The Process of Compliance with Self-Care among Patients with Hypertension: A Grounded Theory Study

Introduction: Controlling hypertension across world continues to be challenging. Managing hypertension is not only concerned with lowering blood pressure by using antihypertensive medications;it also aims to minimize its consequences through adopting self-care practices. Compliance with self-care practices among patients with hypertension is considered a multidimensional phenomenon. The phenomenon of hypertension has been studied quantitatively, however;little qualitative studies were conducted to understand the compliance with self-care among patients with hypertension. Aim: To understand the process that patients with hypertension go through to comply with self-care practices. Methods: This study used a qualitative design that followed constructivist grounded theory approach;purposive sampling was used to recruit participants from cardiac clinics;semi structured, in-depth and face-to-face interview was used as a major method for data collection. Findings: Four participants with hypertension participated in this study;the phenomena of self-care was identified as the central phenomena;the start of the disease was identified as a casual condition;beliefs toward hypertension disease, beliefs toward self-care practices, knowledge and awareness regarding hypertension disease and self-care practices were identified as strategies;experiencing self-care practices was identified as consequence and being patients with hypertension in a social context. Conclusions: The process of compliance with self-care has a path of actions and interactions. The process started from the moment of diagnosis where the patients start to think about self-care. The absence of health care context leads to varying level of compliance with self-care among patients with hypertension. This indicated the need for more effective patient and health care provider relationship, education and awareness campaign.

On Computing the Suitability of Non-Human Resources for Business Process Analysis

Business process improvement is a systematic approach used by several organizations to continuously improve their quality of service.Integral to that is analyzing the current performance of each task of the process and assigning the most appropriate resources to each task.In continuation of our previous work,we categorize resources into human and non-human resources.For instance,in the healthcare domain,human resources include doctors,nurses,and other associated staff responsible for the execution of healthcare activities;whereas the non-human resources include surgical and other equipment needed for execution.In this study,we contend that the two types of resources(human and non-human)have a different impact on the process performance,so their suitability should be measured differently.However,no work has been done to evaluate the suitability of non-human resources for the tasks of a process.Consequently,it becomes difficult to identify and subsequently overcome the inefficiencies caused by the non-human resources to the task.To address this problem,we present a three-step method to compute a suitability score of non-human resources for the task.As an evaluation of the proposed method,a healthcare case study is used to illustrate the applicability of the proposed method.Furthermore,we performed a controlled experiment to evaluate the usability of the proposed method.The encouraging response shows the usefulness of the proposed method.

How can collective leadership influence the implementation of change in health care?

Aim: This study focuses on how a collective leadership style could influence the implementation of change in health care.Methods: Kotter's 8-step process and leadership can guide the implementation of change. Collective leadership can highlight all levels of staff engagement, establish an organizational culture of learning and trust, and create continuous improvement. At the same time, it can formulate a well-designed plan;develop efficient strategies; communicate and empower the staff; assess the performance; and integrate the improvement.Results: Collective leadership can establish vision and trust, highlight all levels of staff engagement,establish an organizational culture of learning and trust, create continuous improvement, communicate and empower the staff and integrate the improvement.Conclusions: Collective leadership can be a powerful way to overcome the barrier and create an effective environment of adaptation of changes by analyzing Kotter's eight stage process.

Assessment of quality of postnatal care services offered to mothers in Dedza district, Malawi

This study was conducted to assess quality of postnatal care that midwives provide to women seeking postnatal services in health facilities in Dedza district, the central region ofMalawi. The study design was descriptive cross sectional and utilized quantitative data collection and analysis method to determine structural, process and outcome components of postnatal care in two facilities that offer emergency obstetric and neonatal care and five that offer basic emergency obstetric and neonatal care. All 60 midwives who were providing postnatal care during the time of study in the district were interviewed using a structured questionnaire. In addition, the midwives actual practice was observed and compared to a standard checklist on postnatal care practice which was developed by the Malawi Ministry of Health. Data were analyzed using SPSS version 16.0. Results show that structure for providing postnatal counseling services was inappropriate and inadequate. Furthermore, the contents of postnatal services were below reproductive health standards because the clients were neither monitored nor examined physically on discharge. On average, all the seven facilities scored 48% on postnatal services rendered which is far below the recommended 80% according to the Reproductive Health Standards. There is a need to provide basic infrastructure in all the basic emergency obstetric and neonatal care facilities. In addition, refresher training courses for midwives in maternal and neonatal health with emphasis on postnatal care are recommended. There is also a need to restructure the maternal and neonatal health departments in the facilities so that the postnatal care units become stand-alone priority sites to improve the quality of the postnatal care services rendered.

Effect of Emergency Care Process Optimization on Rescue Efficiency of Emergency Patients

Objective: This paper discusses the impact of emergency care process optimization on the rescue efficiency of emergency patients. Methods: 102 cases of emergency patients received from January 2017 to February 2018 in our hospital were selected as research objects. According to the order of treatment, they were divided into control group and observation group. The routine nursing process was given to the control group, and the observation group was given an optimized nursing process to compare the rescue efficiency and nursing satisfaction of the two groups. Results: According to the results of the study, the nursing satisfaction of the two groups was compared. Among them, the total satisfaction of the observation group was 49, accounting for 96.07%;the control group was very satisfied with the nursing work, accounting for 82.35%. There was a significant difference in nursing satisfaction between the two groups, which was statistically significant (P<0.05). Comparing the rescue efficiency of the two groups of patients, the observation time, rescue time, infusion time and disease remission time were significantly lower than the control group, the rescue success rate was 94.11%, and the rescue success rate of the control group was 78.43%. The results have statistical significance (P < 0.05). Conclusion: The optimization of emergency nursing process can greatly improve the rescue efficiency of emergency patients, reduce the disability rate and mortality, improve the quality of nursing, and enhance the satisfaction of nursing. It is worthy of clinical promotion practice.

Design of Pharmaceutical Care Process for Retail Pharmacies Based on Pareto Analysis

Objective To study the problems of pharmaceutical care in retail pharmacies and provide reference for the standardized development of pharmaceutical care in China.Methods Based on the literature of CNKI database,Pareto analysis was used to study the present situation of pharmaceutical care in retail pharmacies.Then the following problems in pharmaceutical care were found such as low personnel professional quality,inadequate attention,imperfect laws and regulations,and lack of standard service process.As to the first three problems,there were more research references.But there was less literature on the standard care process.Results and Conclusion Focusing on the customer demand,taking drug sales process as the basic framework of pharmaceutical care standardized process,and combining with the collaboration,the service process including prescription drugs review and OTC drugs purchase consultation is established.This process elaborates the division of staff services as well as the service standards in pre-sale,on-sale,and after-sale stages.Besides,it also puts forward some advice for the previous three problems,which will ensure the smooth implementation of pharmaceutical care in drugstores.

Healthcare interprofessional team members' perspectives on human caring: A directed content analysis study

Objectives:As Watson's Human Caring Theory continues to evolve and guide the discipline of nursing,the challenge is to find ways to integrate it into practice.The purpose of this study is to describe interprofessional team members'perspectives on human caring based on the Ten Caritas Processes(R)/Caritas-Veritas Literacy of Watson's Human Caring Theory within the Unitary Caring Science.Methods:This is a qualitative directed content analysis study,taking place in a Children's Hospital in the United States between November 2017 and April 2018.Information redundancy was utilized to guide the recruitment.Data were collected via a one-time face-to-face individual interview.A qualitative directed content analysis was conducted using Watson's Ten Caritas Processes(R)/Caritas-Veritas Literacy as a coding framework.Results:Twenty-seven healthcare professionals participated in the study.Interprofessional human caring,based on the Ten Caritas Processes(R)/Caritas-Veritas Literacy,was referred to as performing lovingkindness to patients,each other,and self;maintaining faith-hope in teamwork;valuing intersubjective interactions and building trust among team members;cultivating heart-centered-caring relations;acknowledging and processing positive and negative feelings non-judgmentally;applying all ways of knowing in caring;encouraging reciprocal teaching-learning;developing caring-healing environments collaboratively;respecting human dignity of patients and each other;and being open-minded to the unknowns and believing in miracles.Conclusions:Watson's Human Caring Theory can be an underlying guide to enrich human-to-human relations and create a caring-healing environment.When human caring is applied in interprofessional teams,healthcare professionals find a caring consciousness to care for oneself and each other and promote patient care.

Empirical Verification of Swanson’s Caring Processes Found in Nursing Actions: Systematic Review

Caring has long been recognized as central to nursing and is increasingly posited as a core concept although developing a theoretical description of caring which is adequate in the 21st. century continues to be a difficult task for nursing scholars. Consequently, verifying existing theoretical structures of caring remains an ongoing challenge. The aim of this article is to provide empirical verification of the caring processes of “knowing,” “being with,” “doing for,” “enabling” and “maintaining belief” from Swanson’s Middle Range Caring Theory based on the categorization of nursing actions from a systematic literature review on care. Methods: A systematic literature review was conducted in the fields of nursing sciences, medicine and psychology. Purposeful sampling was carried out covering a period from 2003-2013. The final sample included 25 articles. Results: Major themes of nursing actions included “knowing” which consisted of centering, nurturing, informed understanding, assessment skills, communication and respect for individual differences. “Being with” was characterized by intimate relationship, connecting, presencing, emotional adaptability awareness of self/other and decentering. “Doing for” included competence, knowledge, professional/technical skills, helping actions, anticipatory, multidisciplinary and preserving dignity. “Enabling” was characterized by self care, commitment, complexity of care, appropriate communication, information/education, sharing power, enabling choice and ongoing validation. Finally, “maintaining belief” was characterized by spiritual being, humanistic view, harmonious balance, hope, love, and compassion, meaning, and religious and spiritual orientation. Conclusion: Empirical verification was shown for the caring processes described in Swanson’s Caring Theory grounded in concrete nursing actions.

Caring Science in Nursing.coming of Age in:Theory-Practice-Research

Jean Watson(华生)博士通过探究护理的哲学与科学根基,比较自然科学之医学典范与人文科学之护理典范的差异,以"Caring"为护理核心本质,发展了关怀科学(Caring Science)。本论著中Watson博士概述了关怀科学的理论根基——整体论(Unitary Ontology),及其伦理归属(Ethic of Belonging);介绍了人文关怀的10大要素(Caritas Processes);阐述了人际间关怀时刻(Transpersonal Caring Moment)的内涵以及护理人员实现人性关怀的方法学(CaritasHeart TM Methodology)。最后,Watson博士提出了关怀科学在护理实践应用的指导方针。希望此论著对我国护理工作者认识和实践人文关怀有所裨益!

Automatic quality improvement reports in the intensive care unit: One step closer toward meaningful use

AIM: To examine the feasibility and validity of electronic generation of quality metrics in the intensive care unit(ICU).METHODS: This minimal risk observational study was performed at an academic tertiary hospital. The Critical Care Independent Multidisciplinary Program at Mayo Clinic identified and defined 11 key quality metrics. These metrics were automatically calculated using ICU Data Mart, a near-real time copy of all ICU electronic medical record(EMR) data. The automatic report was compared with data from a comprehensive EMR review by a trained investigator. Data was collected for 93 randomly selected patients admitted to the ICU during April 2012(10% of admitted adult population). This study was approved by the Mayo Clinic Institution Review Board.RESULTS: All types of variables needed for metric calculations were found to be available for manual and electronic abstraction, except information for availability of free beds for patient-specific time-frames. There was 100% agreement between electronic and manual data abstraction for ICU admission source, admission service, and discharge disposition. The agreement between electronic and manual data abstraction of the time of ICU admission and discharge were 99% and 89%. The time of hospital admission and discharge were similar for both the electronically and manually abstracted datasets. The specificity of the electronically-generated report was 93% and 94% for invasive and non-invasive ventilation use in the ICU. One false-positive result for each type of ventilation was present. The specificity for ICU and in-hospital mortality was 100%. Sensitivity was 100% for all metrics.CONCLUSION: Our study demonstrates excellent accuracy of electronically-generated key ICU quality metrics. This validates the feasibility of automatic metric generation.

The BP-M* Methodology for Process Analysis in the Health Sector

In this paper we present the main phases of the BP-M* methodology and its application to a care pathway for patients in the Oncology Division of a large hospital, to evaluate pros and cons of different drug administration modalities and the impact of these modalities to the organizational process. BP-M* has been developed for the manufacturing sector but the relevance of business modeling, analysis and reorganization is not restricted to a specific sector. The aim of this work is to show its application to a real life study of a complex process in the health sector.

Factors Influencing Practice of Patient Education among Nurses at the University College Hospital, Ibadan

Patient education is the process of influencing patient behaviour and producing the changes in knowledge, attitudes and skills necessary to maintain or improve health. Health education may be general preventive, health promotion or diseases specific education. With an education system in place, patients will be satisfied with care, patients will be healthier, and will seek medical services less frequently. There is little or no documentation on the practice of patient education at the University College Hospital, Ibadan. The aim of this descriptive study was to explore factors influencing the practice of patient education among nurses at the University College Hospital, Ibadan. Stratified and simple random sampling techniques were used in selecting 200 nurses at the University College Hospital Ibadan. A self-designed questionnaire was used to collect data. Statistical package for social sciences version 15 (SPSS 15) was used in analysing data. The study revealed that the knowledge and practice of patient education among the nurses in University College Hospital was high and the knowledge was found to be significantly associated with its practice (X2 = 7.89, p = 0.017). The working experience of nurses does not determine whether they practice patient education or not. Almost all the respondents (70% - 90%) in this study affirmed that the nurses’ experiences, cultural barriers, work place culture, lack of time, heavy workload, insufficient staffing, and the complexity of patients’ condition were important factors that influenced the practice of patient education. In conclusion, nurses at the University College Hospital have good knowledge and positive attitude towards patient education but could not practice effectively. A more critical approach in addressing heavy workload, insufficient staffing, among others is needed to improve patient education. Further studies should be carried out on developing nurses’ roles as patient educators.

Prevalence of the Nursing Diagnosis Lack of Adherence in People Living with AIDS

Introduction: In the 1990s, the development of highly active combination antiretroviral therapy in the treatment of AIDS was highlighted. The great benefit generated by the use of this treatment was the prolongation of survival of the people who got this disease, since it is no longer considered fatal, becoming a chronic condition. Objective: To identify the prevalence of the nursing diagnosis Lack of Adherence, its defining characteristics and related factors in people living with AIDS, to investigate the association between them and the prevalence rates. Methods: Cross-sectional study with 113 patients in a hospital in northeastern Brazil. For data analysis, the test of Pearson chi-square and Fisher’s exact test were used, and also calculated the prevalence rates. Results: Lack of Adherence diagnosis was present in 69% of the sample investigated. The defining characteristics and related factors that are statistically associated with that diagnosis were: lack of adherence behavior, missing scheduled appointments, complications related to development, insufficient skills to implement the system and complex treatment system. The first two characteristics had the highest chances for the development of this diagnosis. Conclusion: The study showed that the diagnostic studied was prevalent in these patients and 3 characteristics and 2 factors showed significant association.

The Biopsychosocial Vulnerability in Primary Care

The need for early screening of the biopsychosocial vulnerability within primary care is clear in the literature, but there is disagreement on the definition and type of score to be used. Health is influenced by determining not only biological, but also psychological and social. The aims of the study are research and evaluation tools to determine the biopsychosocial vulnerability and the creation of a flow-chart for the establishment of health and socio-personalized care programs, but based on scientific evidence. In our study we have built an original scale of assessment for the general medicine, which could simultaneously analyze the Bio-Psycho-Social aspect of patients. A group of GPs （general practitioners） have tested this tool on a group of complex patients. The results of the study show that a high score on our scale of assessment is not correlated with the age of a patient （R = 0.454）; instead there is a straight correlation between the high score and the number of GPs and patient contacts （R = 0.790） and a border-line significant correlation （R = 0.590） between high scores and hospital admissions and resources utilization. In conclusion, with our assessment scale we built a general medicine instrument, simple, integrated with primary care setting and tools, fast in use. In the research and validation phase we showed how this scale would be able to identify patients in need of more attention where there is a necessity to go from a Guideline and EBM-Based approach to a Personalized approach.

Automated Extraction and Analysis of CBC Test from Scanned Images

Health care is an important part of human life and is a right for everyone. One of the most basic human rights is to receive health care whenever they need it. However, this is simply not an option for everyone due to the social conditions in which some communities live and not everyone has access to it. This paper aims to serve as a reference point and guide for users who are interested in monitoring their health, particularly their blood analysis to be aware of their health condition in an easy way. This study introduces an algorithmic approach for extracting and analyzing Complete Blood Count (CBC) parameters from scanned images. The algorithm employs Optical Character Recognition (OCR) technology to process images containing tabular data, specifically targeting CBC parameter tables. Upon image processing, the algorithm extracts data and identifies CBC parameters and their corresponding values. It evaluates the status (High, Low, or Normal) of each parameter and subsequently presents evaluations, and any potential diagnoses. The primary objective is to automate the extraction and evaluation of CBC parameters, aiding healthcare professionals in swiftly assessing blood analysis results. The algorithmic framework aims to streamline the interpretation of CBC tests, potentially improving efficiency and accuracy in clinical diagnostics.

基于CARES工具课题达成型品管圈构建晚期肿瘤患者安宁疗护全流程照护模式

目的基于CARES工具的课题达成型品管圈构建晚期肿瘤患者安宁疗护全流程照护模式。方法以新疆医科大学附属肿瘤医院安宁疗护团队为主导的品管圈小组确定了“基于CARES工具构建晚期肿瘤患者安宁疗护全流程照护模式”的活动主题,按照课题达成型品管圈操作步骤,在现况调查基础上从人员、制度、流程等方面对晚期肿瘤患者安宁疗护全流程照护模式进行构建。结果活动实施后,初步构建了晚期肿瘤患者安宁疗护全流程照护模式,晚期癌症患者疼痛控制有效率由90.54%提升至98.52%,呼吸困难改善率由60.53%提升至87.10%,谵妄状态改善率由21%提升至55.66%,晚期癌症患者照护者中重度负担水平由72%降至46.15%,ACP的普及率由10%提升至25.74%。圈员在专业知识、积极性、品管手法和团队凝聚力的能力均有所提高。结论基于CARES工具应用课题达成型品管圈构建晚期肿瘤患者安宁疗护全流程照护模式为患者及其照护者提供了有效的支持,同时促进了安宁疗护工作推广和进步。

Stroke Care in an Australian Rural Private Health Care Setting

Stroke is a leading cause of disability and death in Australia. There is a clear benefit in caring for stroke patients in stroke care units. Access to these centres is limited particularly in the rural setting. Certified stroke care units in the private health care setting are also unheard of. The superiority of these units is thought to be due to better adherence to processes of care (early utility of CT scan, allied health input within 24 hours, neurological observations, DVT prophylaxis and appropriate use of antiplatelet and anticoagulant use). We audited care of 100 patients who presented to the St. John of God Hospital (rural private hospital) over a period of 3 years. This included baseline demographics, adherence of processes of care, utility of appropriate investigations, and outcome measures such as discharge destination, level of function at discharge and complication rates. These data were compared with the national stroke report (AuSCR) and adherence to processes of care was compared with the SCOPE study (the first study to establish the benefit of POC). When compared with data from the AuSCR national report 2012, we found a higher mortality rate, an increased rate of disability on discharge, and a mixed adherence to processes of care. We also found a significant proportion of patients (40%) who were eligible to receive thrombolysis but did not. Overall we found that there were significant strengths to be drawn upon in the rural private healthcare setting and a more organised approach could improve outcomes.

Competency Driven Resource Evaluation Method for Business Process Intelligence

Enterprises are continuously aiming at improving the execution of processes to achieve a competitive edge.One of the established ways of improving process performance is to assign the most appropriate resources to each task of the process.However,evaluations of business process improvement approaches have established that a method that can guide decision-makers to identify the most appropriate resources for a task of process improvement in a structured way,is missing.It is because the relationship between resources and tasks is less understood and advancement in business process intelligence is also ignored.To address this problem an integrated resource classification framework is presenting that identifies competence,suitability,and preference as the relationship of task with resources.But,only the competence relationship of human resources with a task is presented in this research as a resource competence model.Furthermore,the competency calculation method is presented as a user guider layer for business process intelligencebased resource competence evaluation.The computed capabilities serve as a basic input for choosing the most appropriate resources for each task of the process.Applicability of method is illustrated through a heathcare case study.

Contact Precaution: Acceptance of Health Professionals to Teaching Hospital

The adoption by health professionals to the practice of patient isolation is a decision that reduces patients’ risks of occupational exposure to potentially contaminated biological material and prevents nosocomial infections. Verify the compliance of health professionals to the practices of contact precautions in patients colonized by microorganisms in a teaching hospital. This was a prospective observational cohort study in a special-sized hospital located in southeastern Brazil. The observation of health professionals in delivery of health care to patients with contact precaution was performed regarding hand hygiene, use of overcoat, glove, and mask. We carried out 1502 observations involving the following professional categories: nursing technicians and/or nursing assistants (n = 1028;68.4%), nurses (n = 200;13.3%), physical therapists (n = 185;12.3%), and physicians (n = 89;5.9%), totaling 971.8 hours. Regarding the level of compliance of professionals to contact precaution practices with hand hygiene after the procedures, the use of overcoats, gloves, and masks, all were statistically significant (p Klebsiella pneumoniae was the most positive pathogen identified in laboratory tests. This study provided the mapping of the compliance of health professionals to the practices of contact precautions in order to support a safer management of patient care reducing the risks of Healthcare-Associated Infections (HAI). This study also showed that health professionals are using practice management to deal with their behavior to protect their health.

Nursing Process in a Patient with Crohn’s Disease: Case Report

Background: Inflammatory Bowel Disease is a term that covers intestinal diseases, including ulcerative colitis and Crohn’s disease. Due to the condition of chronic and complex disease, the disease requires specialized nursing care and management in the context of a multi-disciplinary approach. As a guarantee of quality nursing care, it is essential to carry out the nursing process. Considering the commitment to assist the patient with Crohn’s disease, the nurse, through the nursing consultation, is able to diagnose the patient’s needs, proceed to the prescription of care and later evaluate the interventions, having the opportunity to develop work aimed at improving the quality of life of these patients. Objective: To describe the nursing process in a patient with Crohn’s disease. Methods: Exploratory case report study, carried out at the outpatient clinic for inflammatory bowel diseases of a public hospital in the countryside of the state of São Paulo, from June 2019 to October 2019. Data collection was performed through anamnesis, physical examination and analysis of medical records. Results: Female patient, 34 years old, diagnosed with Crohn’s disease. With the completion of the nursing process, it was possible to identify five nursing diagnoses and the elaboration of interventions and outcomes. The nursing evaluation was continuous and the patient adhered to the proposed interventions. Final considerations: The systematization and organization of the work of the nursing team proved to be essential for quality care, with efficiency and effectiveness, guaranteeing the patient comfort, general well-being and good rehabilitation.