 2012, 2013). Missed or incomplete nursing care has been identified as a key mechanism explaining the widely demonstrated association between nurse staffing levels and patient outcomes including mortality (Aiken et al., 2014; Ball, Murrells, Rafferty, Morrow, & Griffiths, 2014). Optimising the quality of care is essential in healthcare settings internationally, particularly for older people, which for the example of the United Kingdom includes care for more than half a million people over 65 per annum, and costs more than £12 billion (Care Quality Commission, 2014).

Arising from such concerns, a number of initiatives have sought to refocus nursing on central tenets of practice including “compassion” (Commissioning Board Chief Nursing Officer and DH Chief Nursing Adviser, 2012) and “fundamental nursing care” (Kitson, Robertson‐Malt, & Conroy, 2013), in the latter case accompanied by an international campaign to identify and emphasise the components of essential (or fundamental) nursing care (Kitson, Conroy, Wengstrom, Profetto‐McGrath, & Robertson‐Malt, 2010)—defined as action to address safety, comfort, communication, dignity, respiration, privacy, eating and drinking, respecting choice, elimination, mobility, personal cleansing and dressing, expressing sexuality, temperature control, rest and sleep (Kitson, Conroy, Kuluski, Locock, & Lyons, 2013). Unfortunately, this drive to refocus nursing on its core values and functions has exposed the paucity of systematic evidence to guide practising nurses.

In an evidence‐based healthcare environment, improving nursing care requires action to produce robust evidence that ensures nurses do more good than harm to those in their care. Much recent work (Richards, Coulthard, & Borglin, 2014) has confirmed the findings of previous reviews that the nursing research literature remains descriptive (Mantzoukas, 2009), largely irrelevant to practising nurses (Hallberg, 2009) and a prime candidate for the term “research waste” (Chalmers & Glasziou, 2009; Richards et al., 2014). In this situation, it is difficult for practising nurses to follow clear evidence‐based guidelines. Therefore, we conducted a review of four of the elements of fundamental nursing care rated as most important in a previous international consensus study (Kitson, Conroy, et al., 2013). Although our overall programme of research has also reviewed nonexperimental descriptive and qualitative studies, in this report, we outline the findings from our review of experimental interventions only, using the PRISMA guidelines for reporting reviews of effectiveness.
2 REVIEW QUESTION

What is the effectiveness of nursing interventions that address the nutrition, elimination, mobility and hygiene needs of people in hospital and residents in care homes as investigated in experimental studies?

3 METHODS
3.1 Eligibility criteria

We included experimental studies on any intervention undertaken by either professionally qualified and/or unregistered nurses for people in hospital or resident in care/nursing homes that aimed to address and measure the impact on participants’ nutrition, elimination, mobility and hygiene needs. We defined interventions related to nutrition as those assisting or supporting people in consuming adequate food and fluids to achieve optimum nutritional and hydration status; elimination to address people’s toileting needs, and assist them to eliminate urine and faeces conventionally or by catheterisation; mobility including assistance or support for people to move to meet their own care needs and to remain independent; hygiene including assisting or supporting patients to maintain bodily cleanliness and to dress themselves independently.

We included reports of randomised controlled trials (RCTs), nonrandomised controlled trials (nRCTs) and uncontrolled experimental trials (UCTs) such as before‐after trials. We excluded reports that solely investigated medical devices (such as catheter type, washing products, incontinence devices, food supplements and mobility aids), and observational studies where there was no experimental manipulation of an intervention. We included studies in English.
3.2 Information sources

We undertook searches during a period of time from May 2015–March 2016. We searched all relevant databases including embase, medline, cinahl, psychlit, psychinfo, science citation, bids and cancerlit, in process and other nonindexed citations, COCHRANE reviews databases using the OVID® platform, and individual database searches. We contacted the authors of studies where we were unable to access the full report through online databases and journals.

Note: Please stick to the marking criteria provided to effectively address this paper please!!

Nursing Care Interventions Paper