Query: presence in nursing care

title: Dementia Care Training Regulations and Deficiencies of Care for Inappropriate Psychotropics Use in Nursing Homes
abstract: Psychotropics are often used to manage behavioral and psychological symptoms of dementia (BPSD) in nursing homes (NHs) despite their adverse effects and lack of efficacy. NHs can be flagged for inappropriate psychotropics use as a deficiency of care (F tag 758) To improve dementia care, 15 states require dementia specific in service training for NH nursing staff with specific training content and hours. The study aimed to relate the occurrence of F 758 citations to the presence of dementia specific in service training regulations, stratified by nurse staffing levels <75th vs =75th percentile of nurse hours per resident day, HPRD) Certification and Survey Provider Enhanced Reporting data (n=14,548 NHs) from 2017 18 were used, containing 1,872 NHs with F 758 tags related to care of residents with dementia. NHs in states specifying training content and hours had significantly lower odds of receiving F 758 tags (OR=0.75, 95% CI=0.60 0.94) Among NHs with lower registered nurse HPRD, those in states regulating training content and hours had significantly lower odds of receiving F 758 tags (OR=0.66, 95% CI=0.49 0.89) with similar findings among NHs with lower certified nurse assistant HPRD (OR=0.69, 95% CI=0.51 52 0.91 92) This study found that required dementia specific in service training may be helpful in facilities with lower staffing. It is recommended that states develop more comprehensive, robust dementia care training regulations for NH nursing staff.

title: Spiritual care interventions in nursing: an integrative literature review
abstract: As an important part of the holistic care, spiritual care is considered an indicator of care quality. This study aims to identify and characterize nursing spiritual care interventions. In order to identify and select resources, an integrative review was done. The search was conducted in national and international databases such as Google Scholar, Scopus, INML, Iran Medex, Iran Doc, Web of Science, Wiley, SID, ProQuest, Ovid, Science Direct, PubMed, ebrary, Sage, CINAHL, and Magiran from 1994 to 2018. As a result, 1625 articles were detected, 59 of which were included in synthesis. Data extraction and analysis presented eight categories of spiritual care interventions in the field of nursing including (1) the exploration of spiritual perspective, (2) healing presence, (3) the therapeutic use of self, (4) intuitive sense, (5) patient centeredness, (6) meaning centered therapeutic interventions, (7) the creation of a spiritually nurturing environment, and (8) the documentation and evaluation of spiritual care.

title: Mindful presence: Being "with" in our nursing care.

title: DESCRIBING A CONCEPT OF NURSE INTUITION AND IMPLICATIONS FOR DEMENTIA CARE IN NURSING HOMES
abstract: The purpose of this concept analysis was to explore nurse intuition historically and in current literature, appraise the value of nurse intuition to research and practice, and discuss implications for practice in caring for residents with behavioral and psychological symptoms of Dementia (BPSD) in nursing homes. To date, no research has examined the presence or utility of nurse intuition in the nursing home setting. A conceptual analysis using pragmatic utility was chosen and based on the work of Walker and Avant (2005) In the literature, nurse intuition is characterized by attributes of knowledge not preceded by inference, knowledge that is holistic in nature, independent of linear thinking, and drawn from synthesis instead of analysis. Nurse intuition is based on preconditions of experience, empathy, limited information, and limited time to make vital decisions about patient care. Studies on nurse intuition have been criticized for their lack of rigor and empirical evidence of the effect of nurse intuition on positive patient outcomes. The attributes of intuitive nursing practice have important implications in nursing applied to residents with BPSD. The nursing home nurse with extensive educational and experiential knowledge is well situated to understand the complex, changing needs of residents exhibiting various forms of BPSD in an effort to communicate their needs. Future studies on nurse intuition should focus on early education in dementia care, nurse residency mentor programs to enhance intuitive thinking in the management of BPSD, and more empirical studies on the use of intuition in the context of dementia care.

title: Presence: A Step Closer to Spiritual Care in Nursing.
abstract: This article argues that while not all nurses are comfortable with spiritual care, nurses may be comfortable with enacting presence. Presence, an encompassing element in spiritual care, might be a more accessible first step for nurses toward spiritual care. To further highlight this viewpoint, the nature, consequences, and cultivation of presence are also discussed.

title: Critically ill patients' experiences of nursing care in the intensive care unit.
abstract: Understanding critically ill patients' experiences of nursing care is an important aspect that can improve quality of care in the intensive care unit.  To elicit critically ill patients' experiences of nursing care in the adult intensive care units.  A qualitative descriptive design was utilized.  Sixteen patients who had a predicted mortality risk of above 50% within the first 24 h of admission to the intensive care unit and had been discharged to the ward were purposively selected. The study was conducted at three academic affiliated, tertiary/quaternary specialist hospitals in South Africa. Individual semi structured interviews were conducted with the selected participants until a point of data saturation was reached. Data were analysed using a conventional content analysis technique (Hsieh and Shannon, 2005) Lincoln and Guba's criteria for ensuring the trustworthiness of qualitative research were applied.  Four major themes emerged: 'being in someone's shoes' 'communication' 'presence' and 'religion and spirituality'  Even though some participants' responses reflected 'good' nursing care, the majority of the participants had negative experiences in relation to the nursing care they received while admitted in the selected intensive care units.  TO CLINICAL PRACTICE This study demonstrates critically ill patients' voices and preferences of intensive nursing care and describes some issues that require not only nurses' but also managerial improvements and interventions in order to ensure quality care and, eventually, patients' satisfaction with intensive nursing care.

title: Dying From COVID 19: Loneliness, End of Life Discussions, and Support for Patients and Their Families in Nursing Homes and Hospitals. A National Register Study
abstract: Preparation for an impending death through EOL (end of life) discussions and human presence when a person is dying is important for both patients and families.  The aim was to study whether EOL discussions were offered and to what degree patients were alone at time of death when dying from Covid 19, comparing deaths in nursing homes and hospitals.  The national Swedish Register of Palliative Care (SRPC) was used. All expected deaths from Covid 19 in nursing homes and hospitals were compared with, and contrasted to, deaths in a reference population (deaths in 2019) Setting and subjects A total of 1346 expected Covid 19 deaths in nursing homes (n=908) and hospitals (n=438) were analyzed.  Those who died were of a more advanced age in nursing homes (mean 86.4 years) and of a lower age in hospitals (mean 80.7 years) (p<0.0001) Fewer EOL discussions with patients were held compared with deaths in 2019 (74% vs. 79% p<0.001) and dying with someone present was much more uncommon (59% vs. 83% p<0.0001) In comparisons between nursing homes and hospital deaths, more patients dying in nursing homes were women (56% vs. 37% p<0.0001) and significantly fewer had a retained ability to express their will during the last week of life (54% vs. 89% p<0.0001) Relatives were present at time of death in only 13% and 24% of the cases in nursing homes and hospitals, respectively (p<0.001) The corresponding figures for staff were 52% and 38% (p<0.0001)  Dying from Covid 19 negatively affects the possibility of holding an EOL discussion and the chances of dying with someone present. This has considerable social and existential consequences for both patients and families.

title: Could robots become authentic companions in nursing care?
abstract: Creating android and humanoid robots to furnish companionship in the nursing care of older people continues to attract substantial development capital and research. Some people object, though, that machines of this kind furnish human robot interaction characterized by inauthentic relationships. In particular, robotic and artificial intelligence (AI) technologies have been charged with substituting mindless mimicry of human behaviour for the real presence of conscious caring offered by human nurses. When thus viewed as deceptive, the robots also have prompted corresponding concerns regarding their potential psychological, moral, and spiritual implications for people who will be interacting socially with these machines. The foregoing objections and concerns can be assessed quite differently, depending upon ambient religious beliefs or metaphysical presuppositions. The complaints may be set aside as unnecessary, for example, within religious traditions for which even current robots can be viewed as presenting spiritual aspects. Elsewhere, technological cultures may reject the complaints as expression of outdated superstition, holding that the machines eventually will enjoy a consciousness described entirely in materialist and behaviourist terms. While recognizing such assessments, the authors of this essay propose that the heart of the foregoing objections and concerns may be evaluated, in part, scientifically albeit with a conclusion recommending fundamental revisions in AI modelling of human mental life. Specifically, considerations now favour introduction of AI models using interactive classical and quantum computation. Without this change, the answer to the essay's title question arguably is 'no' with it, the answer plausibly becomes 'maybe' Either outcome holds very interesting implications for nurses.

title: Palliative care during the final week of life of older people in nursing homes: A register based study
abstract: Our aim was to explore the presence of symptoms, symptom relief, and other key aspects of palliative care during the final week of life among older people residing in nursing homes.  Our study employed data from the Swedish Palliative Care Register on all registered individuals aged 60 and older who had died in nursing homes during the years 2011 and 2012. Variables pertaining to monitoring and treatment of symptoms, end of life discussions, circumstances around the death, and the individual characteristics of deceased individuals were explored using descriptive statistics.  The most common underlying causes of death among the 49,172 deceased nursing home residents were circulatory diseases (42.2% and dementia (22.7% The most prevalent symptom was pain (58.7% followed by rattles (42.4% anxiety (33.0% confusion (21.8% shortness of breath (14.0% and nausea (11.1% Pain was the symptom with the highest degree of total relief (46.3% whereas shortness of breath and confusion were totally relieved in 6.1 and 4.3% of all individuals, respectively. The use of valid instruments for symptom assessment was reported for pain in 12.3% and for other symptoms in 7.8% of subjects. The most prevalent individual prescriptions for injection PRN (pro re nata, according to circumstances) were for pain treatment (79.5% and rattles (72.8% End of life discussions were performed with 27.3% of all the deceased individuals and with 53.9% of their relatives. Of all individuals, 82.1% had someone present at death, and 15.8% died alone. Of all the nursing home resident deaths recorded, 45.3% died in their preferred place.  There were large variations in degree of relief from different symptoms during the final week of life. Pain was the most prevalent symptom, and it was also the symptom with the highest proportion of total/partial relief. Other symptoms were less prevalent but also less well relieved. Our results indicate a need for improvement of palliative care in nursing home settings, focusing on management of distressing symptoms and promotion of end of life discussions.

title: Satisfaction of surgical patients with perioperative nursing care in a Spanish tertiary care hospital
abstract: Although numerous studies have assessed patient satisfaction in diverse settings, in the realm of nursing surgical care, standardization of measurement for patient experience and satisfaction is lacking. Therefore, the aim of this study was to assess the satisfaction of surgical patients with perioperative nursing care.  A descriptive cross sectional survey was conducted. Sociodemographic characteristics and clinical data were recorded. Patient satisfaction was measured with a modified version of the La Monica Oberst Patient Satisfaction Scale (LOPSS 12) Results: 150 patients (73 women, 49% and 77 men; 51% completed the survey. The mean age was 63 years (standard deviation, 16 years) The mean overall satisfaction score on the La Monica Oberst Patient Satisfaction Scale was 3.17 (standard deviation, 0.21) The scale showed adequate content validity (Lawshe's Content Validity Index was 0.76) and moderate reliability (Cronbach's alpha 0.70) Two variables patient sex and the presence of comorbidities were significantly associated with overall satisfaction: men and patients with comorbidities were more satisfied with the care received. Patients with university studies were significantly more likely than patients with less education to consider nurses "impatient," but also considered the nurses' advice to be "useful." Patients with hospital acquired complications were more likely to perceive nurses to be "more interested in completing tasks than in listening," although they also felt that nurses worked "conscientiously."  Overall, patient satisfaction with perioperative nursing care was good. This study identified several areas of nursing care in need of improvement, particularly the need to spend more time with patients and to keep them better informed about the perioperative process. The modified La Monica Oberst Patient Satisfaction Scale is suitable for measuring surgical patient satisfaction with perioperative nursing care. The findings presented here may be of value to nursing administrators, educators, and nursing care providers to improve patient satisfaction and to develop strategies to prevent patient dissatisfaction.