Full Text Available Background: Nursing as a clinical discipline is developing in the emergency wards. Health care systems should continuously assess and prioritize indicators of clinical competency in these wards. The lack of clear standards of clinical competency indicators challenges evaluation. The purpose of this study was to determine clinical competency indicators and its priority based on nurses' views in educational and therapeutic centers in Guilan. Materials and Methods: The Q methodology was conducted in three phases, that is, phase I (determining the clinical competency indicators, phase II (classifying clinical competency indicators by an expert panel, and phase III (prioritizing clinical competency indicators. The subjects were selected by convenience sampling among nurses working in the emergency wards of teaching hospitals affiliated to Guilan in 2013. Finally, clinical competency indicators were prioritized using exploratory factor analysis. Results: In the prioritizing phase, data were collected from 710 nurses over two months. Five factors with 30 general competencies were found in three domains: communication, professional maturity, and personality characteristics. Six factors with 37 specific competencies were also found in two domains: scientific and technical capabilities and basic clinical skills that can provide a structured instrument for assessing clinical competence in emergency nurses. Conclusions: Achieved competencies can be used as a reference for nursing education and practice in emergency. Further research on health care system is needed in order to achieve a reliable and valid instrument.
Leary, Alison; Baxter, Jane
Clinical nurse specialists (CNS) in cancer perform a range of complex activities, including the management of care. However, they often report a high administrative burden for services, which makes providing expert nursing care challenging. Administrative work for a service can be seen as a priority for non-nurses, yet a high administrative burden allows less time for complex nursing care. A London trust admitted a mean of four lung cancer patients per month for symptom control in progressive disease or end-of-life care, with a mean stay of 6 days. This was often a default location: the acute hospital was not always the patient's preferred place of care for end of life. The CNS negotiated away the administrative burden, which occupied 38% of their working time, and adopted standard proactive case management in line with national standards. The CNS were also able to build a collaborative relationship with others, such as local GPs and community palliative care teams. Their proactive and vigilant case management resulted in fewer admissions for non-acute problems: a mean of four emergency admissions per month fell to a mean of fewer than one (0.3). For this service, the mean length of emergency admission was 6 days, so a reduction in the admission rate represented a significant saving in bed days (266 a year) and a higher rate of achieving the preferred place of end-of-life care. In conclusion, CNS who practise proactive case management and refocus services in line with best practice represent a good return on investment (ROI).
Kim, Sunghee; Shin, Gisoo
Since previous studies on simulation-based education have been focused on fundamental nursing skills for nursing students in South Korea, there is little research available that focuses on clinical nurses in simulation-based training. Further, there is a paucity of research literature related to the integration of the nursing process into simulation training particularly in the emergency nursing care of high-risk maternal and neonatal patients. The purpose of this study was to identify the effects of nursing process-based simulation on knowledge, attitudes, and skills for maternal and child emergency nursing care in clinical nurses in South Korea. Data were collected from 49 nurses, 25 in the experimental group and 24 in the control group, from August 13 to 14, 2013. This study was an equivalent control group pre- and post-test experimental design to compare the differences in knowledge, attitudes, and skills for maternal and child emergency nursing care between the experimental group and the control group. The experimental group was trained by the nursing process-based simulation training program, while the control group received traditional methods of training for maternal and child emergency nursing care. The experimental group was more likely to improve knowledge, attitudes, and skills required for clinical judgment about maternal and child emergency nursing care than the control group. Among five stages of nursing process in simulation, the experimental group was more likely to improve clinical skills required for nursing diagnosis and nursing evaluation than the control group. These results will provide valuable information on developing nursing process-based simulation training to improve clinical competency in nurses. Further research should be conducted to verify the effectiveness of nursing process-based simulation with more diverse nurse groups on more diverse subjects in the future. Copyright © 2015 Elsevier Ltd. All rights reserved.
Hassankhani, Hadi; Hasanzadeh, Firooz; Powers, Kelly A; Dadash Zadeh, Abbas; Rajaie, Rouzbeh
Emergency nurses play an important role in the care of critically ill and injured patients, and their competency to perform clinical skills is vital to safe and effective patient care. The aim of this study was to evaluate the frequency of clinical skills performed and perceived competency levels among Iranian emergency nurses. In addition, attitudes toward expanding the professional roles of Iranian emergency nurses were also assessed. In this descriptive correlational study, 319 emergency nurses from 30 hospitals in northwest Iran participated. Data were collected using a self-report questionnaire. Descriptive statistics and Pearson's correlation coefficient were used to present the findings. Overall competency of the emergency nurses was 73.31 ± 14.2, indicating a good level of perceived competence. The clinical skills most frequently performed were in the domains of organizational and workload competencies (3.43 ± 0.76), diagnostic function (3.25 ± 0.82), and the helping role (3.17 ± 0.83). A higher level of perceived competence was found for skills within these domains. Less frequently, participants performed skills within the domains of effective management of rapidly changing situations (2.70 ± 0.94) and administering and monitoring therapeutic interventions (2.60 ± 0.97); a lower perceived level of competence was noted for these clinical skills. There was a significant correlation between frequency of performing clinical skills and perceived competency level (r = 0.651, P skills. This has implications for nurse managers and educators who may consider offering more frequent experiential and educational opportunities to emergency nurses. Expansion of nurses' roles could also result in increased experience in clinical skills and higher levels of competency. Research is needed to investigate nurses' clinical competence using direct and observed measures. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Luiking, Marie-Louise; Aarts, Leon; Bras, Leo; Grypdonck, Maria; van Linge, Roland
Nurses' clinical autonomy is considered important for patients' outcome and influenced by the implementation approach of innovations. Emergent change approach with participation in the implementation process is thought to increase clinical autonomy. Planned change approach without this participation is thought not to increase clinical autonomy. Evidence of these effects on clinical autonomy is however limited. To examine the changes in clinical autonomy and in personal norms and values for a planned change and emergent change implementation of an innovation, e.g. intensive insulin therapy. Prospective comparative study with two geographically separated nurses' teams on one intensive care unit (ICU), randomly assigned to the experimental conditions. Data were collected from March 2008 to January 2009. Pre-existing differences in perception of team and innovation characteristics were excluded using instruments based on the innovation contingency model. The Nursing Activity Scale was used to measure clinical autonomy. The Personal Values and Norms instrument was used to assess orientation towards nursing activities and the Team Learning Processes instrument to assess learning as a team. Pre-implementation the measurements did not differ. Post-implementation, clinical autonomy was increased in the emergent change team and decreased in the planned change team. The Personal Values and Norms instrument showed in the emergent change team a decreased hierarchic score and increased developmental and rational scores. In the planned change team the hierarchical and group scores were increased. Learning as a team did not differ between the teams. In both teams there was a change in clinical autonomy and orientation towards nursing activities, in line with the experimental conditions. Emergent change implementation resulted in more clinical autonomy than planned change implementation. If an innovation requires the nurses to make their own clinical decisions, an emergent change
Uhrenfeldt, Lisbeth; Hall, Elisabeth
This paperexamines clinical wisdom which has emerged from a broader study anout nurse managers´influence on proficient registered nurse turnover and retention. The purpose of the study was to increase understanding of proficient nurses´experience and clinical practice by giving voice to the nurses...
This paper reports on a detailed analysis of findings from a larger study of 'Nordic nursing theorists and clinical nurses' reflections on and experience with production and use of research, theory and findings'. The development of nursing science in the Nordic countries goes back to the late 1970s....... With use of a sociological approach the aim was to explore whether nursing science has constituted itself as an autonomous nursing research field in Bourdieu's terms. In-depth interviews were undertaken with a purposive sample of 10 professors drawn from seven universities in the Nordic countries....... The interview agenda explored the participants' research activities and knowledge production. Our conclusion is that one cannot speak of nursing research in the Nordic countries as a fully developed and autonomous field. Yet we see the outlines of an emerging nursing research field with a common doxa. At least...
... Infectious Diseases Opioid Crisis Behavioral Health Infection Control Human Trafficking Membership Join Renew Membership Options Member Benefits Get ... to Train Emergency Nurses to Help Victims of Human Trafficking! MISSION ZERO Act for ZERO Preventable Deaths Support ...
Hernández Ruipérez, Tomás; Adánez Martínez, María de Gracia; Díaz Agea, José Luís; García Pérez, Bartolomé; Leal Costa, César
To design and validate a clinical simulation method for training nurses to use the Emergency Severity Index (ESI) for triage. Descriptive, cross-sectional study carried out in the emergency department of Hospital Clínico Universitario Virgen de la Arrixaca in Murcia, Spain. The educational intervention had 3 phases focused on theory, skills, and application. The participants, who were nurses with at least a year's experience in the emergency department, numbered 55, 43, and 32 in each phase, respectively. They undertook training in ESI for triage (phase 1), participated in simulations with patient-actors (phase 2), and applied their acquired skills (phase 3). We used Cohen's K and the intraclass correlation coefficient (ICC) to compare the nurses' triage assignments to gold-standard triage assignments. We had data for 1100, 799, and 410 observations of performance in each phase, respectively. Agreement statistics between the nurses' performance and the gold standard were 0.68, 0.67, and 0.68 (Cohen's K) and 0.870, 0.836, and 0.811 (ICC) in each phase, respectively. These results reflect good agreement. This study supports the relevance of clinical simulations for training nurses to implement structured triage, and in particular to use the ESI. We can state that this study opens the door to further research into whether the reliability of triage can be improved by using this approach, specifically whether it can facilitate better interobserver agreement.
Alameddine, Mohamad; Mufarrij, Afif; Saliba, Miriam; Mourad, Yara; Jabbour, Rima; Hitti, Eveline
Peer evaluation is increasingly used as a method to assess physicians' interpersonal and communication skills. We report on experience with soliciting registered nurses' feedback on physicians' non-clinical performance in the ED of a large academic medical center in Lebanon. We utilized a secondary analysis of a de-identified database of ED nurses' assessment of physicians' non-clinical performance coupled with an evaluation of interventions carried out as a result of this evaluation. The database was compiled as part of quality/performance improvement initiatives using a cross-sectional design to survey registered nurses working at the ED. The survey instrument included open ended and closed ended questions assessing physicians' communication, professionalism and leadership skills. Three episodes of evaluation were carried out over an 18 month period. Physicians were provided with a communication training carried out after the first cycle of evaluation and a detailed feedback on their assessment by nurses after each evaluation cycle. A paired t-test was carried out to compare mean evaluation scores between the three cycles of evaluation. Thematic analysis of nurses' qualitative comments was carried out. A statistically significant increase in the averages of skills was observed between the first and second evaluations, followed by a significant decrease in the averages of the three skills between the second and third evaluations. Personalized feedback to ED physicians and communication training initially contributed to a significant positive impact on improving ED physicians' non-clinical skills as perceived by the ED nurses. Yet, gains achieved were lost upon reaching the third cycle of evaluation. However, the thematic analysis of the nurses' qualitative responses portrays a decrease in concerns across the various dimensions of non-clinical performance. Nurses' evaluation of the non-clinical performance of physicians has the potential of improving communication
Hjelmeland, Heidi; Osafo, Joseph; Akotia, Charity S; Knizek, Birthe L
Attempted suicide is still considered a crime in Ghana. The purpose of this study was to investigate the attitudes toward this law held by health workers and police officers in Ghana so as to provide culture-sensitive arguments to aid in abolishing the law. Qualitative interviews were conducted with eight clinical psychologists, eight emergency ward nurses, and eight police officers. The majority of informants did not agree with the law criminalizing attempted suicide in Ghana, although five of the emergency ward nurses and two police officers did. Arguments for agreeing with the law were that people have no right to take life and that the law has a deterrent effect and thus it will help reduce the suicide rate. The main argument for not agreeing with the law was that suicidal behavior is a mental health issue. Those who argued in favor of the law did not seem to reflect much on the reasons for suicidal behavior. Education on how to understand suicidal behavior and suicidal people may aid the work toward decriminalizing attempted suicide in Ghana.
Fernandez-Parsons, Robin; Rodriguez, Lori; Goyal, Deepika
For nurses, moral distress leads to burnout, attrition, compassion fatigue, and patient avoidance. Using a quantitative, cross-sectional, and descriptive design, we assessed the frequency, intensity, and type of moral distress in 51 emergency nurses in 1 community hospital using a 21-item, self-report, Likert-type questionnaire. Results showed a total mean moral distress level of 3.18, indicative of overall low moral distress. Situations with the highest levels of moral distress were related to the competency of health care providers and following family wishes to continue life support, also known as futile care. Moral distress was the reason given by 6.6% of registered nurses for leaving a previous position, 20% said that they had considered leaving a position but did not, and 13.3% stated that they are currently considering leaving their position because of moral distress. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.
Full Text Available Nurses are the largest group of healthcare workers in Africa. By adequately equipping nurses to identify, intervene and care for emergency conditions, emergency healthcare systems can be strengthened. To address this need, a nursing working group was formed within the African Federation for Emergency Medicine (AFEM. The aim of this international emergency nursing group was to develop a guiding document to help improve emergency nursing skills within Africa. Using this guiding document, a group of Tanzanian clinical nurse trainers was selected to develop a context specific short course. They used this guiding document as a foundation to improve skill development. The pilot course was well received and has since expanded to training in five regions within the United Republic of Tanzania. The clinical nurse trainers leading the course, are supported by a mentorship programme with competent educators within a global emergency nursing infrastructure. This course, a combination of local knowledge, formal mentorship programs, and international nursing support, demonstrates that investing in the improvement of emergency nursing skills can have high impact results with low-cost. This will ultimately improve emergency care on the continent.
Woo, Brigitte Fong Yeong; Lee, Jasmine Xin Yu; Tam, Wilson Wai San
The prevalence of chronic illness and multimorbidity rises with population aging, thereby increasing the acuity of care. Consequently, the demand for emergency and critical care services has increased. However, the forecasted requirements for physicians have shown a continued shortage. Among efforts underway to search for innovations to strengthen the workforce, there is a heightened interest to have nurses in advanced practice participate in patient care at a great extent. Therefore, it is of interest to evaluate the impact of increasing the autonomy of nurses assuming advanced practice roles in emergency and critical care settings on patient outcomes. The objectives of this study are to present, critically appraise, and synthesize the best available evidence on the impact of advanced practice nursing on quality of care, clinical outcomes, patient satisfaction, and cost in emergency and critical care settings. A comprehensive and systematic search of nine electronic databases and a hand-search of two key journals from 2006 to 2016 were conducted to identify studies evaluating the impact of advanced practice nursing in the emergency and critical care settings. Two authors were involved selecting the studies based on the inclusion criteria. Out of the original search yield of 12,061 studies, 15 studies were chosen for appraisal of methodological quality by two independent authors and subsequently included for analysis. Data was extracted using standardized tools. Narrative synthesis was undertaken to summarize and report the findings. This review demonstrates that the involvement of nurses in advanced practice in emergency and critical care improves the length of stay, time to consultation/treatment, mortality, patient satisfaction, and cost savings. Capitalizing on nurses in advanced practice to increase patients' access to emergency and critical care is appealing. This review suggests that the implementation of advanced practice nursing roles in the emergency and
Richardson, Karen J; Sengstack, Patricia; Doucette, Jeffrey N; Hammond, William E; Schertz, Matthew; Thompson, Julie; Johnson, Constance
The primary aim of this performance improvement project was to determine whether the electronic health record implementation of stroke-specific nursing documentation flowsheet templates and clinical decision support alerts improved the nursing documentation of eligible stroke patients in seven stroke-certified emergency departments. Two system enhancements were introduced into the electronic record in an effort to improve nursing documentation: disease-specific documentation flowsheets and clinical decision support alerts. Using a pre-post design, project measures included six stroke management goals as defined by the National Institute of Neurological Disorders and Stroke and three clinical decision support measures based on entry of orders used to trigger documentation reminders for nursing: (1) the National Institutes of Health's Stroke Scale, (2) neurological checks, and (3) dysphagia screening. Data were reviewed 6 months prior (n = 2293) and 6 months following the intervention (n = 2588). Fisher exact test was used for statistical analysis. Statistical significance was found for documentation of five of the six stroke management goals, although effect sizes were small. Customizing flowsheets to meet the needs of nursing workflow showed improvement in the completion of documentation. The effects of the decision support alerts on the completeness of nursing documentation were not statistically significant (likely due to lack of order entry). For example, an order for the National Institutes of Health Stroke Scale was entered only 10.7% of the time, which meant no alert would fire for nursing in the postintervention group. Future work should focus on decision support alerts that trigger reminders for clinicians to place relevant orders for this population.
Di Giulio, Paola; Campagna, Sara; Dimonte, Valerio
Clinical trials are pivotal for the development of nursing knowledge. To describe the clinical trials published in nursing journals in the last two years and propose some general reflections on nursing research. A search with the key-word trial was done on PubMed (2009-2013) on Cancer Nursing, European Journal of Oncology Nursing, International Journal of Nursing Studies, Journal of Advanced Nursing, Journal of Clinical Nursing and Nursing Research. Of 228 trials identified, 104 (45.8%) were published in the last 2 years. Nurses from Asian countries published the larger number of trials. Educational and supportive interventions were the most studied (61/104 trials), followed by clinical interventions (33/104). Samples were limited and most trials are monocentric. A growing number of trials is published, on issues relevant for the nursing profession, however larger samples and multicentric studies would be necessary.
Jones, Tamsin; Shaban, Ramon Z; Creedy, Debra K
Presentations to emergency departments (EDs) and patient acuity continue to increase. Whilst strategies to deliver safe patient care in the ED are evolving, emergency nurses need to be well educated through specialist qualifications to enable delivery of advanced patient care. This paper presents a comparative analysis of available international practice and competency standards for nurses graduating from emergency nursing courses in Australia, Canada, New Zealand, the United Kingdom, and the United States. CINAHL, Scopus, Ovid MEDLINE, and Embase were searched for papers, published in English, using the terms: 'emergency', 'accident and emergency', 'nursing', 'competency', 'practice standards', 'scope of practice', 'regulation', and 'specialist standards'. Secondary sources from relevant reference lists and professional websites were also searched. The standards from the five countries were common across five domains: clinical expertise, communication, teamwork, resources and environment, and legal. None of the standards were specific to the emergency nursing graduate, and there was variability in the level of expertise required for which the standards apply. The available practice standards demonstrated some commonality. Consideration of the utility of a universal framework for informing the development of emergency nursing practice standards and emergency nursing curriculum for nurses wishing to specialise is needed. Copyright © 2015 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
The consultant nurse concept has not yet been transferred to the military setting. The motivation for developing the role in the NHS was to improve the quality of patient care by strengthening professional leadership and extending the clinical career ladder. The consultant nurse may be defined as an expert in their clinical field, possessing expert leadership and visionary skills. The role is based on four domains: expert practice, professional leadership, education and research. Typically, the emergency consultant nurse spends 50% of their time working clinically, thereby providing senior clinical expertise and adding value to the clinical role. In a military context the consultant nurse role could be perceived as the coming together of the senior command and administrative role and the clinical role. The military has the opportunity to develop a senior clinical emergency nurse role encompassing elements of the civilian consultant nurse model, which may strengthen leadership, provide a central resource of expertise and raise the profile of military nursing. This has the added potential to provide inspiration for junior nurses and retain experienced emergency nurses in the clinical arena.
Park, Hye-Young; Kim, Ji-Soo
Emergency nurses are expected to provide required nursing services by using their professional expertise to reduce the risk posed by disasters. Thus, emergency nurses' disaster nursing core competencies are essential for coping with disasters. The purpose of the study reported here was to identify factors influencing the disaster nursing core competencies of emergency nurses. A survey was conducted among 231 emergency nurses working in 12 hospitals in South Korea. Data were collected on disaster-related experience, attitude, knowledge, and disaster nursing core competencies by means of a questionnaire. In multiple regression analysis, disaster-related experience exerted the strongest influence on disaster nursing core competencies, followed by disaster-related knowledge. The explanatory power of these factors was 25.6%, which was statistically significant (F=12.189, pcompetencies of emergency nurses could be improved through education and training programs that enhance their disaster preparedness. The nursing profession needs to participate actively in the development of disaster nursing education and training programs. Copyright © 2017 Elsevier Inc. All rights reserved.
Maria da Graça Oliveira Crossetti
Full Text Available The objective of this study was to analyze the structural elements of critical thinking (CT of nurses in the clinical decision-making process. This exploratory, qualitative study was conducted with 20 emergency care nurses in three hospitals in southern Brazil. Data were collected from April to June 2009, and a validated clinical case was applied from which nurses listed health problems, prescribed care and listed the structural elements of CT. Content analysis resulted in categories used to determine priority structural elements of CT, namely theoretical foundations and practical relationship to clinical decision making; technical and scientific knowledge and clinical experience, thought processes and clinical decision making: clinical reasoning and basis for clinical judgments of nurses: patient assessment and ethics. It was concluded that thinking critically is a skill that enables implementation of a secure and effective nursing care process.
Enns, Carol L; Sawatzky, Jo-Ann V
Caring is a universal phenomenon. However, as a result of higher patient acuity and staff shortages within the chaotic ED environment, caring behaviors may be in peril. The purpose of this study was to gain insight into the meaning of caring from the perspective of emergency nurses. Exploring nurses' perspectives of caring is central to improving staffing and retention issues in this unique work environment. As part of a larger study, a subsample of emergency nurses who work in public hospitals in Manitoba, Canada (n = 17) were interviewed. A qualitative descriptive design was used to gain insight into the caring perspectives of nurses by asking them, "What does caring meaning to you?" and "What affects caring in your practice in the emergency department?" Emerging themes were extracted through analysis of audio tapes and transcripts. Advocacy and holistic care emerged as major themes in the meaning of caring for emergency nurses. Caring was affected by a number of factors, including workload, lack of time, staffing issues, shift work, and lack of self-care. However, lack of management support was the most consistent hindrance to caring identified by study participants. Caring continues to be a unifying concept in nursing; however, influencing factors continue to undermine caring for emergency nurses. Caring is not subsidiary to nursing; it is the central core of nursing. Therefore, fostering a caring working environment is essential for nurses to practice holistic nursing care. It is also imperative to job satisfaction and the retention of emergency nurses. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Incivility in nursing education is a complicated problem which causes disruptions in the learning process and negatively affects future nursing practice. This mixed method research study described incivility as well as incivility's effects through extensive literature review and application of a modified Incivility in Nursing Education (INE) survey. The INE included six demographic items, four quantitative sections, and five open-ended questions. The survey examined emergency nurses' perceptions of incivility and how the experience affected their personal nursing practice. The INE was initially tested in a 2004 pilot study by Dr. Cynthia Clark. For this research study, modifications were made to examine specifically emergency nurse's perceptions of incivility and the effects on their practice. The population was a group of nurses who were members of the emergency nurses association in a Midwestern state. In the quantitative component of the Incivility in Nursing Education (INE) survey, the Likert scale questions indicated that the majority of the participants reported witnessing or experiencing the uncivil behaviors. In the qualitative section of the INE survey, the participants reported that although they have not seen incivility within their own academic career, they had observed faculty incivility with nursing students when the participants were assigned as preceptors as part of their emergency nursing practice.
Hedda Bøe Nyhus
Conclusion: This study has identified key aspects of emergency nursing speciality training to be developed through theoretical and skill-based education provided by the nursing schools and hospital clinical facilities in Sierra Leone.
Bell, Sue Anne; Oteng, Rockefeller; Redman, Richard; Lapham, Jeremy; Bam, Victoria; Dzomecku, Veronica; Yakubu, Jamila; Tagoe, Nadia; Donkor, Peter
The formal provision of emergency health care is a developing specialty in many sub-Saharan African countries, including Ghana. While emergency medicine training programs for physicians are on the rise, there are few established training programs for emergency nurses. The results of a unique collaboration are described between a university in the United States, a Ghanaian university and a Ghanaian teaching hospital that has developed an emergency nursing diploma program. The expected outcomes of this training program include: (a) an innovative, interdisciplinary, team-based clinical training model, (b) a unique and low-resource emergency nursing curriculum and (c) a comprehensive and sustainable training program to increase in-country retention of nurses. Copyright © 2014 Elsevier Ltd. All rights reserved.
Rozo, Jose Andres; Olson, DaiWai M; Thu, Hlaing Sue; Stutzman, Sonja E
Emergency departments are high-stress environments for patients and clinicians. As part of the clinical team, nurses experience this stress daily and are subject to high levels of burnout, which has been shown to lead to hypertension, depression, and anxiety. Presence of these diseases may also contribute to burnout, creating a cycle of stress and illness. This prospective qualitative study used a phenomenological approach to better understand factors associated with burnout among emergency department nurses. Burnout manifests itself in multiple modes, can affect nurses' decisions to leave the profession, and must be addressed to mitigate the phenomenon.
Corujo Fontes, Sergio José
The branch hospital triage aimed at, as well as exercised by nurses, has evolved to meet their needs to organize and make visible the nurses' duties. However, it is still not properly considered as independent nursing intervention. Evidencing practice triage nurse in hospital as experienced by their protagonists disclosed the possible causes of this paradoxical competence. In a sample of 41 nurses, of the 52 possible with previous experience in hospital triage in the Emergency Department of the Hospital General Dr. José Molina Orosa in Lanzarote, the nurses themselves carried out an opinion survey that group together statements about different aspects of the triaje nurse. In its results, 65.8% of those polled thought the triaje nursing training to be deficient and even though nearly half 48.7%, was considered competent to decide the level of emergency, 46.3% disagreed to take this task part of their duty. It is conclusive that the training received in hospital triage, regulated and sustained, is deficient, that is the main reason why professionals have their doubts to take on an activity they are not familiar with. Triage systems do not record the entire outcome of the nursing work and nursing methodology does not seem to be quite indicative for this task.
Sofarelli, Theresa A; Ricks, Jane H; Anand, Rahul; Hale, Devon C
International travel plays a significant role in the emergence and redistribution of major human diseases. The importance of travel medicine clinics for preventing morbidity and mortality has been increasingly appreciated, although few studies have thus far examined the management and staff training strategies that result in successful travel-clinic operations. Here, we describe an example of travel-clinic operation and management coordinated through the University of Utah School of Medicine, Division of Infectious Diseases. This program, which involves eight separate clinics distributed statewide, functions both to provide patient consult and care services, as well as medical provider training and continuing medical education (CME). Initial training, the use of standardized forms and protocols, routine chart reviews and monthly continuing education meetings are the distinguishing attributes of this program. An Infectious Disease team consisting of one medical doctor (MD) and a physician assistant (PA) act as consultants to travel nurses who comprise the majority of clinic staff. Eight clinics distributed throughout the state of Utah serve approximately 6,000 travelers a year. Pre-travel medical services are provided by 11 nurses, including 10 registered nurses (RNs) and 1 licensed practical nurse (LPN). This trained nursing staff receives continuing travel medical education and participate in the training of new providers. All nurses have completed a full training program and 7 of the 11 (64%) of clinic nursing staff serve more than 10 patients a week. Quality assurance measures show that approximately 0.5% of charts reviewed contain a vaccine or prescription error which require patient notification for correction. Using an initial training program, standardized patient intake forms, vaccine and prescription protocols, preprinted prescriptions, and regular CME, highly trained nurses at travel clinics are able to provide standardized pre-travel care to
Carlson, K E
The purpose of this descriptive, exploratory study was to identify reasons that motivate the emergency nurse to take the Certification Exam for Emergency Nursing (CEN exam); reasons certified emergency nurses (CEN) give concerning their decisions to recertify; and a comparison of demographic characteristics in relation to these reasons. A random sample of 500 registered nurses who are currently members of the Emergency Nurses Association (ENA) and who are working in the emergency department was obtained from the ENA. These nurses received a questionnaire packet containing a cover letter explaining the purpose of the study, a combined Educational Participation Scale (EPS) and Deterrents to Participation Scale (DPS), a personal data questionnaire, and a return envelope.
Discussion: Current nurse knowledge and function as well as areas to focus on for future specialty training in emergency nursing have been identified by this needs assessment. The emergency department nurses shared an overwhelming interest in increasing their skill level, learning new methods of patient care and implementing new technologies into their clinical practice.
Wilbeck, Jennifer; Roberts, Eric; Rudy, Susanna
Increasing numbers of patients are presenting to national emergency departments (EDs). This is occurring simultaneously with reductions in providers along with ED closures, creating a significant gap in emergency care. According to the advanced practice registered nurse consensus model, specialty-specific knowledge and practice build upon generalist nurse practitioner (NP) population foci. Although the National Organization of Nurse Practitioner Faculties provides guidelines for educational programs at the NP population level, determination of core specialty knowledge lies with specialty organizations. Emergency nurse practitioners (ENPs) require additional specialty-specific education to manage patients spanning age and acuity continuums. Although certification mechanisms are now in place to recognize NP specialty knowledge, a nationally standardized curriculum remains to be proposed. This article proposes core educational content for ENP specialty education; the utility of this content may serve as the foundation for the development of standardized ENP academic and postgraduate fellowship programs.
Morgan, Sofie Rahman; Acquisto, Nicole M; Coralic, Zlatan; Basalyga, Vicki; Campbell, Matthew; Kelly, John J; Langkiet, Kevin; Pearson, Claire; Sokn, Erick; Phelan, Michael
The emergency department (ED) is a fast-paced, high-risk, and often overburdened work environment. Formal policy statements from several notable organizations, including the American College of Emergency Physicians (ACEP) and the American Society of Health-System Pharmacists (ASHP), have recognized the importance of clinical pharmacists in the emergency medicine (EM) setting. EM clinical pharmacists work alongside emergency physicians and nurses at the bedside to optimize pharmacotherapy, improve patient safety, increase efficiency and cost-effectiveness of care, facilitate antibiotic stewardship, educate patients and clinicians, and contribute to scholarly efforts. This paper examines the history of EM clinical pharmacists and associated training programs, the diverse responsibilities and roles of EM clinical pharmacists, their impact on clinical and financial outcomes, and proposes a conceptual model for EM clinical pharmacist integration into ED patient care. Finally, barriers to implementing EM clinical pharmacy programs and limitations are considered. Copyright © 2018 Elsevier Inc. All rights reserved.
Codier, Estelle; Codier, David
A significant body of research suggests there is a correlation between measured emotional intelligence (EI) abilities and performance in nursing. The four critical elements of EI, namely the abilities to identify emotions correctly in self and others, using emotions to support reasoning, understanding emotions and managing emotions, apply to emergency care settings and are important for safe patient care, teamwork, retention and burnout prevention. This article describes 'emotional labour' and the importance of EI abilities for emergency nurses, and suggests that such abilities should be considered core competencies for the profession.
Rawson, Helen; Bennett, Paul N; Ockerby, Cherene; Hutchinson, Alison M; Considine, Julie
Older adults are high users of emergency department services and their care requirements can present challenges for emergency nurses. Although clinical outcomes for older patients improve when they are cared for by nurses with specialist training, emergency nurses' knowledge and self-assessment of care for older patients is poorly understood. To assess emergency nurses' knowledge and self-rating of practice when caring for older patients. A cross-sectional self-report survey of emergency nurses (n=101) in Melbourne, Australia. Mean scores were 12.7 (SD 2.66) for the 25-item knowledge of older persons questionnaire, and 9.04 (SD 1.80) for the 15-item gerontic health related questions. Scores were unaffected by years of experience as a registered nurse or emergency nurse. More than 80% of nurses rated themselves as 'very good' or 'good' in assessing pain (94.9%), identifying delirium (87.8%), and identifying dementia (82.8%). Areas with a 'poor' ratings were identifying depression (46.5%), assessing polypharmacy (46.5%) and assessing nutrition (37.8%). There was variation in knowledge and self-rating of practice related to care of older patients. The relationship between knowledge and self-ratings of practice in relation to actual emergency nursing care of older people and patient outcomes warrants further exploration. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
Advanced nurse practitioners in the author's emergency department (ED) work autonomously and as part of a team to assess, diagnose and treat patients with unexplained and undiagnosed illnesses and injuries over a 24-hour cycle of care. The complexity of the role in EDs is often not fully understood, and expectations can vary between trusts and between different clinical areas within trusts. This article describes one night shift in the author's ED to explain the complexity of advanced nurse practitioners' roles in this environment. The article focuses on autonomous decision-making skills and the use of advanced clinical skills in the context of evidence-based practice.
Richardson, S; Ardagh, M; Grainger, P; Robinson, V
To outline the impact of the Canterbury, New Zealand (NZ) earthquakes on Christchurch Hospital, and the experiences of emergency nurses during this time. NZ has experienced earthquakes and aftershocks centred in the Canterbury region of the South Island. The location of these, around and within the major city of Christchurch, was unexpected and associated with previously unknown fault lines. While the highest magnitude quake occurred in September 2010, registering 7.1 on the Richter scale, it was the magnitude 6.3 event on 22 February 2011 which was associated with the greatest injury burden and loss of life. Staff working in the only emergency department in the city were faced with an external emergency while also being directly affected as part of the disaster. SOURCES OF EVIDENCE: This paper developed following interviews with nurses who worked during this period, and draws on literature related to healthcare responses to earthquakes and natural disasters. The establishment of an injury database allowed for an accurate picture to emerge of the injury burden, and each of the authors was present and worked in a clinical capacity during the earthquake. Nurses played a significant role in the response to the earthquakes and its aftermath. However, little is known regarding the impact of this, either in personal or professional terms. This paper presents an overview of the earthquakes and experiences of nurses working during this time, identifying a range of issues that will benefit from further exploration and research. It seeks to provide a sense of the experiences and the potential meanings that were derived from being part of this 'moment in time'. Examples of innovations in practice emerged during the earthquake response and a number of recommendations for nursing practice are identified. © 2013 The Authors. International Nursing Review © 2013 International Council of Nurses.
Darawad, Muhammad W; Al-Hussami, Mahmoud; Saleh, Ali M; Mustafa, Waddah Mohammad; Odeh, Haifa
Violence against nurses in emergency departments (EDs) has become a widespread phenomenon affecting nurses' job satisfaction and work performance. Literature is scarce regarding prevalence rates and causes of violence directed toward nurses in Jordan. The present study investigated violence experienced by Jordanian nurses in EDs and causes of violence from their perspectives. This descriptive study collected data from 174 Jordanian ED nurses. The majority of the participants (91.4%) reported experiencing violence (verbal 95.3% vs. physical 23.3%). According to participants, the most common causes of violence in the ED were crowding and workload (75.9%), and the least was care of patients with dementia or Alzheimer's disease (35.6%). Violence is common in Jordanian EDs, giving rise to many heath and behavioral consequences. Health care administrators are obligated to protect nurses from violent incidents by providing adequate safety measures, beneficial administrative procedures, and sincere efforts to overcome the causes of this phenomenon. © 2015 The Author(s).
Adams, Jeffrey M
This department highlights emerging nursing leaders who have demonstrated leadership in advancing innovation and patient care in practice, policy, research, education, and theory. This interview profiles Lesly Kelly, PhD, RN, Assistant Professor at the Arizona State University College of Nursing and Health Innovation and Nursing and Clinical Research Program Director at Banner-University Medical Center Phoenix.
Mannix, Judy; Wilkes, Lesley; Daly, John
Clinical leadership has been identified as crucial to positive patient/client outcomes, across all clinical settings. In the new millennium, transformational leadership has been the dominant leadership style and in more recent times, congruent leadership theory has emerged to explain clinical leadership in nursing. This article discusses these two leadership models and identifies some of the shortcomings of them as models for clinical leadership in nursing. As a way of overcoming some of these limitations, aesthetic leadership is proposed as a style of leadership that is not antithetical to either model and reflects nursing's recognition of the validity of art and aesthetics to nursing generally. Aesthetic leadership is also proposed as a way to identify an expert clinical leader from a less experienced clinical leader, taking a similar approach to the way Benner (1984) has theorised in her staging of novice to expert clinical nurse.
Bender, Miriam; Spiva, LeeAnna; Su, Wei; Hites, Lisle
To determine the power of a conceptual clinical nurse leader practice model to explain the care model's enactment and trajectory in real world settings. How nursing, organised into specific models of care, functions as an organisational strategy for quality is not well specified. Clinical nurse leader integrated care delivery is one emerging model with growing adoption. A recently validated clinical nurse leader practice model conceptualizes the care model's characteristics and hypothesizes their mechanisms of action. Pattern matching case study design and mixed methods were used to determine how the care model's constructs were operationalized in one regional United States health system that integrated clinical nurse leaders into their care delivery system in 2010. The findings confirmed the empirical presence of all clinical nurse leader practice model constructs and provided a rich description of how the health system operationalized the constructs in practice. The findings support the hypothesized model pathway from Clinical Nurse Leader structuring to Clinical Nurse Leader practice and outcomes. The findings indicate analytic generalizability of the clinical nurse leader practice model. Nursing practice organised to focus on microsystem care processes can catalyse multidisciplinary engagement with, and consistent enactment of, quality practices. The model has great potential for transferability across diverse health systems. © 2018 John Wiley & Sons Ltd.
Skjøt-Arkil, Helene; Pontoppidan, Louise L; Laursen, Jens O
OBJECTIVES: The aim of this study was to investigate the agreement on triage level between prehospital providers and emergency department (ED) nurses in clinical practice when using the same triage system. The objectives were as follows: (a) What is the agreement of triage between prehospital...... providers and ED nurses, when using Danish Emergency Process Triage (DEPT) correctly? (b) Which part of the triage process yields the highest agreement regarding the final triage? METHODS: The study was a prospective and observational efficacy study. Patients transported to the ED by ambulances were...... included. They were triaged by prehospital providers while being transported by ambulance to the ED, and by ED nurses upon arrival. Triage was done using the DEPT - a five-level triage system based on vital signs and a presenting complaint algorithm. An agreement analysis was performed. RESULTS: DEPT...
Case study and case-based research in emergency nursing and care: Theoretical foundations and practical application in paramedic pre-hospital clinical judgment and decision-making of patients with mental illness.
Shaban, Ramon Z; Considine, Julie; Fry, Margaret; Curtis, Kate
Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate. This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
Cristiane Chaves de Souza
Full Text Available Objective. Get to know how nurses perceive the accomplishment of risk classification in an emergency service. Methodology. In this qualitative study, 11 nurses were included with at least two months of experience in the risk classification of patients who visited the emergency service. Semistructured interviews were used to collect the information. The data were collected between August and December 2011. For data analysis, Bardin's theoretical framework was used. Results. The nurses in the study consider the risk classification as a work organization instruments that permits closer contact between nurses and patients. The nursing skills needed for risk classification were identified: knowledge about the scale used, clinical perspective, patience and agility. The availability of risk classification scales was the main facilitator of this work. The main difficulties were the disorganization of the care network and the health team's lack of knowledge of the protocol. Conclusion. Risk classification offers an opportunity for professional autonomy to the extent that it is the main responsible for regulating care at the entry door of the emergency services.
Hypnoanalgesia is practised in accordance with care ethics and as a complement to other medical and/or psychological therapies. It is aimed at people with acute, chronic or treatment-related pain. Its practice is founded on clinical nursing reasoning, which targets the health problem and the therapeutic objectives guiding the hypnosis session. A clinical assessment finalises the interactional process. Copyright © 2017 Elsevier Masson SAS. All rights reserved.
Davoodvand, Shirmohammad; Abbaszadeh, Abbas; Ahmadi, Fazlollah
One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. The nurses worked in intensive care units (ICUs), coronary care units (CCUs), and emergency units. The study participants were selected via purposeful sampling. The data was collected through semi-structured interviews and analyzed using content analysis. Data analysis showed that patient advocacy consisted of the two themes of empathy with the patient (including understanding, being sympathetic with, and feeling close to the patient) and protecting the patients (including patient care, prioritization of patients' health, commitment to the completion of the care process, and protection of patients' rights). The results of this study suggest that nurses must be empathetic toward and protective of their patients. The results of the present study can be used in health care delivery, nursing education, and nursing management and planning systems to help nurses accomplish their important role as patient advocates. It is necessary to further study the connections between patient advocacy and empathy.
Rosted, Elizabeth Emilie; Wagner, Lis; Hendriksen, Carsten
To describe and test a model for structured nursing assessment and intervention to older people discharged from emergency department (ED). Background. Older people recently discharged from hospital are at high risk of readmission. This risk may increase when they are discharged straight home from...... assessment, the nurse made relevant referrals to the geriatric outpatient clinic, community health centre, general practitioner or made arrangements with next of kin. Results. One hundred and fifty people participated, mean age was 81.7. At discharge, they had a mean of 1.9 unresolved problems, after 1 month...
Sherman, Rose; Dyess, Susan; Hannah, Ed; Prestia, Angela
A global nursing leadership shortage is projected by the end of this decade. There is an urgent need to begin developing emerging nurse leaders now. This article describes the work of an academic-practice partnership collaborative of nurse leaders. The goal of the partnership is to develop and promote an innovative enhanced nursing administration master's program targeted to young emerging nurse leaders, who have not yet moved into formal leadership roles. An action research design is being used in program development and evaluation. Qualities needed by emerging leaders identified through research included a need to be politically astute, competency with business skills required of nurse leaders today, comfort with ambiguity, use of a caring approach, and leadership from a posture of innovation. The current curriculum was revised to include clinical immersion with a nurse leader from the first semester in the program, a change from all online to online/hybrid courses, innovative assignments, and a strong mentorship component. Eighteen young emerging nurse leaders began the program in January 2012. Early outcomes are positive. The emerging nurse leaders may be uniquely positioned, given the right skills sets, to be nurse leaders in the new age.
Full Text Available M Lindell Joseph, Diane L Huber College of Nursing, The University of Iowa, Iowa City, IA, USA Abstract: With the implementation of the Affordable Care Act, elevated roles for nurses of care coordinator, clinical nurse leader, and advanced practice registered nurse have come to the forefront. Because change occurs so fast, matching development and education to job requirements is a challenging forecasting endeavor. The purpose of this article is to envision clinical leadership development and education opportunities for three emerging roles. The adoption of a common framework for intentional leadership development is proposed for clinical leadership development across the continuum of care. Solutions of innovation and interdependency are framed as core concepts that serve as an opportunity to better inform clinical leadership development and education. Additionally, strategies are proposed to advance knowledge, skills, and abilities for crucial implementation of improvements and new solutions at the point of care. Keywords: clinical leadership, nursing leadership, CNL, care coordination, innovation, interdependency
Abou-ElWafa, Hala Samir; El-Gilany, Abdel-Hady; Abd-El-Raouf, Samar E; Abd-Elmouty, Samia Mahmoud; El-Sayed, Rabab El-Sayed Hassan
Workplace violence (WPV) against nurses is a common but neglected problem in Egypt. The objectives are to estimate the prevalence and associated risk factors of different types of violence against nurses working in the emergency hospital compared with those working in non-emergency clinics, circumstances of violence, type of perpetrators, and victims' response. This cross-sectional comparative study was carried out at Mansoura University Hospitals, Egypt, during January 2013. The data were collected through the adapted version of a self-administered questionnaire developed by the International Labor Office/International Council of Nurses/World Health Organization/Public Services International on WPV in the health sector. All types of WPV are common among nurses. Precipitating factors for violent incidents identified by respondents are emergency specialty, having work shift, and younger age. Violent incidents result in work dissatisfaction and consequently impair work productivity. Nurses working in emergency hospital experienced a higher level of different types of WPV. There is an urgent need to formulate and implement a policy for dealing with violent events. © The Author(s) 2014.
Siller, Jennifer; Dolansky, Mary A; Clavelle, Joanne T; Fitzpatrick, Joyce J
Lack of work engagement in emergency nurses has been linked to increased job turnover, burnout, and lack of job satisfaction. Shared governance is a vehicle that can be used by emergency nursing leaders to increase work engagement among emergency nurses. Research is lacking about the relationship between perceptions of shared governance and work engagement in emergency nurses. In this study we examined the relationship between ED nurses' perceptions of shared governance and work engagement. A descriptive correlation design was used with a convenience sample of 43 emergency nurses recruited through the ENA Web site. Participants completed a demographic questionnaire, the Index of Professional Nursing Governance Tool, and the Utrecht Work Engagement Scale. The mean total work engagement score indicated average engagement (M = 4.4, standard deviation = 1.2). A significant positive relationship was found between shared governance and work engagement, indicating that as perceptions of shared governance increase, work engagement increases (r (41) = 0.62, P emergency nurses. Understanding the relationship between perceptions of shared governance and work engagement in emergency nurses may assist emergency nursing leaders in developing and testing interventions to enhance it. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Temmink, Denise; Hutten, Jack B.F.; Francke, Anneke L.; Rasker, Johannes J.; Abu-Saad, Huda Huijer
Objectives: Transmural rheumatology nurse clinics, where nursing care is provided under the joint responsibility of a home care organization and a hospital, were recently introduced into Dutch health care. This article gives insight into outcomes of the transmural rheumatology nurse clinics. -
Temmink, D.; Hutten, J.B.F.; Francke, A.L.; Rasker, J.J.; Huijer Abu-Saad, H.; Zee, J. van der
Objectives: "Transmural rheumatology nurse clinics," where nursing care is provided under the joint responsibility of a home care organization and a hospital, were recently introduced into Dutch health care. This article gives insight into outcomes of the transmural rheumatology nurse clinics.
Higher cognitive skills are essential competencies for nurses joining the technologically and increasingly complex health care environment to provide safe and effective nursing care. Educators and clinical facilitators have recognised that newly qualified nurses do not meet the expectations for entry level clinical judgement ...
What is your job? I am a clinical development specialist at Hasbro Children's Hospital, the paediatric division of Rhode Island Hospital in Providence, US. I educate and mentor new graduate nurses from the paediatric emergency department (ED) and inpatient areas.
Georges, Jane M
This philosophical article posits that an emerging theme in contemporary nursing epistemology is bio-power and proposes the use of philosopher Giorgio Agamben's perspectives as a useful approach for the future investigation of bio-power in nursing knowledge. Building upon Meleis' characterization of diversity as the most recent "milestone" of contemporary theoretical development of the nursing discipline, selected recent texts from the nursing literature are analyzed, and implications for future nursing knowledge in the context of Agamben's work are explored.
Dominguez-Gomez, Elvira; Rutledge, Dana N
Emergency nurses often care for persons exposed to traumatic events. In the presence of empathetic caring, nurses exposed to such stressors over time can suffer from Secondary Traumatic Stress (STS), or Compassion Fatigue (CF). STS symptoms (intrusion, avoidance, and arousal) may lead to job dissatisfaction or burnout. The purpose of this study is to investigate the prevalence of STS in emergency nurses. Exploratory comparative design, with 67 emergency nurses from three general community hospitals in California. Survey instruments included a demographic tool and the STS Survey (STSS). Nurses were most likely to have Arousal symptoms (irritability reported by 54% of nurses), followed by Avoidance symptoms (avoidance of patients 52%), and Intrusion symptoms (intrusive thoughts about patients 46%). The majority of nurses (85%) reported at least one symptom in the past week. Utilizing Bride's algorithm to identify STS, 15% of nurses met no criteria, while 33% met all. Nurse participation in stress management activities was associated with less prevalence of STS symptoms. High prevalence of STS in our sample indicates that potentially large numbers of emergency nurses may be experiencing the negative effects of STS. Symptoms may contribute to emotional exhaustion and job separation of emergency nurses. Subsequent studies should be done to evaluate the association of CF/STS on actual burnout and attrition among emergency nurses.
In the UK 127,000 people are diagnosed with Parkinson's disease, many of whom are frequently admited to hospital. However, Parkinson's disease is not usually the primary cause of admission. Emergency department (ED) nurses must be aware of the medication needs of people with Parkinson's disease and how these can be met in emergency setings to ensure the stability of their condition and to prevent the development of neuroleptic malignant syndrome, a potentially fatal condition caused by abrupt omission of Parkinson's medication. This article highlights the importance of ensuring that patients with Parkinson's disease continue their medication regimen while in an ED, even if they are temporarily unable to swallow, and uses a case study to illustrate various ways of achieving this. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.
The Emergency Nurse Practitioner (ENP) role has become established over the last two decades within emergency care. This role has developed to meet the rising demands of healthcare, combat the continuing medical workforce shortfall and address targets around healthcare delivery within emergency care. The ENP role has been widely evaluated in terms of patient satisfaction, safety and outcome. To date there is no published literature exploring what drives senior nurses to undertake this role which involves additional clinical responsibility and educational preparation for no increase in pay. This research seeks to explore how Emergency Nurse Practitioners view their role within the Emergency Department and Emergency Care Team. A qualitative approach was utilised in order to gain greater in-depth understanding of ENPs' perspectives. A purposive sample of eight ENPs was chosen and semi-structured interviews were digitally recorded. The transcribed interviews were subjected to thematic analysis to look for any recurrent themes. Following analysis of the data, four main themes emerged with a total of eight sub themes. The findings suggested that whilst the role had been accepted amongst doctors within the ED, there was still a lack of understanding of the role outside the ED and conflict still existed amongst junior nurses. ENPs were motivated to undertake the role in order to gain greater job satisfaction. The findings also highlighted the concerns regarding financial remuneration for the role, lack of standardisation of the role and educational preparation. The study concludes that education has a key role in the development and acceptance of the role and that ENPs are disappointed with the lack of financial remuneration for the role. Copyright © 2015 Elsevier Ltd. All rights reserved.
In this study the question asked is: what clinical nursing skills are predominantly used in intellectual disability nursing? A survey of the nursing needs of people with moderate to severe intellectual disability in both residential and community units was undertaken with a questionnaire.The measure was a Likert design scale ranging across: skills used more than once a day, skills used daily, skills used weekly, skills used monthly, skills very rarely used, and skills never used.The results o...
Caramanica, Laura; Spiva, LeeAnna
The study identifies what constitutes nurse manager (NM) support and other resources that enable clinical nurses (CNs) to engage in evidence-based practice (EBP). Clinical nurses report that NM support enables them to use EBP but what constitutes NM support is still unclear. Nurse managers, CNs, and EBP mentors received specialized education and use a team approach for EBP. Data were collected preintervention, mid-intervention, and postintervention from observations, interviews, journaling, and surveys. Results demonstrate how NMs can perform their role responsibilities and still engage CNs to develop a spirit of inquiry, seek answers to their clinical questions using EBP, and advance their clinical performance to improve patient outcomes. Four NM supportive behaviors emerged: cultivating a shared EBP vision, ensuring use of EBP, communicating the value of EBP, and providing resources for EBP. Through education and support, NMs describe supportive behaviors necessary for the successful conduction of EBP by CNs.
Oermann, Marilyn H; Nordstrom, Cheryl K; Wilmes, Nancy A; Denison, Doris; Webb, Sue A; Featherston, Diane E; Bednarz, Hedi; Striz, Penelope; Blair, Darlene A; Kowalewski, Kathleen
The purposes of the study were to describe the extent of research, clinical and evidence-based practice articles published in clinical nursing journals and to explore the communication of research and practice knowledge in the clinical nursing literature using citation analysis. For nursing research to have an impact on clinical practice and build evidence for practice, findings from research must transfer into the clinical practice literature. By analysing the extent of research published in clinical nursing journals, the citations in those articles, and other characteristics of the nursing literature, we can learn more about the linkages between research and practice in nursing. This was a descriptive study of 768 articles and 18901 citations in those articles. Feature articles were classified into four groups - (i) original research reports; (ii) clinical practice articles (non-data based papers on a clinical topic); (iii) systematic reviews, integrative literature reviews, guidelines and papers describing evidence-based practice; and (iv) others. Each citation was then examined to determine if it was a reference to a research study or to a document on clinical practice. Nearly a third of the articles in clinical nursing journals were reports on research studies; another third addressed clinical practice. Of the 14232 citations analysed in clinical nursing journals, 6142 were to research reports (43.2%) and about the same number of citations were to clinical documents (n = 5844, 41.1%). Medical research articles were cited most frequently - 27.1% of the citations in clinical journal articles. Nursing research articles were only 7.6% of the cited documents in clinical publications. Dissemination of research findings in the clinical nursing literature occurred at two levels: through articles that reported studies of potential value to the nurse's practice and citations to research publications within articles. Relevance to clinical practice. Disseminating research
Akamine, Itsuko; Uza, Miyoko; Shinjo, Masaki; Nakamori, Eri
The aim of this study was to develop a new scale, the Competence Scale for Senior Clinical Nurses (CS-SCN), to assess and evaluate senior clinical nurses in hospitals, and to confirm the validity and reliability of the scale. A cross-sectional questionnaire survey was undertaken at a hospital in Japan, using an anonymous self-administered questionnaire administered to clinical nurses (n=374). A useable sample of 218 was achieved, which was used in the analysis. Statistical analysis examined exploratory/confirmatory factor analysis, internal consistency, and construct validity. A five factor solution with 22 items was extracted for nursing competence in senior clinical nurses, which was the interpretable questionnaire. In the confirmatory factor analysis, the indices of fitness supported these results. Cronbach's alpha coefficient was 0.93 for the total score and varied between 0.63 and 0.90 in the five factors. Five factors emerged from an oblique factor analysis, with a cumulative variance of 66.7%: "role accomplishment"; "self-management"; "research"; "practice and coordination"; and "work implementation". The five factors had only a moderate correlation (0.30-0.77, Pcompetence of senior clinical nurses, was developed. Results suggest initial support for the new instrument as a measure of competence of senior clinical nurses, but it must be further refined, tested, and evaluated. Both the validity and reliability of the scale were verified. Future studies using the CS-SCN might lead to improvement in the competence of senior clinical nurses. © 2012 The Authors. Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science.
Sawatzky, Jo-Ann V; Enns, Carol L
To explore the factors that predict the retention of nurses working in emergency departments. The escalating shortage of nurses is one of the most critical issues facing specialty areas, such as the emergency department. Therefore, it is important to identify the key influencing and intermediary factors that affect emergency department nurses' intention to leave. As part of a larger study, a cross-sectional survey was completed by 261 registered nurses working in the 12 designated emergency departments within rural, urban community and tertiary hospitals in Manitoba, Canada. Twenty-six per cent of the respondents will probably/definitely leave their current emergency department jobs within the next year. Engagement was the key predictor of intention to leave (P job satisfaction, compassion satisfaction, compassion fatigue, and burnout (P nursing management, professional practice, collaboration with physicians, staffing resources and shift work emerged as significant influencing factors for engagement. Engagement plays a central role in emergency department nurses intention to leave. Addressing the factors that influence engagement may reduce emergency department nurses' intention to leave. This study highlights the value of research-based evidence as the foundation for developing innovative strategies for the retention of emergency department nurses. © 2012 Blackwell Publishing Ltd.
Many patients admitted to emergency departments (EDs) require therapy delivered by cannula. Mid-Western Regional Hospital, Tipperary, used to run a system in which many patients had to endure two invasive procedures: on arrival their blood was taken by nurses and later they were cannulated by doctors. To reduce the number of procedures, ED nurses initiated a project to extend their skills to include cannulation. The new system of nurse cannulation at triage has also helped reduce waiting times.
Jennings, Natasha; Gardner, Glenn; O'Reilly, Gerard
To evaluate emergency nurse practitioner service effectiveness on outcomes related to quality of care and service responsiveness. Increasing service pressures in the emergency setting have resulted in the adoption of service innovation models; the most common and rapidly expanding of these is the emergency nurse practitioner. The delivery of high quality patient care in the emergency department is one of the most important service indicators to be measured in health services today. The rapid uptake of emergency nurse practitioner service in Australia has outpaced the capacity to evaluate this model in outcomes related to safety and quality of patient care. Pragmatic randomized controlled trial at one site with 260 participants. This protocol describes a definitive prospective randomized controlled trial, which will examine the impact of emergency nurse practitioner service on key patient care and service indicators. The study control will be standard emergency department care. The intervention will be emergency nurse practitioner service. The primary outcome measure is pain score reduction and time to analgesia. Secondary outcome measures are waiting time, number of patients who did not wait, length of stay in the emergency department and representations within 48 hours. Scant research enquiry evaluating emergency nurse practitioner service on patient effectiveness and service responsiveness exists currently. This study is a unique trial that will test the effectiveness of the emergency nurse practitioner service on patients who present to the emergency department with pain. The research will provide an opportunity to further evaluate emergency nurse practitioner models of care and build research capacity into the workforce. Trial registration details: Australian and New Zealand Clinical Trials Registry dated 18th August 2013, ACTRN12613000933752. © 2014 John Wiley & Sons Ltd.
Govranos, Melissa; Newton, Jennifer M
Health care systems demand that nurses are flexible skilful workers who maintain currency and competency in order to deliver safe effective patient centered care. Nurses must continually build best practice into their care and acquire lifelong learning. Often this learning is acquired within the work environment and is facilitated by the clinical nurse educator. Understanding clinical nurses' values and needs of continuing education is necessary to ensure appropriate education service delivery and thus enhance patient care. To explore clinical ward-based nurses' values and perceptions towards continuing education and what factors impact on continuing education in the ward. A case study approach was utilized. A major teaching hospital in Melbourne, Australia. A range of clinical nursing staff (n=23). Four focus groups and six semi-structured individual interviews were undertaken. Focus group interviews explored participants' values and perceptions on continuing education through a values clarification tool. Thematic analysis of interviews was undertaken to identify themes and cluster data. Three central themes: 'culture and attitudes', 'what is learning?' and 'being there-being seen', emerged reflecting staffs' values and perceptions of education and learning in the workplace. Multiple factors influence ward nurses' ability and motivation to incorporate lifelong learning into their practice. Despite variance in nurses' values and perceptions of CE in clinical environments, CE was perceived as important. Nurses yearned for changes to facilitate lifelong learning and cultivate a learning culture. Clinical nurse educators need to be cognizant of adult learners' characteristics such as values, beliefs, needs and potential barriers, to effectively facilitate support in a challenging and complex learning environment. Organizational support is essential so ward managers in conjunction with educational departments can promote and sustain continuing education, lifelong
Burchill, Christian N; Polomano, Rosemary
Regimented vital signs (VS) assessment for all emergency patients is a common practice in many US emergency departments despite the paucity of evidence supporting its utility. Nurse attitude may be a factor that maintains this ritualized practice. Understanding the relationship between attitudes, practices, and nurse demographic factors may be the first step to challenging this ritual in order to implement evidence-based practices. A 20-item questionnaire was developed to assess emergency nurse attitudes and practices related to VS. A convenience sample of emergency nurses from the mid-Atlantic region of the United States was used. Eighty-one emergency nurses participated. Results demonstrated wide variations in VS practice and attitudes, though some strongly held attitudes are inconsistent with the literature. Certification in emergency nursing had significant associations with beliefs that nurses' clinical judgment should be the determinant for VS frequency (p nurse attitudes and practices of VS so that evidence-based changes can be implemented and further research on VS frequency conducted. It also demonstrates the relationship between specialty certification and evidence-supported attitudes and practices. Copyright © 2015 Elsevier Ltd. All rights reserved.
da Silva, Rafael Celestino; Ferreira, Márcia de Assunção; Apostolidis, Thémistoklis; Brandão, Marcos Antônio Gomes
to propose a conceptual framework for clinical nursing care in intensive care. descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks. the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.
Rafael Celestino da Silva
Full Text Available Objective: to propose a conceptual framework for clinical nursing care in intensive care.Method: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software.Results: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nurses characteristic of the intensive care and care frameworks.Conclusion: the conceptual framework of the clinic's intensive care articulates elements characteristic of the dynamics of this scenario: objective elements regarding technology and attention to equipment and subjective elements related to human interaction, specific of nursing care, countering criticism based on dehumanization.
Hu, Yi-Chun; Chen, Jih-Chang; Chiu, Hsiao-Ting; Shen, Hsi-Che; Chang, Wen-Yin
(1) To understand nurses' subjective perceptions of the current nursing workforce in their emergency departments, (2) to examine the relationship between nurses' workforce perceptions and its impact on the managerial outcomes and (3) to analyse the correlation between nurses' characteristics and the scores on workforce perception. While the association between workforce perceptions and nurse outcomes is well-documented, few studies have examined how emergency department nurses perceive current workforce and related outcomes. A cross-sectional questionnaire survey. A self-reported workforce perception questionnaire was used to survey 538 registered nurses in the emergency departments of 19 hospitals in northern Taiwan, during May to October 2006. Data were analysed using descriptive statistics, chi-square test, independent t-test, Pearson correlation and one-way anova. The mean score of workforce perception was 6.28 points (total = 10 points). Both overtime (p = 0.02) and number of callbacks on days off (p = 0.01) were significantly correlated to current nursing workforce and hospital level. Older nurses tended to have more emergency department experience (r = 0.37; p = 0.01) and those with more emergency department experience tended to have vacation accumulation (r = 0.09; p = 0.04), overtime (r = 0.10; p = 0.03) and better perception of their emergency department's current workforce (r = 0.09; p = 0.05). Although nurses' perceptions were found to be only moderate, overtime and number of callbacks on days off are potential problems that should be addressed by nursing leaders to benefit future emergency nurses. The findings can help drive strategies to ensure adequate staffing, to stabilise the nursing workforce and to prevent nurses from burnout factors such as working long hours, unpredictable schedules and a stressful work environment that may impact both the quality of emergency care and the quality of the nurses' work environment.
Fontes, Honore Culleton
The nursing faculty at Mercy College (New York) affiliated with several prison facilities to provide clinical experiences for senior nursing students. An ideal setting for the clinical group leadership course, the prison affiliations also helped students develop social awareness and advocacy strategies for this at-risk population. (SK)
Lin, Chiou-Fen; Kao, Ching-Chiu
The significant changes in nursing manpower utilization in Taiwan over the past two decades are due in large part to the implementation of the National Health Insurance program and the rising need for long-term care. The changes have impacted clinical nursing manpower utilization in two important ways. Firstly, there has been a substantial increase in overall demand for nursing manpower. In particular, the need for clinical nurses has nearly quadrupled during this time period. Secondly, the level of difficulty involved in patient care has risen dramatically, with factors including increased disease severity and increased care quality expectations, among others. These changes, coupled with demands on nursing manpower imposed from other sectors, underpin and further exacerbate the problem of nursing manpower shortages throughout the healthcare system. To raise the quality of the nursing work environment, the Ministry of Health and Welfare (MOHW) brought together Taiwan's key professional nursing organizations to promote 10 care-reform strategies, establish the nursing-aid manpower system, and create the nursing classification system as an approach to effectively attract nurses to take positions in the medical system.
Heidari, Mohammad Reza; Norouzadeh, Reza
The importance of optimal clinical nursing education in professional skills development is undeniable. In clinical education, nursing students are often faced with problems. Recognizing nursing students' perception on clinical education is the first step to remove the barriers of this challenge. Methods This descriptive cross-sectional study was conducted to determine the nursing students' perspectives on clinical education. 150 nursing students were selected randomly from nursing and midwifery schools (Tehran). Data collection instrument was a researcher made questionnaire consisting of five domains: objective and curricula, instructor, feedback to student in clinical field, clinical environment, supervision and evaluation. Mean and standard deviation were calculated for each item, using SPSS, ver.14. Chi- square test was used to compare the nursing students' perspectives on clinical education based on age, sex and the work experience. The significance level was considered 0.05. Mean age of the students was 21.58±26.97 students (66%) were male. 44 students (30.1%) had work experience (3.58±6.48 month). Male and female students had different perceptions in domains of clinical education (p<0.05). Nursing student had different perceptions as to objectives and curricula (p=0.039), how to deal with students in the clinical environment (p=0.032), supervision, and evaluation (p<0.001) with respect to their work experience duration. The most positive responses were in clinical instructor (81.5%) and the most negative ones were the clinical environment (33.66%), respectively. Providing an optimal clinical environment and improving the supervision and evaluation of student practice should prioritized in schools of nursing and midwifery.
MOHAMMAD REZA HEIDARI
Full Text Available Introduction: The importance of optimal clinical nursing education in professional skills development is undeniable. In clinical education, nursing students are often faced with problems. Recognizing nursing students’ perception on clinical education is the first step to remove the barriers of this challenge. Methods: This descriptive cross-sectional study was conducted to determine the nursing students’ perspectives on clinical education. 150 nursing students were selected randomly from nursing and midwifery schools (Tehran. Data collection instrument was a researcher made questionnaire consisting of five domains: objective and curricula, instructor, feedback to student in clinical field, clinical environment, supervision and evaluation. Mean and standard deviation were calculated for each item, using SPSS, ver. 14. Chi-square test was used to compare the nursing students’ perspectives on clinical education based on age, sex and the work experience. The significance level was considered 0.05. Results: Mean age of the students was 21.58±26.97 students (66% were male. 44 students (30.1% had work experience (3.58±6.48 month. Male and female students had different perceptions in domains of clinical education (p<0.05. Nursing student had different perceptions as to objectives and curricula (p=0.039, how to deal with students in the clinical environment (p=0.032, supervision, and evaluation (p<0.001 with respect to their work experience duration. The most positive responses were in clinical instructor (81.5% and the most negative ones were the clinical environment (33.66%, respectively. Conclusion: Providing an optimal clinical environment and improving the supervision and evaluation of student practice should prioritized in schools of nursing and midwifery.
Van Osch, Mary; Scarborough, Kathy; Crowe, Sarah; Wolff, Angela C; Reimer-Kirkham, Sheryl
To explore the influential factors and strategies that promote an experienced nurse's intent to stay in their emergency or critical care area. Turnover among registered nurses (herein referred to as nurses) working in specialty areas of practice can result in a range of negative outcomes. The retention of specialty nurses at the unit level has important implications for hospital and health systems. These implications include lost knowledge and experience which may in turn impact staff performance levels, patient outcomes, hiring, orientating, development of clinical competence and other aspects of organizational performance. This qualitative study used an interpretive descriptive design to understand nurses' perceptions of the current factors and strategies that promote them staying in emergency or critical care settings for two or more years. Focus groups were conducted with 13 emergency and critical care nurses. Data analysis involved thematic analysis that evolved from codes to categories to themes. Four themes were identified: leadership, interprofessional relationships, job fit and practice environment. In addition, the ideas of feeling valued, respected and acknowledged were woven throughout. Factors often associated with nurse attrition such as burnout and job stresses were not emphasised by the respondents in our study as critical to their intent to stay in their area of practice. This study has highlighted positive aspects that motivate nurses to stay in their specialty areas. To ensure quality care for patients, retention of experienced emergency and critical care nurses is essential to maintaining specialty expertise in these practice settings. © 2017 John Wiley & Sons Ltd.
Considine, Julie; Lucas, Elspeth; Martin, Roslyn; Stergiou, Helen E; Kropman, Matthew; Chiu, Herman
The impact of emergency nursing roles in demand management systems is poorly understood. The aim of this study was to evaluate emergency nurses' role in a specific emergency department (ED) demand management system: rapid intervention and treatment zone (RITZ). A descriptive exploratory approach was used. Data were collected from audit of 193 randomly selected patient records and 12 h of clinical practice observation. The median age of participants was 31 years, 51.8% were males and 99.5% were discharged home. Nurse qualifications or seniority had no significant effect on waiting time or length of stay (LOS). There were disparities between documented and observed nursing practice. The designation and qualifications of RITZ nurses made little difference to waiting times and ED LOS. Specific documentation and communication systems for areas of the ED that manage large numbers of low complexity patients warrant further research. © 2012 Blackwell Publishing Asia Pty Ltd.
Knowles, Amy J. B.
Ethics is an integral component of the nursing profession. This phenomenological study aimed to describe how baccalaureate nursing students experience learning ethics both in the classroom and clinical setting. The interviews in this study were conducted with eight second semester senior nursing students. Four themes emerged from analyses of the…
Ailey, Sarah; Lamb, Karen; Friese, Tanya; Christopher, Beth-Anne
One of the goals of nursing education is to develop caring and responsible nurses with clinical reasoning skills who are capable of improving outcomes in complex healthcare systems. Using the Model of Situated Learning in Nursing Leadership, generalist entry graduate nursing students at Rush University in Chicago, part of a large academic medical centre with Magnet recognition for excellence in nursing practice, are educated using a curriculum based on the clinical nurse leader (CNL) competencies. This article presents a case study that demonstrates how the model is used to provide experiences for learning the CNL role. The students learn leadership in practice through their involvement in ongoing efforts at the medical centre to improve the care of patients with intellectual and developmental disabilities. The case study provides lessons in teaching CNL leadership competencies through efforts to improve the quality of care for an at-risk group of patients.
Linnarsson, Josefin Rahmqvist; Benzein, Eva; Årestedt, Kristofer
To describe Nurses' views of forensic care provided for victims of violence and their families in EDs, to identify factors associated with Nurses' attitudes towards families in care and to investigate if these attitudes were associated with the involvement of patients' families in care. Interpersonal violence has serious health consequences for individuals and family members. Emergency departments provide care for victims of violence, and nurses play a key role in forensic care. However, there is limited knowledge of their views and their involvement of family members. A cross-sectional design was used with a sample of all registered nurses (n = 867) in 28 emergency departments in Sweden. A self-report questionnaire, including the instrument Families' Importance in Nursing Care - Nurses' Attitudes, was used to collect data. Descriptive statistics, multiple linear regression and ordinal regression were used to analyse data. Four hundred and fifty-seven nurses completed the questionnaire (53%). Most nurses provided forensic care, but few had specific education for this task. Policy documents and routines existed for specific patient groups. Most nurses involved family members in care although education and policy documents rarely included them. Being a woman, policy documents and own experience of a critically ill family member were associated with a positive attitude towards family. A positive attitude towards family members was associated with involving patients' families in care. Many emergency department nurses provided forensic care without having specific education, and policy documents only concerned women and children. Nurses' positive attitude to family members was not reflected in policies or education. These results can inspire clinical forensic care interventions in emergency departments. Educational efforts for nurses and policies for all groups of victims of violence are needed. Emergency departments may need to rethink how family members are included
Davoodvand, Shirmohammad; Abbaszadeh, Abbas; Ahmadi, Fazlollah
One of the advanced nursing care procedures emphasized by nursing organizations around the world is patient or nursing advocacy. In addition to illustrating the professional power of nursing, it helps to provide effective nursing care. The aim of the present study was to explain the concept of patient advocacy from the perspective of Iranian clinical nurses. This was a qualitative study that examined the viewpoint and experiences of 15 clinical nurses regarding patient advocacy in nursing. Th...
Clinical research nursing is becoming more visible to nephrology professionals. As more nephrology practices and units are participating in clinical trials, clinical research nursing is gaining interest as a career niche among nephrology nurses. This unique specialty requires that nephrology clinical nurse nurses (CRNs) reconcile the roles of nurse as caregiver and nurse as researcher, which may result in a role conflict. Nephrology nurses should be aware that they may experience this role conflict when transitioning from patient care to a position as a clinical research nurse. These nurses can rely on the American Nurses Association's Code of Ethics for Nurses and the Oncology Nursing Society's Oncology Clinical Trials Nurse Competencies to help reconcile the potential role conflict.
Roberta Juliane Tono de Oliveira
Full Text Available Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Conclusion. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.
Tono de Oliveira, Roberta Juliane; Vieira Hermida, Patrícia Madalena; da Silva Copelli, Fernanda Hannah; Guedes Dos Santos, José Luís; Lorenzini Erdmann, Alacoque; Regina de Andrade, Selma
Understand the conditions involved in the management of nursing care in emergency care units. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency services; inadequate number of professionals; work overload of emergency care units in the urgent care network; difficulty in implementing nursing care systematization, and need for team meetings. Facilitating factors are: teamwork; importance of professionals; and confidence of the nursing technicians in the presence of the nurse. Whereas the hindering factors in care management are related to the organizational aspects of the emergency care units in the urgency care network, the facilitating ones include specific aspects of teamwork.
nurses should be based on: “educational and experiential background, technical and clinical competence, leadership skills , critical thinking skills ...aeromedical evacuation squadron, military flight nurses have limited opportunities to maintain their clinical skills . This results in attempting to...method to improve the clinical skills of military flight nurses . 1 INTRODUCTION A lack of registered nurses has plagued the nursing profession
A study involving 300 nursing students, 155 nurse practitioners, and 80 assessors tested a model of responsive assessment that includes identification of learning needs and potential, assignment to suitable placements, continuous assessment of clinical practice and patient care, and alignment of teaching and assessment with patient needs and…
Mohr, Lynn D; Coke, Lola A
Today's healthcare environment poses diverse and complex patient care challenges and requires a highly qualified and experienced nursing workforce. To mitigate these challenges are graduate nursing roles, each with a different set of competencies and expertise. With the availability of many different graduate nursing roles, both patients and healthcare professionals can be confused in understanding the benefit of each role. To gain the maximum benefit from each role, it is important that healthcare providers and administrators are able to distinguish the uniqueness of each role to best use the role and develop strategies for effective collaboration and interprofessional interaction. The purpose of this article was to define the role, educational preparation, role differences, and practice competencies for the clinical nurse specialist (CNS), nurse practitioner, clinical nurse leader, and nurse educator/staff development educator roles. A second purpose was to provide role clarity and demonstrate the unique value the CNS brings to the healthcare environment. Using evidence and reviewing role competencies established by varying organizations, each role is presented with similarities and differences among the roles discussed. In addition, collaboration among the identified roles was reviewed, and recommendations were provided for the new and practicing CNSs. Although there are some similarities among the graduate nursing roles such as in educational, licensing, and certification requirements, each role must be understood to gain the full role scope and benefit and glean the anticipated outcomes. Healthcare providers must be aware of the differences in graduate nursing roles, especially in comparing the CNS with other roles to avoid confusion that may lead to roles being underused with a limited job scope. The CNS provides a unique set of services at all system outcome levels and is an essential part of the healthcare team especially in the acute care setting.
Baugh, Nancy G.; Mellott, Karen G.
Clinical concept mapping promotes critical thinking and prepares nursing students for clinical experience by helping them organize patient data and view patients holistically. It aids their assessment of what they know and what they still need to learn. (SK)
Anna C. van Graan
The findings emphasized clinical judgement as skill within the clinical nursing environment, thereby improving autonomous and accountable nursing care. These findings will assist nurse leaders and clinical nurse educators in developing a teaching-learning strategy to promote clinical judgement in undergraduate nursing students, thereby contributing to the quality of nursing care.
Lambe, Katherine; Currey, Judy; Considine, Julie
To explore the factors emergency nurses use to inform their decisions regarding frequency and nature of vital sign assessment. Research related to clinical deterioration and vital sign assessment in the emergency department is in its infancy. Studies to date have explored the frequency of vital sign assessment in the emergency department; however, there are no published studies that have examined factors that emergency nurses use to inform their decisions regarding frequency and nature of ongoing vital sign assessment. A prospective exploratory design was used. Data were collected using a survey consisting of eight patient vignettes. The study was conducted in one emergency department in metropolitan Melbourne. Participants were emergency nurses permanently employed at the study site. A 96% response rate was achieved (n = 47/49). The most common frequency of patient reassessment nominated by participants was 15 or 30 minutely, with an equal number of participants choosing these frequency intervals. Abnormality in initial vital sign parameters was the most common factor identified for choosing either a 15- or 30-minute assessment interval. Frequency of assessment decisions was influenced by years of emergency nursing experience in one vignette and level of postgraduate qualification in three vignettes. Heart rate, respiratory rate and blood pressure were all nominated by over 80% of participants as vital signs that participants considered important for reassessment. The frequency and nature of vital signs selected varied according to vignette content. There were significant negative correlations between assessment of conscious state and years of nursing experience and assessment of respiratory rate and years of emergency nursing experience. Level of postgraduate qualification did not influence selection of parameters for reassessment. Emergency nurses are tailoring vital sign assessment to patients' clinical status, and nurses are integrating known vital sign data
Jiang, Jinxia; Zeng, Li; Kue, Jennifer; Li, Hong; Shi, Yan; Chen, Cuiping
Millennial nursing students are different from generations before especially with the rapid development of China's economy, their varieties of characteristics affect the clinical teaching and learning. But how their learning preference impact their learning outcomes remain unclear. The aim of this study is to explore effective teaching methods in the emergency department from the perspective of Millennial nursing students in Shanghai, China. One of the main objectives is to provide valuable information to help nursing programs in China to effectively educate Millennial students to deliver patient-centered care and to meet medical changes according to Chinese healthcare reform. Qualitative study design was used and semistructured interviews were conducted in a purposive sample of 16 nursing students from six colleges of nursing and five nursing high schools in Shanghai. They are from eight geographical areas across China and have a clinical practice in the teaching hospital. Colaizzi seven-step framework was applied for data analysis. Three themes were emerged including: demonstrating harmonious faculty-student relationship, possessing professional competence and being empathetic for teaching. The findings of this study provide valuable information for promoting the clinical teaching quality in China. It is crucial to put more emphasis on demonstrating harmonious faculty-student relationship, rendering Millennial students more caring behavior, possessing sufficient competence in both knowledge and skills, and taking full advantage of technology in clinical teaching. The results of this study are relevant to envision the future training of clinical nursing teachers. Copyright © 2017 Elsevier Ltd. All rights reserved.
traumatic incidents,3 although Burns and Harm found that debriefings were definitely helpful to emergency nurses.4. Particularly nurses who were inexpe- rienced benefited from a debriefing ... Critical-incident stress debriefing is a specific model of ... of the resuscitation technique could be discussed, for example, as could ...
Ramos, Mary M.; Greenberg, Cynthia; Sapien, Robert; Bauer-Creegan, Judith; Hine, Beverly; Geary, Cathy
Background: As members of interdisciplinary teams, school nurses provide behavioral health services. Studies indicate that school nurses may lack sufficient continuing education in adolescent behavioral health and in the management of behavioral health emergencies, specifically. We conducted this study to describe the adolescent behavioral health…
Purpose/aim(s): Internationally, student nurses' attrition after clinical practice is an increasing problem (Hamshire, Willgoss, & Wibberley, 2012; Pilegård Jensen, 2006). A better understanding of 'becoming a nurse' as situated practice in the hospital wards might help avoid pitfalls...... in the clinical practice. Thus a thorough insight into the field is necessary in order to change it. The purpose of this paper is to show and discuss how it is possible methodologically to do ethnographic research in clinical education and how the field of clinical nursing education in the hospital wards might...... be improved after insights obtained through ethnographic research. Methods: Using nexus analysis (Scollon & Scollon, 2004, 2007) as an ethnographic framework in four Danish hospital wards, a study of the development of a professional identity among student nurses in Denmark was conducted. Scollon and Scollon...
McHugh, Catherine; Krinsky, Rhonda; Sharma, Rahul
Emergency department overcrowding and acuity are significant challenges to patients and staff. Low-acuity patients have extended wait times, and decreased satisfaction can have a negative effect on patient flow. A multidisciplinary ED team developed and launched the first ED-based Telehealth Express Care Service, where patients who present to the emergency department with minor complaints are offered a "virtual visit" with a board-certified emergency physician located remotely. More than 6 months into the program, more than 1,300 patients have been treated. These patients experienced decreased length of stay (2.5 hours to 38 minutes) and increased satisfaction. The program is very well received by staff members who appreciate its efficiency. Telehealth has the potential to optimize ED efficiency, increase patient satisfaction, and promote safe, high-quality provision of care. Copyright © 2018 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Moore, An'Nita; Fisher, Kathleen
Healthcare information technology in US hospitals and ambulatory care centers continues to expand, and nurses are expected to effectively and efficiently utilize this technology. Researchers suggest that clinical information systems have expanded the realm of nursing to integrate technology as an element as important in nursing practice as the patient or population being served. This study sought to explore how medical surgical nurses make use of healthcare information technology in their current clinical practice and to examine the influence of healthcare information technology on nurses' clinical decision making. A total of eight medical surgical nurses participated in the study, four novice and four experienced. A conventional content analysis was utilized that allowed for a thematic interpretation of participant data. Five themes emerged: (1) healthcare information technology as a care coordination partner, (2) healthcare information technology as a change agent in the care delivery environment, (3) healthcare information technology-unable to meet all the needs, of all the people, all the time, (4) curiosity about healthcare information technology-what other bells and whistles exist, and (5) Big Brother is watching. The results of this study indicate that a new care partnership has emerged as the provision of nursing care is no longer supplied by a single practitioner but rather by a paired team, consisting of nurses and technology, working collaboratively in an interdependent relationship to achieve established goals.
Bowers, Ben; Pellett, Candice
This paper helps district nurses to understand how and why existing quality measurement tools can be used as part of everyday practice to demonstrate clinical effectiveness. We consider how productivity has historically been used to crudely indicate district nurses' clinical effectiveness and why this is now being balanced alongside a range of more robust clinical effectiveness measurement tools. Evaluating clinical effectiveness and improving future care involves examining a number of indicators alongside each other. These include patient safety indicators, patient satisfaction, productivity measurement tools, and how effective clinicians are in supporting people to achieve their best clinical outcomes.
Nelson, Scott C; Hooker, Roderick S
One role of physician assistants (PAs) and nurse practitioners (NPs) is to meet the growing demand for access to rural health care. Critical Access Hospitals, those with less than 25 beds, are usually located in rural communities, often providing continuity of care that clinics cannot deliver. Because little is known about staffing in these small hospital emergency departments, an exploratory study was undertaken using a mixed-methods approach. In Washington State, 18 of the 39 Critical Access Hospitals staff their emergency departments with PAs and NPs. Utilization data were collected through structured interviews by phone or in person on site. Most PAs and NPs lived within the community and staffing tended to be either 24 hours in-house or short notice if they lived or worked nearby. Emergency department visits ranged from 200 to 25,000 per year. All sites were designated level V or IV trauma centers and often managed cardiac events, significant injuries and, in some larger settings, obstetrics. In most instances, PAs were the sole providers in the emergency departments, albeit with physician backup and emergency medical technician support if a surge of emergency cases arose. Two-thirds of the PAs had graduated within the last 5 years. Most preferred the autonomy of the emergency department role and all expressed job satisfaction. Geographically, the more remote a Washington State Critical Access Hospital is, the more likely it will be staffed by PAs/NPs. The diverse utilization of semiautonomous PAs and NPs and their rise in rural hospital employment is a new workforce observation that requires broader investigation.
Mannix, Judy; Wilkes, Lesley; Daly, John
To explore how clinical leaders enact aesthetic leadership in clinical nursing workplaces. Clinical leadership is heralded as vital for safe and effective nursing. Different leadership styles have been applied to the clinical nursing workplace over recent years. Many of these styles lack an explicit moral dimension, instead focusing on leader qualities and developing leader competence around team building, quality and safety. Aesthetic leadership, with its explicit moral dimension, could enhance clinical leadership effectiveness and improve nursing workplaces. How aesthetic leadership is enacted in clinical nursing settings requires exploration. A qualitative design, employing conversation-style interviews with experienced registered nurses and written responses gathered from an online descriptive survey. Narrative data were gathered from interviews with 12 registered nurses and written accounts from 31 nurses who responded to an online survey. Together, transcribed interview data and the written accounts were subject to thematic analysis. Three main themes emerged: Leading by example: 'be seen in the clinical area'; Leading with composure: 'a sense of calm in a hideous shift'; and Leading through nursing values: 'create an environment just by your being'. Aesthetic leadership was shown to enhance clinical leadership activities in the nursing workplace. The capacity for clinical leaders to be self-reflective can positively influence the nursing workplace. It was apparent that clinical leader effectiveness can be enhanced with nursing values underpinning leadership activities and by being a visible, composed role model in the clinical workplace. Aesthetic leadership can enhance clinical nursing workplaces with its explicit moral purpose and strong link to nursing values. Clinical leaders who incorporate these attributes with being a visible, composed role model have the capacity to improve the working lives of nurses across a range of clinical settings. © 2015 John
Anderson, Carina; Moxham, Lorna; Broadbent, Marc
This discussion paper poses the question 'What enables or deters Registered Nurses to take up their professional responsibility to support undergraduate nursing students through the provision of clinical education?'. Embedded within many nursing standards are expectations that Registered Nurses provide support and professional development to undergraduate nursing students undertaking clinical placements. Expectations within nursing standards that Registered Nurses provide support and professional development to nursing students are important because nursing students depend on Registered Nurses to help them to become competent practitioners. Contributing factors that enable and deter Registered Nurses from fulfilling this expectation to support nursing students in their clinical learning include; workloads, preparedness for the teaching role, confidence in teaching and awareness of the competency requirement to support students. Factors exist which can enable or deter Registered Nurses from carrying out the licence requirement to provide clinical education and support to nursing students.
Ennis, Gary; Happell, Brenda; Broadbent, Marc; Reid-Searl, Kerry
Communication has been identified as an important attribute of clinical leadership in nursing. However, there is a paucity of research on its relevance in mental health nursing. This article presents the findings of a grounded theory informed study exploring the attributes and characteristics required for effective clinical leadership in mental health nursing, specifically the views of nurses working in mental health about the importance of effective communication in day to day clinical leadership. In-depth interviews were conducted to gain insight into the participants' experiences and views on clinical leadership in mental health nursing. The data that emerged from these interviews were constantly compared and reviewed, ensuring that any themes that emerged were based on the participants' own experiences and views. Participants recognized that effective communication was one of the attributes of effective clinical leadership and they considered communication as essential for successful working relationships and improved learning experiences for junior staff and students in mental health nursing. Four main themes emerged: choice of language; relationships; nonverbal communication, and listening and relevance. Participants identified that clinical leadership in mental health nursing requires effective communication skills, which enables the development of effective working relationships with others that allows them to contribute to the retention of staff, improved outcomes for clients, and the development of the profession.
Gerard, Sally; Grossman, Sheila; Godfrey, Marjorie
The scope of the clinical nurse leader (CNL) is evolving in practice across the country. The preparation of this pivotal role in a complex healthcare environment has prompted the collaboration of nurse academics, nurse administrators, and clinicians to design unique educational experiences to maximize best practice. Knowledge attained regarding healthcare improvement and patient safety must not only be theoretical, but personal and application focused. Utilizing the American Association of Colleges of Nursing's CNL white paper and published resources faculty developed a clinical leadership course focused on active learning and reflection. Students explore concepts of improvement and quality related to business models of high functioning organizations including healthcare. Three key components of the course are described in detail; "quality is personal", executive interviews and the "5P" clinical microsystems assessment. Evaluation outcomes are discussed. Course content and innovative teaching/learning strategies for CNL are shared which may support the growth of CNL program development nationally. Copyright © 2012 Elsevier Inc. All rights reserved.
Wang, Henry E.; Shah, Manish N.; Allman, Richard M.; Kilgore, Meredith
BACKGROUND/OBJECTIVES The Emergency Department (ED) is an important source of health care for nursing home residents. The objective of this study was to characterize ED use by nursing home residents in the United States (US). DESIGN Analysis of the National Hospital Ambulatory Medical Care Survey SETTING US Emergency Departments, 2005-2008 PARTICIPANTS Individuals visiting US EDs, stratified by nursing home and non-nursing home residents. INTERVENTIONS None MEASUREMENTS We identified all ED visits by nursing home residents. We contrasted the demographic and clinical characteristics between nursing home residents and non-nursing home residents. We also compared ED resource utilization, length of stay and outcomes. RESULTS During 2005-2008, nursing home residents accounted for 9,104,735 of 475,077,828 US ED visits (1.9%; 95% CI: 1.8-2.1%). The annualized number of ED visits by nursing home residents was 2,276,184. Most nursing home residents were elderly (mean 76.7 years, 95% CI: 75.8-77.5), female (63.3%), and non-Hispanic White (74.8%). Compared with non-nursing home residents, nursing home residents were more likely have been discharged from the hospital in the prior seven days (adjusted OR 1.4, 95% CI: 1.1-1.9). Nursing home residents were more likely to present with fever (adjusted OR 1.9; 95% CI: 1.5-2.4) or hypotension (systolic blood pressure ≤90 mm Hg, OR 1.8; 95% CI: 1.5-2.2). Nursing home patients were more likely to receive diagnostic test, imaging and procedures in the ED. Almost half of nursing home residents visiting the ED were admitted to the hospital. Compared with non-nursing home residents, nursing home residents were more likely to be admitted to the hospital (adjusted OR 1.8; 95% CI 1.6-2.1) and to die (adjusted OR 2.3; 95% CI 1.6-3.3). CONCLUSIONS Nursing home residents account for over 2.2 million ED visits annually in the US. Compared with other ED patients, nursing home residents have higher medical acuity and complexity. These
Brian F Gage
Full Text Available Introduction: The objective of this study was to evaluate emergency medicine physician and nurse acceptance of nonnurse, nonphysician screening for geriatric syndromes. Methods: This was a single-center emergency department (ED survey of physicians and nurses after an 8-month project. Geriatric technicians were paid medical student research assistants evaluating consenting ED patients older than 65 years for cognitive dysfunction, fall risk, or functional decline. The primary objective of this anonymous survey was to evaluate ED nurse and physician perceptions about the geriatric screener feasibility and barriers to implementation. In addition, as a secondary objective, respondents reported ongoing geriatric screening efforts independent of the research screeners. Results: The survey was completed by 72% of physicians and 33% of nurses. Most nurses and physicians identified geriatric technicians as beneficial to patients without impeding ED throughput. Fewer than 25% of physicians routinely screen for any geriatric syndromes. Nurses evaluated for fall risk significantly more often than physicians, but no other significant differences were noted in ongoing screening efforts. Conclusion: Dedicated geriatric technicians are perceived by nurses and physicians as beneficial to patients with the potential to improve patient safety and clinical outcomes. Most nurses and physicians are not currently screening for any geriatric syndromes. [West J Emerg Med. 2011;12(4:489–495.
Robinson, Ruthie; Stinson, Cynthia Kellam
Although many nursing studies have focused on moral distress, very few have looked at moral distress and emergency nurses despite the fact that this group works in stressful, fast-paced environments that often involve situations that can lead to moral distress. The goals of this qualitative study are to determine how emergency nurses define moral distress, describe the experiences of moral distress by emergency nurses and its impact, and identify possible strategies to combat moral distress. This study used a phenomenological qualitative design. A convenience sample was used and included 8 registered nurses from 3 different emergency departments in a midsized urban county in the South Central United States. A structured open-ended interview technique was used. Four major themes were identified: (1) there was no face of the family, (2) asking God for forgiveness, (3) flipping the switch, and (4) it changes who we are. Nurses in this study all reported experiencing moral distress. Sources of moral distress identified included patient advocacy issues, professional behavior of other health care professionals, internal conflicts with what they perceived to be the right thing to do and that which was asked of them, and guilt over their own feelings about patient care. These nurses described effective and ineffective coping mechanisms.
Seright, T J
Nurses in rural settings are often the first to assess and interpret the patient's clinical presentations. Therefore, an understanding of how nurses experience decision-making is important in terms of educational preparation, resource allocation to rural areas, institutional cultures, and patient outcomes. Theory development was based on the in-depth investigation of 12 novice nurses practicing in rural critical access hospitals in a north central state. This grounded theory study consisted of face-to-face interviews with 12 registered nurses, nine of whom were observed during their work day. The participants were interviewed a second time, as a method of member checking, and during this interview they reviewed their transcripts, the emerging themes and categories. Directors of nursing from both the research sites and rural hospitals not involved in the study, experienced researchers, and nurse educators facilitated triangulation of the findings. 'Sociocentric rationalizing' emerged as the central phenomenon and referred to the sense of belonging and agency which impacted the decision-making in this small group of novice nurses in rural critical access hospitals. The observed consequences, which were conceptualized during the axial coding process and were derived from observations and interviews of the 12 novice nurses in this study include: (1) gathering information before making a decision included assessment of: the credibility of co-workers, patients' subjective and objective data, and one's own past and current experiences; (2) conferring with co-workers as a direct method of confirming/denying decisions being made was considered more realistic and expedient than policy books and decision trees; (3) rural practicum clinical experiences, along with support after orientation, provide for transition to the rural nurse role; (4) involved directors of nursing served as both models and protectors of novice nurses placed in high accountability positions early in
Liu, Hsing-Yuan; Li, Yun Ling
The initial nursing clinical practice is the necessary practicum required for nursing students. Because of the changing learning style, many of them are under great pressure for environmental change and therefore their daily routine is severe affected. Interacting directly with patients in a female-dominated occupation, along with the general gender stereotypes, the impact is especially significant to male nursing students than to female nursing students. The purpose of this preliminary qualitative study is to explore the gendered experiences of male nursing students during their first initial nursing clinical practice. Both focus group interviews and individual interviews are conducted with twenty-two sophomore nursing students from a university of technology in northern Taiwan, with ten male students and twelve female students. Two main themes emerge from the gendered experiences shared by the nursing students: Gender consciousness awakening and thus maintaining masculinity, and male advantage in the learning environments. The results identify the specific gendered experiences of nursing students, providing implications for future nursing education and counseling service. Further, this study may serve to promote an active yet gender-sensitive nursing education for training nursing professionals. Published by Elsevier Ltd.
Pedreira Pernas, María; Duarte Novo, Sonia; Bernárdez Otero, Manuel; Pérez López, Gabina; Sánchez Santos, Luis; Iglesias Vázquez, José Antonio
To describe nurse consultants' work at the Health Emergency Coordination Center of Galicia (CCUSG-061) in terms of their ability to resolve problems and the appropriateness of their decisions. Retrospective, observational, descriptive study that included all telephone calls attended by nurses between July 2013 and 2014. The results of a consultation were considered successful if a request for help was resolved without mobilization of resources and did not lead to a new call to the emergency service, a hospital admission, or a death in the next 24 hours. The nurses attended 37 553 calls, resolving 92% without mobilizing resources or patients. Ninety-seven percent of the calls resolved did not generate new calls or complications in the next 24 hours. Nurses resolve most patients' emergency care requirements safely without moving patients or mobilizing health resources.
Brooks, Beth A
A new phenomenon, the inverted or "flipped" classroom, assumes that students are no longer acquiring knowledge exclusively through textbooks or lectures. Instead, they are seeking out the vast amount of free information available to them online (the very essence of open source) to supplement learning gleaned in textbooks and lectures. With so much open-source content available to nursing faculty, it benefits the faculty to use readily available, technologically advanced content. The nurse content curator supports nursing faculty in its use of such content. Even more importantly, the highly paid, time-strapped faculty is not spending an inordinate amount of effort surfing for and evaluating content. The nurse content curator does that work, while the faculty uses its time more effectively to help students vet the truth, make meaning of the content, and learn to problem-solve. Brooks. © 2014 Wiley Periodicals, Inc.
Supamanee, Treeyaphan; Krairiksh, Marisa; Singhakhumfu, Laddawan; Turale, Sue
This qualitative study explored the clinical nursing leadership competency perspectives of Thai nurses working in a university hospital. To collect data, in-depth interviews were undertaken with 23 nurse administrators, and focus groups were used with 31 registered nurses. Data were analyzed using content analysis, and theory development was guided by the Iceberg model. Nurses' clinical leadership competencies emerged, comprising hidden characteristics and surface characteristics. The hidden characteristics composed three elements: motive (respect from the nursing and healthcare team and being secure in life), self-concept (representing positive attitudes and values), and traits (personal qualities necessary for leadership). The surface characteristics comprised specific knowledge of nurse leaders about clinical leadership, management and nursing informatics, and clinical skills, such as coordination, effective communication, problem solving, and clinical decision-making. The study findings help nursing to gain greater knowledge of the essence of clinical nursing leadership competencies, a matter critical for theory development in leadership. This study's results later led to the instigation of a training program for registered nurse leaders at the study site, and the formation of a preliminary clinical nursing leadership competency model. © 2011 Blackwell Publishing Asia Pty Ltd.
Romain-Glassey, Nathalie; Ninane, Françoise; de Puy, Jacqueline; Abt, Maryline; Mangin, Patrice; Morin, Diane
The objectives of this article were to systematically describe and examine the novel roles and responsibilities assumed by nurses in a forensic consultation for victims of violence at a University Hospital in French-speaking Switzerland. Utilizing a case study methodology, information was collected from two main sources: (a) discussion groups with nurses and forensic pathologists and (b) a review of procedures and protocols. Following a critical content analysis, the roles and responsibilities of the forensic nurses were described and compared with the seven core competencies of advanced nursing practice as outlined by Hamric, Spross, and Hanson (2009). Advanced nursing practice competencies noted in the analysis included "direct clinical practice," "coaching and guidance," and "collaboration." The role of the nurse in terms of "consultation," "leadership," "ethics," and "research" was less evident in the analysis. New forms of nursing are indeed practiced in the forensic clinical setting, and our findings suggest that nursing practice in this domain is following the footprints of an advanced nursing practice model. Further reflections are required to determine whether the role of the forensic nurse in Switzerland should be developed as a clinical nurse specialist or that of a nurse practitioner.
Endacott, Ruth; Bogossian, Fiona E; Cooper, Simon J; Forbes, Helen; Kain, Victoria J; Young, Susan C; Porter, Joanne E
To examine nursing students' and registered nurses' teamwork skills whilst managing simulated deteriorating patients. Studies continue to show the lack of timely recognition of patient deterioration. Management of deteriorating patients can be influenced by education and experience. Mixed methods study conducted in two universities and a rural hospital in Victoria, and one university in Queensland, Australia. Three simulation scenarios (chest pain, hypovolaemic shock and respiratory distress) were completed in teams of three by 97 nursing students and 44 registered nurses, equating to a total of 32 student and 15 registered nurse teams. Data were obtained from (1) Objective Structured Clinical Examination rating to assess performance; (2) Team Emergency Assessment Measure scores to assess teamwork; (3) simulation video footage; (4) reflective interview during participants' review of video footage. Qualitative thematic analysis of video and interview data was undertaken. Objective structured clinical examination performance was similar across registered nurses and students (mean 54% and 49%); however, Team Emergency Assessment Measure scores differed significantly between the two groups (57% vs 38%, t = 6·841, p groups, there was a correlation between technical (Objective Structured Clinical Examination) and nontechnical (Team Emergency Assessment Measure) scores for the respiratory distress scenario (student teams: r = 0·530, p = 0·004, registered nurse teams r = 0·903, p teams: r = 0·534, p = 0·02, registered nurse teams: r = 0·535, p = 0·049). Themes generated from the analysis of the combined quantitative and qualitative data were as follows: (1) leadership and followership behaviours; (2) help-seeking behaviours; (3) reliance on previous experience; (4) fixation on a single detail; and (5) team support. There is scope to improve leadership, team work and task management skills for registered nurses and nursing students. Simulation appears to be
Wolf, Lisa A; Delao, Altair M; Perhats, Cydne; Moon, Michael D; Carman, Margaret J
Little information has been published regarding the actual practice, training, and validation of basic skills and competencies needed by the advanced practice registered nurse (APRN) in the emergency care setting. The purpose of this study was to (1) identify skills being performed by APRNs practicing in emergency care settings (2); explore types of training; and (3) describe competency validation. Additionally, we explored frequency of skill use and facilitators and barriers to performing a skill to the full extent of training and education. An exploratory mixed-methods study was performed incorporating a self-report survey and focus group interviews. The educational path to advanced practice nursing in emergency care settings is not standardized. Few programs incorporate or address the need for APRNs to receive acute care training across the life span, which is the hallmark of emergency nursing practice. Similarly, training is reported as fragmented, and validation of skills for both nurse practitioners and clinical nurse specialists can vary. APRN practice autonomy is affected by the presence of other providers (specifically physicians), institutional culture, and state boards of nursing that regulate practice. Integrated educational and orientation programs are needed that address high-acuity patients across the life span. Additionally, a more nuanced approach to assessing APRN capabilities as a combination of hard (clinical emergency) and soft (communication and organizational) skills may be an appropriate framework within which to examine the advanced practice role. Future research should continue to evaluate training, competency assessment, and outcomes for APRNs in the emergency care setting. Copyright © 2017 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
McKie, Andrew; Baguley, Fiona; Guthrie, Caitrian; Jackson, Carol; Kirkpatrick, Pamela; Laing, Adele; O'Brien, Stephen; Taylor, Ruth; Wimpenny, Peter
The recent interest in wisdom in professional health care practice is explored in this article. Key features of wisdom are identified via consideration of certain classical, ancient and modern sources. Common themes are discussed in terms of their contribution to 'clinical wisdom' itself and this is reviewed against the nature of contemporary nursing education. The distinctive features of wisdom (recognition of contextual factors, the place of the person and timeliness) may enable their significance for practice to be promoted in more coherent ways in nursing education. Wisdom as practical knowledge (phronesis) is offered as a complementary perspective within the educational preparation and practice of students of nursing. Certain limitations within contemporary UK nursing education are identified that may inhibit development of clinical wisdom. These are: the modularization of programmes in higher education institutions, the division of pastoral and academic support and the relationship between theory and practice.
The health care of homeless people, of whom there are thousands across the UK, presents several problems to emergency nurses, who often become their primary care providers. Many homeless people have poor physical and mental health, as well as alcohol or drug problems, and they present to emergency departments (EDs), and are admitted to hospitals, more often than other patient groups. This article discusses initiatives in which emergency nurses collaborate with other professionals to improve the care of homeless people in and outside EDs.
Cooper, Mark A; Lindsay, Grace M; Kinn, Sue; Swann, Ian J
Emergency Nurse Practitioners (ENP) are increasingly managing minor injuries in Accident and Emergency departments across the United Kingdom. This study aimed to develop methods and tools that could be used to measure the quality of ENP-led care. These tools were then tested in a randomized controlled trial. A convenience sample of 199 eligible patients, over 16 years old, and with specific minor injuries was randomized either to ENP-led care (n = 99) or Senior House Officer (SHO)-led care (n = 100) and were diagnosed, treated, referred or discharged by this lead clinician. Following treatment, patients were asked to complete a patient satisfaction questionnaire related to the consultation. Clinical documentation was assessed using a 'Documentation Audit Tool'. A follow-up questionnaire was sent to all patients at 1 month. Return visits to the department and missed injuries were monitored. Patients were satisfied with the level of care from both ENPs and SHOs. However, they reported that ENPs were easier to talk to (P = 0.009); gave them information on accident and illness prevention (P = 0.001); and gave them enough information on their injury (P = 0.007). Overall they were more satisfied with the treatment provided by ENPs than with that from SHOs (P trial could be used in Accident and Emergency departments to measure the quality of ENP-led care.
Oermann, Marilyn H; Shaw-Kokot, Julia; Knafl, George J; Dowell, Jo
The purpose of our study was to describe the dissemination of research into the clinical nursing literature. The literature provides a means of transferring knowledge from a research study through citations of the work by other authors. This was a citation analysis study to explore the dissemination of research into the clinical nursing literature, beginning with the publication of an original research study and including all of the citations to that article through 2009. The authors searched five academic nursing research journal titles, using CINAHL, for original research reports that had clinical relevance and were published between 1990-1999. The search process yielded a final data set of 28 research articles. For each of the articles, the authors searched three databases, CINAHL, Web of Science(®) and Google Scholar, to determine the citation patterns from the date of publication to August 2009. All of the research studies were cited in articles published in clinical journals although there was a wide range in the number of citations, from 3-80. The 28 research articles had a total of 759 citations; 717 (94.5%) of those citations were in articles published in clinical nursing journals. The median length of time between publication of the original study and the first citation was 1.5 years. Some of the studies were still being cited for 18 years after publication of the original work. All of the original research reports examined in this study were cited in articles in clinical journals, disseminating the research beyond the original work to reach clinicians. Clinical nursing journals keep readers up-to-date and informed about new practices in nursing and serve another important role: they disseminate research that is clinically relevant by publishing original studies and papers that cite research reports. © 2010 Blackwell Publishing Ltd.
Lee, Byoung Sook; Eo, Yong Sook; Lee, Mi Aie
The purpose of this study was to understand and describe the leadership experience of clinical nurses. During 2014, data were collected using focus group interviews. Three focus group interviews were held with a total of 20 clinical nurses participating. All interviews were recorded as they were spoken and transcribed and data were analyzed using qualitative content analysis. Fifteen categories emerged from the five main themes. 1) Thoughts on the leadership category: to lead others, to cope with problem situations adequately and to serve as a shield against difficulties. 2) Situations requiring leadership: situation that requires correct judgement, coping and situations that need coordination and cooperation. 3-1) Leadership behaviors: other-oriented approach and self-oriented approach. 3-2) Leadership behavior consequences: relevant compensation and unfair termination. 4-1) Facilitators of leadership: confidence and passion for nursing and external support and resources. 4-2) Barriers to leadership: non-supportive organization culture and deficiency in own leadership competencies. 5) Strategies of leadership development: strengthen leadership through self-development and organizational leadership development. In conclusion, the results indicate that it is necessary to enhance clinical nurses' leadership role in healthcare. Enhancement can be achieved through leadership programs focused on enlarging leadership experience, constant self-development, leadership training, and development of leadership competencies suited to the nursing environment.
Georgino, Madeline M; Kress, Terri; Alexander, Sheila; Beach, Michael
The purpose of this project was to measure trauma nurse improvement in familiarity with emergency preparedness and disaster response core competencies as originally defined by the Emergency Preparedness Information Questionnaire after a focused educational program. An adapted version of the Emergency Preparedness Information Questionnaire was utilized to measure familiarity of nurses with core competencies pertinent to first responder capabilities. This project utilized a pre- and postsurvey descriptive design and integrated education sessions into the preexisting, mandatory "Trauma Nurse Course" at large, level I trauma center. A total of 63 nurses completed the intervention during May and September 2014 sessions. Overall, all 8 competencies demonstrated significant (P in familiarity. In conclusion, this pilot quality improvement project demonstrated a unique approach to educating nurses to be more ready and comfortable when treating victims of a disaster.
Fox, Amanda; Gardner, Glenn; Osborne, Sonya
This research aimed to explore factors that influence sustainability of health service innovation, specifically emergency nurse practitioner service. Planning for cost effective provision of healthcare services is a concern globally. Reform initiatives are implemented often incorporating expanding scope of practice for health professionals and innovative service delivery models. Introducing new models is costly in both human and financial resources and therefore understanding factors influencing sustainability is imperative to viable service provision. This research used case study methodology (Yin, ). Data were collected during 2014 from emergency nurse practitioners, emergency department multidisciplinary team members and documents related to nurse practitioner services. Collection methods included telephone and semi-structured interviews, survey and document analysis. Pattern matching techniques were used to compare findings with study propositions. In this study, emergency nurse practitioner services did not meet factors that support health service sustainability. Multidisciplinary team members were confident that emergency nurse practitioner services were safe and helped to meet population health needs. Organizational support for integration of nurse practitioner services was marginal and led to poor understanding of service capability and underuse. This research provides evidence informing sustainability of nursing service models but more importantly raises questions about this little explored field. The findings highlight poor organizational support, excessive restrictions and underuse of the service. This is in direct contrast to contemporary expanding practice reform initiatives. Organizational support for integration is imperative to future service sustainability. © 2017 John Wiley & Sons Ltd.
Roberta Juliane Tono de Oliveira; Patrícia Madalena Vieira Hermida; Fernanda Hannah da Silva Copelli; José Luís Guedes dos Santos; Alacoque Lorenzini Erdmann; Selma Regina de Andrade
Objective.Understand the conditions involved in the management of nursing care in emergency care units. Methodology. Qualitative research using the methodological framework of the Grounded Theory. Data collection occurred from September 2011 to June 2012 through semi-structured interviews with 20 participants of the two emergency care units in the city of Florianopolis, Brazil. Results. Hindering factors to care management are: lack of experience and knowledge of professionals in emergency se...
Montezeli, Juliana Helena; Peres, Aida Maris; Bernardino, Elizabeth
Objective: To identify the management skills needed for this professional at an emergency care unit. Method: An exploratory descriptive qualitative study conducted with eight nurses in which semi-structured interviews with nonparticipating systematic observation were conducted; the data was processed by content analysis. Results: The categories which emerged from the content analysis served as a list of management skills necessary to their work at the emergency care unit: leadership, decision...
Thompson, Patricia; Lulham, Kevin
More than 90 members of the American Association of Colleges of Nursing and 190 practice sites have partnered to develop the clinical nurse leader (CNL) role. The partnership has created synergy between education and practice and nurtured innovation and diffusion of learning on a national basis. In this ongoing department, the editor, Jolene Tornabeni, MA, RN, FAAN, FACHE, showcases a variety of nurse leaders who discuss their new patient care delivery models in preparation for the CNL role and CNLs who highlight partnerships with their clinical colleagues to improve patient care. In this article, the authors explore differences and similarities between the CNL and the clinical nurse specialist roles, describing the working strategies between a CNL and clinical nurse specialist, and role delineations that have resulted from their cooperation, collaboration, and planning.
Brown, Janie; Sims, Shanette
Clinical handover ensures continuity of care, providing the opportunity to transfer responsibility and accountability for the care of a patient from nurse to nurse. The aim of this study was to examine afternoon nursing clinical handover from the perspective of nurses, exploring the quality of information, the interactions and support, the efficiency and the involvement of parents in a private neonatal unit. An exploratory, descriptive, prospective quantitative survey with qualitative elements was undertaken using The Handover Evaluation Scale (O'Connell, MacDonald, & Kelly, 2008). All nurses working in the Neonatal unit who attend afternoon handover, were invited to participate in the study (N = 22), with N = 16 responses received. The quantitative and qualitative results indicate that the quality of the information handed over in neonatal care units can be maintained despite intrinsic limitations. Additionally, high levels of support and interaction between nursing staff in this stressful practice environment occur during the handover period. Given the vulnerability of neonates it is important that accurate information is efficiently handed over. In order to do this distractions should be minimised. Finally, parental involvement in handover should be actively encouraged whenever feasible.
Voltelen, Barbara; Konradsen, Hanne; Østergaard, Birte
Aim: This study aimed to explore what was documented during structured Family Nursing (FN) conversations with patients diagnosed with Heart Failure and their families, and to gain knowledge about the nurses’ experiences conducting FN. Background: Patients with HF face many challenges, and so do...... their families. Research has shown that families want to be involved in the caring and treatment of their loved ones. The FN intervention based on The Calgary Family Assessment and Intervention Model could improve patient and family outcome. Methods: Data consisted of 34 case reports with documentation from...... throughout the FN intervention and a Focus group interview with 6 nurses who were conducting the conversations. Content analyses of all text material dealt with both manifest and latent content, and were analyzed through a deductive and inductive process. Results: Enabling bonding emerged as the overall...
DeSocio, Janiece E
The aims of this paper are to synthesize and report research findings from neuroscience and epigenetics that contribute to an emerging explanatory framework for advanced practice psychiatric nursing. Discoveries in neuroscience and epigenetics reveal synergistic mechanisms that support the integration of psychotherapy, psychopharmacology, and psychoeducation in practice. Advanced practice psychiatric nurses will benefit from an expanded knowledge base in neuroscience and epigenetics that informs and explains the scientific rationale for our integrated practice. © 2015 Wiley Periodicals, Inc.
Schwab, Darcie; Napolitano, Nancy; Chevalier, Kelly; Pettorini-D'Amico, Susan
The emergency department (ED) environment poses unique risks to developing moral distress and posttraumatic stress disorder (PTSD) in nurses. This impacts ED registered nurses' (RNs') ability to remain resilient. The purpose of this article is to explore the benefit of recognizing the signs and symptoms of burnout, introduce interventions to combat PTSD, and improve resiliency in ED RNs. The use of the wounded healer theory provides a framework to help nurse managers develop strategies such as critical incident stress debriefing (CISD) to address emotional distress.
Fontaine, Guillaume; Forgione, Massimo; Lusignan, Francis; Lanoue, Marc-André; Drouin, Simon
The Canadian C-Spine Rule (CCR) is a clinical decision aid to facilitate the safe removal of cervical collars in the alert, orientated, low-risk adult trauma patient. Few health care settings have assessed initiatives to train charge nurses to use the CCR. This practice improvement project conducted in a secondary trauma center in Canada aimed to (1) train charge nurses of the emergency room to use the CCR, (2) monitor its use throughout the project period, and (3) compare the assessments of the charge nurses with those of emergency physicians. The project began with the creation of an interdisciplinary team. Clinical guidelines were established by the interdisciplinary project team. Nine charge nurses of the emergency room were then trained to use the CCR (3 on each 8-hour shift). The use of the CCR was monitored throughout the project period, from June 1 to October 5, 2016. The 3 aims of this practice improvement project were attained successfully. Over a 5-month period, 114 patients were assessed with the CCR. Charge nurses removed the cervical collars for 54 of 114 patients (47%). A perfect agreement rate (114 of 114 patients, 100%) was attained between the assessments of the nurses and those of physicians. This project shows that the charge nurses of a secondary trauma center can use the CCR safely on alert, orientated, and low-risk adult trauma patients as demonstrated by the agreement in the assessments of emergency room nurses and physicians. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.
Lane, Sandi J; McGrady, Elizabeth
Resilience approaches have been successfully applied in crisis management, disaster response, and high reliability organizations and have the potential to enhance existing systems of nursing home disaster preparedness. This study's purpose was to determine how the Center for Medicare and Medicaid Services (CMS) "Emergency Preparedness Checklist Recommended Tool for Effective Health Care Facility Planning" contributes to organizational resilience by identifying the benchmark resilience items addressed by the CMS Emergency Preparedness Checklist and items not addressed by the CMS Emergency Preparedness Checklist, and to recommend tools and processes to improve resilience for nursing homes. The CMS Emergency Preparedness Checklist items were compared to the Resilience Benchmark Tool items; similar items were considered matches. Resilience Benchmark Tool items with no CMS Emergency Preparedness Checklist item matches were considered breaches in nursing home resilience. The findings suggest that the CMS Emergency Preparedness Checklist can be used to measure some aspects of resilience, however, there were many resilience factors not addressed. For nursing homes to prepare and respond to crisis situations, organizations need to embrace a culture that promotes individual resilience-related competencies that when aggregated enable the organization to improve its resiliency. Social workers have the skills and experience to facilitate this change.
Farrell, Carole; Walshe, Catherine; Molassiotis, Alex
The number of patients requiring ambulatory chemotherapy is increasing year on year, creating problems with capacity in outpatient clinics and chemotherapy units. Although nurse-led chemotherapy clinics have been set up to address this, there is a lack of evaluation of their effectiveness. Despite a rapid expansion in the development of nursing roles and responsibilities in oncology, there is little understanding of the operational aspects of nurses' roles in nurse-led clinics. To explore nurses' roles within nurse-led chemotherapy clinics. A focused ethnographic study of nurses' roles in nurse-led chemotherapy clinics, including semi-structured interviews with nurses. Four chemotherapy units/cancer centres in the UK PARTICIPANTS: Purposive sampling was used to select four cancer centres/units in different geographical areas within the UK operating nurse-led chemotherapy clinics. Participants were 13 nurses working within nurse-led chemotherapy clinics at the chosen locations. Non-participant observation of nurse-led chemotherapy clinics, semi-structured interviews with nurse participants, review of clinic protocols and associated documentation. 61 nurse-patient consultations were observed with 13 nurses; of these 13, interviews were conducted with 11 nurses. Despite similarities in clinical skills training and prescribing, there were great disparities between clinics run by chemotherapy nurses and those run by advanced nurse practitioners. This included the number of patients seen within each clinic, operational aspects, nurses' autonomy, scope of practice and clinical decision-making abilities. The differences highlighted four different levels of nurse-led chemotherapy clinics, based on nurses' autonomy and scope of clinical practice. However, this was heavily influenced by medical consultants. Several nurses perceived they were undertaking holistic assessments, however they were using medical models/consultation styles, indicating medicalization of nurses' roles
Perry, R N Beth
Role modeling excellence in clinical nursing practice is the focus of this paper. The phenomenological research study reported involved a group of 8 nurses identified by their colleagues as exemplary. The major theme revealed in this study was that these exemplary nurses were also excellent role models in the clinical setting. This paper details approaches used by these nurses that made them excellent role models. Specifically, the themes of attending to the little things, making connections, maintaining a light-hearted attitude, modeling, and affirming others are presented. These themes are discussed within the framework of Watson [Watson, J., 1989. Human caring and suffering: a subjective model for health services. In: Watson, J., Taylor, R. (Eds.), They Shall Not Hurt: Human Suffering and Human Caring. Colorado University, Boulder, CO] "transpersonal caring" and [Bandura, A., 1997. Social Learning Theory. Prentice Hall, Englewood Cliffs, NJ] "Social Learning Theory." Particular emphasis in the discussion is on how positive role modeling by exemplary practitioners can contribute to the education of clinical nurses in the practice setting.
Gheidanzadeh, Maryam; Baghersad, Zahra; Abazari, Parvaneh
Clinical education provides a chance to combine theoretical knowledge and clinical skills. Students are the key elements in the evaluation of clinical education efficacy. The present study was aimed to define nursing students' viewpoints concerning conformity to the characteristics of clinical conference and clinical round. This descriptive analytical study was conducted on the bachelor's students of the 4 th -6 th semester of nursing. Sampling was conducted using census sampling method during the 2 nd semester of 2014-2015 school year. Data collection tool was a three-section researcher-made questionnaire containing demographic, nursing round, and clinical conference characteristics. Descriptive and inferential statistical tests (independent t -test, ANOVA, and Spearman and Pearson correlation coefficients) were used for data analysis. Participants were 134 bachelor's students of the 4 th -6 th semester of nursing. According to half of the participants, conformity to the characteristics of clinical conference (45.5%, 53%) and clinical round (44%, 51.5%) were poor and medium, respectively. Paired t -test showed a significant difference between students' viewpoints toward the planning of clinical conference and clinical nursing round ( P = 0.006, t = 2.77). According to the results of the present study on students' viewpoints, clinical education faces a serious challenge with regard to clinical education methods. Considering the necessity and importance of clinical education, more investigation should be conducted to detect its relevant factors and plan for its improvement.
Schiller, Catharine J
Critical realism, a philosophical framework originally developed by Roy Bhaskar in the 1970s, represents a relatively new approach to research generally and to nursing research in particular. This article explores the ontological and epistemological tenets of critical realism and examines the application of critical realist principles to nursing research and practice through a review of the literature. It is evident that few published nursing research studies have, as of yet, utilized critical realism as their paradigm of choice. Both the strengths and limitations of the presentation and use of critical realism in these studies are discussed in this article. Given the varying degrees of success of the authors in explicating critical realism as a philosophical framework, the value of critical realism to the research study, and the ways in which usage of the critical realist framework influenced development of the study and interpretation of findings, it is evident that the quality of future publications espousing the use of critical realism must continue to be strengthened significantly. © 2015 John Wiley & Sons Ltd.
Papi, Giampaolo; Corsello, Salvatore Maria; Pontecorvi, Alfredo
Thyroid-related emergencies are caused by overt dysfunction of the gland which are so severe that require admission to intensive care units (ICU) frequently. Nonetheless, in the ICU setting, it is crucial to differentiate patients with non-thyroidal illness and alterations in thyroid function tests from those with intrinsic thyroid disease. This review presents and discusses the main etiopathogenetical and clinical aspects of hypothyroid coma (HC) and thyrotoxic storm (TS), including therapeutic strategy flow-charts. Furthermore, a special chapter is dedicated to the approach to massive goiter, which represents a surgical thyroid emergency. We searched the electronic MEDLINE database on September 2013. Data Selection and Data Extraction: Reviews, original articles, and case reports on "myxedematous coma," "HC," "thyroid storm," "TS," "massive goiter," "huge goiter," "prevalence," "etiology," "diagnosis," "therapy," and "prognosis" were selected. Severe excess or defect of thyroid hormone is rare conditions, which jeopardize the life of patients in most cases. Both HC and TS are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are high-dose l-thyroxine and/or tri-iodothyroinine; i.v. glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatraemia); treatment of hypothermia; often, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and i.v. glucocorticoids; eventually, high-dose of iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques - e.g., percutaneous laser ablation - are helpful in subjects at high surgical risk or refusing operation.
Full Text Available Objective. Thyroid-related emergencies are caused by overt dysfunction of the gland that are so severe that require admission to intensive care units frequently. Nonetheless, in the ICU setting, it is crucial to differentiate patients with non-thyroidal illness and alterations in thyroid function tests from those with intrinsic thyroid disease. This review presents and discusses the main etiopathogenetical and clinical aspects of hypothyroid coma (HC and thyrotoxic storm (TS, including therapeutic strategy flow-charts. Furthermore, a special chapter is dedicated to the approach to massive goiter, which represents a surgical thyroid emergency.Data source. We searched the electronic MEDLINE database to September 2013.Data selection and Data extraction. Reviews, original articles and case reports on myxedematous coma, hypothyroid coma, thyroid storm, thyrotoxic storm, massive goiter, huge goiter, prevalence, etiology, diagnosis, therapy, prognosis were selected.Data synthesis and conclusions. Severe excess or defect of thyroid hormone are rare conditions which jeopardize the life of patients in most cases. Both HC and TS are triggered by precipitating factors, which occur in patients with severe hypothyroidism or thyrotoxicosis, respectively. The pillars of HC therapy are: high dose l-thyroxine and/or tri-iodothyroinine; i.v. glucocorticoids; treatment of hydro-electrolyte imbalance (mainly, hyponatraemia; treatment of hypothermia; not rarely, endotracheal intubation and assisted mechanic ventilation are needed. Therapy of TS is based on beta-blockers, thyrostatics, and i.v. glucocorticoids; eventually, high-dose iodide compounds or lithium carbonate may be of benefit. Surgery represents the gold standard treatment in patients with euthyroid massive nodular goiter, although new techniques – e.g., percutaneous laser ablation - are helpful in subjects at high surgical risk or refusing operation.
Kim, MinYoung; Oh, Seieun
The purpose of this study was to generate a substantive model that accounts for the explanatory social processes of communication in which nurses were engaged in clinical settings in Korea. Grounded theory methodology was used in this study. A total of 15 clinical nurses participated in the in-depth interviews. "Assimilating to the hierarchical culture" emerged as the basic social process of communication in which the participants engaged in their work environments. To adapt to the cultures of their assigned wards, the nurses learned to be silent and engaged in their assimilation into the established hierarchy. The process of assimilation consisted of three phases based on the major goals that nurses worked to achieve: getting to know about unspoken rules, persevering within the culture, and acting as senior nurse. Seven strategies and actions utilized to achieve the major tasks emerged as subcategories, including receiving strong disapproval, learning by observing, going silent, finding out what is acceptable, minimizing distress, taking advantages as senior nurse, and taking responsibilities as senior nurse. The findings identified how the pattern of communication in nursing organizations affected the way in which nurses were assimilated into organizational culture, from individual nurses' perspectives. In order to improve the rigid working atmosphere and culture in nursing organizations and increase members' satisfaction with work and quality of life, managers and staff nurses need training that focuses on effective communication and encouraging peer opinion-sharing within horizontal relationships. Moreover, organization-level support should be provided to create an environment that encourages free expression.
Chen, Jie; Yang, Jian; Hu, Fen; Yu, Si-Hong; Yang, Bing-Xiang; Liu, Qian; Zhu, Xiao-Ping
Simulation-based curriculum has been demonstrated as crucial to nursing education in the development of students' critical thinking and complex clinical skills during a resuscitation simulation. Few studies have comprehensively examined the effectiveness of a standardised simulation-based emergency and intensive care nursing curriculum on the performance of students in a resuscitation simulation. To evaluate the impact of a standardised simulation-based emergency and intensive care nursing curriculum on nursing students' response time in a resuscitation simulation. Two-group, non-randomised quasi-experimental design. A simulation centre in a Chinese University School of Nursing. Third-year nursing students (N = 39) in the Emergency and Intensive Care course were divided into a control group (CG, n = 20) and an experimental group (EG, n = 19). The experimental group participated in a standardised high-technology, simulation-based emergency and intensive care nursing curriculum. The standardised simulation-based curriculum for third-year nursing students consists of three modules: disaster response, emergency care, and intensive care, which include clinical priorities (e.g. triage), basic resuscitation skills, airway/breathing management, circulation management and team work with eighteen lecture hours, six skill-practice hours and twelve simulation hours. The control group took part in the traditional curriculum. This course included the same three modules with thirty-four lecture hours and two skill-practice hours (trauma). Perceived benefits included decreased median (interquartile ranges, IQR) seconds to start compressions [CG 32 (25-75) vs. EG 20 (18-38); p 0.05] and defibrillation [CG 222 (194-254) vs. EG 221 (214-248); p > 0.05] at the beginning of the course. A simulation-based emergency and intensive care nursing curriculum was created and well received by third-year nursing students and associated with decreased response time in a
Martínez-Segura, Estrella; Lleixà-Fortuño, Mar; Salvadó-Usach, Teresa; Solà-Miravete, Elena; Adell-Lleixà, Mireia; Chanovas-Borrás, Manel R; March-Pallarés, Gemma; Mora-López, Gerard
To identify associations between sociodemographic characteristics variables and competence levels of triage nurses in hospital emergency departments. Descriptive, cross-sectional, multicenter study of triage nurses in hospital emergency departments in the southwestern area of Catalonia (Ebre River territory). We used an instrument for evaluating competencies (the COM_VA questionnaire) and recording sociodemographic variables (age, sex, total work experience, emergency department experience, training in critical patient care and triage) and perceived confidence when performing triage. We then analyzed the association between these variables and competency scores. Competency scores on the COM_VA questionnaire were significantly higher in nurses with training in critical patient care (P=.001) and triage (P=0.002) and in those with longer emergency department experience (P<.0001). Perceived confidence when performing triage increased with competency score (P<.0001) and training in critical patient care (P<.0001) and triage (P=.045). The competence of triage nurses and their perception of confidence when performing triage increases with emergency department experience and training.
Grover, Elise; Porter, Joanne E; Morphet, Julia
Teamwork may assist with increased levels of efficiency and safety of patient care in the emergency department (ED), with emergency nurses playing an indispensable role in this process. A descriptive, exploratory approach was used, drawing on principles from phenomenology and symbolic interactionism. Convenience, purposive sampling was used in a major metropolitan ED. Semi structured interviews were conducted, audio recorded, and transcribed verbatim. Transcripts were analysed using thematic analysis. Three major themes emerged from the data. The first theme 'when teamwork works' supported the notion that emergency nurses perceived teamwork as a positive and effective construct in four key areas; resuscitation, simulation training, patient outcomes and staff satisfaction. The second theme 'team support' revealed that back up behaviour and leadership were critical elements of team effectiveness within the study setting. The third theme 'no time for teamwork' centred around periods when teamwork practices failed due to various contributing factors including inadequate resources and skill mix. Outcomes of effective teamwork were valued by emergency nurses. Teamwork is about performance, and requires a certain skill set not necessarily naturally possessed among emergency nurses. Building a resilient team inclusive of strong leadership and communication skills is essential to being able to withstand the challenging demands of the ED. Copyright © 2017 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.
Moore, Susan; Stichler, Jaynelle F
Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination. Copyright 2015, SLACK Incorporated.
Rautava, Veli-Pekka; Palomäki, Erika; Innamaa, Tapio; Perttu, Mika; Lehto, Päivi; Palomäki, Ari
The aim of this study was to assess nurses' self-reported confidence in their professional skills before and after an extensive Emergency Department (ED) reform in Kanta-Häme Central Hospital. Emergency nurses participated in transitional training commencing two years before the establishment of the new organization in 2007. Training was followed by weekly practical educational sessions in the new ED. During this process nurses improved their transition skills, defined house rules for the new clinic and improved their knowledge of new technology and instruments. The main processes involving critically ill ED patients were described and modelled with an electronic flow chart software.During the transitional training nurses compiled lists of practical skills and measures needed in the ED. These were updated after feedback from physicians in primary and secondary care and head physicians in Kanta-Häme Central Hospital. The final 189-item list comprised 15 different categories, each containing from 4 to 35 items. Based on the work described above, a questionnaire was developed to reflect ED nurses' skills in clinical measures but also to estimate the need for professional education and practical training. Nurses working in the ED were asked to fill the questionnaire in January 2007 (response rate 97%) and in January 2011 (response rate 98%). Nurses' self-reported confidence in their professional skills improved significally in eight classes out of fifteen. These classes were cannulations, urinary catheterizations, patient monitoring, cardiac patients, equipment, triage and nurse practising, psychiatric patients as well as infection risk. Best results were noted in urinary catheterizations, patient monitoring and infection risk. When studying the group of nurses participating in both surveys in 2007 and 2011, improvements were observed in all fifteen categories. All but two of these changes were significant (pimprovement in the professional skills of nurses. This
Hanson, Karla J; Stenvig, Thomas E
Clinical education accounts for a significant portion of baccalaureate nursing (BSN) education. This study examined recent BSN program graduates' views about clinical nursing educator attributes that enhance the ability of the graduates to provide safe, effective patient care. In this descriptive study, 6 participants were interviewed using grounded theory techniques. The study framework blended the elements of cognitive field theory, the humanistic philosophy of teaching and learning, the gestalt theory of learning, and Hergenhahn's behavioral change model. Participants identified three attributes of a good clinical nursing educator: knowledge, interpersonal presentation, and teaching strategies. Analysis revealed that educator attributes and phases of the clinical experience process together form the foundation for clinical experience praxis. Educators can improve the clinical education experience by developing teaching strategies and evaluation tools that build on the positive attributes and phases of the clinical experience identified in this study.
Pulliam, Bryce C; Liao, Mark Y; Geissler, Theodore M; Richards, John R
The boarding of admitted patients in the emergency department (ED) is a major cause of crowding and access block. One solution is boarding admitted patients in inpatient ward (W) hallways. This study queried and compared ED and W nurses' opinions toward ED and W boarding. It also assessed their preferred boarding location if they were patients. A survey administered to a convenience sample of ED and W nurses was performed in a 631-bed academic medical center (30,000 admissions/year) with a 68-bed ED (70,000 visits/ year). We identified nurses as ED or W, and if W, whether they had previously worked in the ED. The nurses were asked if there were any circumstances where admitted patients should be boarded in ED or W hallways. They were also asked their preferred location if they were admitted as a patient. Six clinical scenarios were then presented, and the nurses' opinions on boarding based on each scenario were queried. Ninety nurses completed the survey, with a response rate of 60%; 35 (39%) were current ED nurses (cED), 40 (44%) had previously worked in the ED (pED). For all nurses surveyed 46 (52%) believed admitted patients should board in the ED. Overall, 52 (58%) were opposed to W boarding, with 20% of cED versus 83% of current W (cW) nurses (P boarding, with 82% of cED versus 33% of cW nurses (P boarding were lack of monitoring and patient privacy. For the 6 clinical scenarios, significant differences in opinion regarding W boarding existed in all but 2 cases: a patient with stable chronic obstructive pulmonary disease but requiring oxygen, and an intubated, unstable sepsis patient. Inpatient nurses and those who have never worked in the ED are more opposed to inpatient boarding than ED nurses and nurses who have worked previously in the ED. Primary nursing concerns about boarding are lack of monitoring and privacy in hallway beds. Nurses admitted as patients seemed to prefer not being boarded where they work. ED and inpatient nurses seemed to agree that
Dal Pai, Daiane; Lautert, Liana
This experience report describes the humanized support given by the nurse in the attendance to patients in eminently critical health situation in the Emergency Hospital of Porto Alegre (Brasil). The proposal was based on Jean Watson theory. The experience gave moments for personal and professional self-knowledge, and thoughts concerning the possibilities of construction of interpersonal humanist process in the emergency environment as well. Yet, it was possible to identify some limitations of the theory options referent to its practical applicability.
Berntsen, Karin; Bjørk, Ida Torunn; Brynildsen, Grethe
Background: Nursing students hesitate to choose aged care as a career, and the aged care sectors are on an edge regarding nursing positions. Clinical learning environments may influence nursing students’ career choices. Few studies have explored learning environments in nursing homes, although students increasingly have placements there. Objectives: The aim was to produce information for developing nursing students’ learning opportunities in nursing homes. Design: A cross-sectional survey des...
To describe the opinions of Spanish nurses on hospital emergency department (ED) triage and to compare their level of satisfaction with different triage systems. Descriptive survey-based study of the opinions of nurses working in Spanish EDs. The online questionnaire was self-administered by the respondents. Items covered demographic data, degrees of experience and training, level of satisfaction, and aspects related to triage in general and to the type of triage used in the respondent's hospital. Valid responses were received from 833 of the 857 nurses contacted (97.2% response rate); the nurses worked at 161 hospitals. Eighty hospitals (49.7%) used the Andorran Triage System adapted as the Spanish Triage System (ATM-STS) and 49 (30.4%) used the Manchester Triage System (MTS). The mean (SD) age of respondents was 38.5 (7.8) years; 652 (78.3%) of the respondents were women. Nurses were responsible for triage in 140 (87%) of the hospitals. Four hundred nurses (48.0%) believed triage is a full-team responsibility and 367 (44.0%) believed it was a nursing responsibility. Six hundred three (77.2%) had received specific training in triage. Seven hundred nine (85.1%) believed that triage always or almost always ensures better care for patients with the most serious emergencies, 681 (81.7%) believed that the triage nurse's opinion is taken into consideration, and 663 (79.6%) believed that patients are seen by a physician according to the assigned triage level. Nurses feel supported and generally respected by other nurses. Two hundred thirty (26.7%) would change the triage system they use, but only 100 (43.5%) could name a system they would switch to. Triage is performed by nurses in most of the hospitals, although nearly half of the respondents believe this responsibility should be shared with doctors. Nurses have a good opinion of triage and are generally satisfied with it, but there is variation according to the system implemented in their hospital.
del Barrio-Linares, M; Pumar-Méndez, M J
With the aim of contributing to the development of a more specific professional regulation, the present study was to identify differences and similarities between the competencies of the nursing supervisor and clinical nurse specialist in an intensive care unit. A critical analysis of the literature published between 2003 and 2013 was conducted, identified through systematic searches in electronic databases, health management and practitioner journals and reference lists of the 17 items included. «Management and administration» and «direct clinical practice» were identified as specific competencies of nursing supervisor and clinical nurse specialist respectively. «Collaboration», «leadership» and «research» emerged as competencies shared by both profiles, but with different a operationalization way of conducting it. These findings imply that regulation, education and implementation of these profiles must address their specific skills as the distinctive approach taken in operationalizing shared. Copyright © 2014 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Bj?rk, Ida Torunn; Hamilton, Glenys A.
This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with d...
Palazoğlu, Cansu Atmaca; Koç, Zeliha
Rising levels of burnout and decreasing job satisfaction can inhibit healthcare professionals from providing high-quality care due to a corresponding decrease in their ethical sensitivity. This study aimed to determine the relationship between the level of ethical sensitivity in emergency service nurses and their levels of burnout and job satisfaction. This research employed a descriptive and cross-sectional design. Participants and research context: This study was conducted with a sample of 236 nurses, all of whom worked in emergency service between 24 July 2015 and 28 April 2016. Data were collected using the Moral Sensitivity Questionnaire, Maslach Burnout Inventory, and Minnesota Job Satisfaction Scale. Ethical considerations: This study was approved by the Institutional Ethics Review Board of Ondokuz Mayıs University. There was a weak and negative correlation (r = -0.158, p = 0.015) between Moral Sensitivity Questionnaire and Maslach Burnout Inventory scores. There was also a weak and negative correlation (r = -0.335, p Burnout Inventory and Minnesota Job Satisfaction Scale scores. Decreased job satisfaction and increased burnout levels among emergency service nurses might result in them indulging in improper practices, frequently facing ethical problems, and a decrease in the overall quality of service in hospitals. In order for emergency service nurses to recognize ethical problems and make the most accurate decisions, a high level of ethical sensitivity is critical. In this respect, it is suggested that continuing education after graduation and training programs should be organized.
Henderson, Elizabeth; Harada, Nahoko; Amar, Angela
The Emergency Department (ED) is a point of contact for victims of violence after an act of criminal activity has occurred. Hence, ED clinicians are in a key position to have a significant impact on both the medical and legal outcomes of the forensic patient population. The purpose of this study was to describe and compare forensic knowledge, practice, and experiences of ED nurses and physicians. Specific aims were to (1) describe experiences of nurses and physicians related to forensic practice; (2) compare clinical forensic knowledge and experience between nurses and physicians; and (3) describe forensic learning needs. This descriptive, correlational study utilized a survey questionnaire completed by 134 ED nurses and physicians. Results of the survey revealed no significant differences in the education, knowledge, and confidence with forensic patients between ED nurses and physicians. However, just over half of the sample reported feeling confident in managing forensic patients indicating a need for increased forensic education. Practice implications indicate that forensic education is needed and desired among ED nurses and physicians within the clinical setting. Further studies must be done to gain a more in depth understanding of existing forensic practices and protocols to elevate the level of care received by forensic patients within the ED setting. © 2012 International Association of Forensic Nurses.
Problem based learning (PBL) in clinical nursing is described as an effective learning strategy that can encourage students to become self-directed learners and to master clinical skills that can be transferable to service users. This study explores the usefulness of PBL in a nursing clinical setting from the nursing students' ...
Dell'Acqua, Magda Cristina Queiroz; Miyadahira, Ana Maria Kazue; Ide, Cilene Aparecida Costardi
Thinking about nursing education implies articulating this issue with the expressions of theoretical frameworks, from the perspective of a pedagogical aspect that includes both constructivism and competencies. The objective was to characterize, from a longitudinal view, the construction of care competencies that exist in the teaching plans of nursing undergraduate programs. This exploratory-descriptive study used a qualitative approach. Documentary analysis was performed on the nine teaching plans of undergraduate care subjects. The ethical-legal aspects were guaranteed, so that data was collected only after the study had been approved by the Research Ethics Committee. The data evidenced a curriculum organization centered on subjects, maintaining internal rationales that seem to resist summative organizations. Signs emerge of hardly substantial links between any previous knowledge and the strengthening of critical judgment and clinical reasoning. As proposed, the study contributed with reconsiderations for the teaching-learning process and showed the influence of constructivism on the proposal of clinical competencies.
Nasrin, Hanifi; Soroor, Parvizy; Soodabeh, Joolaee
Nurses are the first role models for students in clinical settings. They can have a significant role on students’ motivation. The purpose of this study was to explore the understanding of nursing students and instructors concerning the role of nurses in motivating nursing students through clinical education. The sampling was first started purposefully and continued with theoretical sampling. The study collected qualitative data through semistructured and interactive interviews with 16 nursing...
Full Text Available Background and Objective: Appropriate clinical environment has an important role in preparing students to use learned knowledge in practice through providing learning opportunities. Since the students’ experiences in the clinical setting affect on quality of their learning, the current study aimed to explain the experiences of nursing students concerning clinical education setting. Materials and Method: The current study was conducted based on conventional content analysis. Sampling was done purposively and the participants were 13 last year nursing students in Zabol Nursing and Midwifery School in 2013-2014. Data collection was done through in-depth semi-structured interviews. Data analysis was conducted through qualitative content analysis approach. Results: Based on the results, five major categories including threats, vision, dual forces, mindset and students’ action to clinical education and also10 subcategorie were identified. Conclusion: Since the formation of students’ experiences in these environments is one of the predictive factors in achieving their learning and in facilitating the professionalization process, thus the attention of managers in clinical settings is very important for decreasing the threats and concerns for students. In this way, the marred prospects of profession can be recovered through the meeting students’ expectations, attractiveness of the profession can be increased and the positive belief, actions and feelings can be created in students.
Yeke-Fallah, Leili; Eskandari, Zahra; Shahrokhi, Akram; Javadi, Amir
Background and aims Rapid response nursing team evaluates the patients in the early stages of clinical exacerbation and prevents unexpected cardiopulmonary arrest. The present study aimed to determine the effect of rapid response nursing team in outcome of patients care in the emergency ward. Methods This clinical trial was conducted on 714 patients in the emergency ward in selected hospitals affiliated to Alborz University of Medical Sciences in 2013. The patients were randomly divided into a control and an intervention group. Rapid response nursing team comprised an intensive care nurse and an anesthesia technician who were in the emergency on a 24/7 basis. If the patient's clinical conditions exacerbated, they immediately attended him, evaluated his clinical condition precisely, and took necessary nursing measures for the patients in the case group, but those in the control group received the conventional treatment in the emergency ward. Patients' conditions and the measures taken for them were precisely recorded for both groups and the data were analyzed in SPSS 16. Results The results of the study showed that there is a significant relationship between establishing rapid response nursing team and outcome of patient care (p=0.028), reduced transfer to special care units (p=0.014) and reduced level of care in the first 24 hours of admission (p=0.001). Conclusion Given the results, rapid response nursing team was effective in preventing unexpected cardiovascular arrests, increased successful cardiopulmonary resuscitation, and reduced transfer of patients to special care units and higher levels of care.
Currey, Judy; Considine, Julie; Khaw, Damien
This article presents a proposal for the Clinical Nurse Research Consultant, a new nursing role. Although healthcare delivery continues to evolve, nursing has lacked highly specialized clinical and research leadership that, as a primary responsibility, drives evidence-based practice change in collaboration with bedside clinicians. International literature published over the last 25 years in the databases of CINAHL, OVID, Medline Pubmed, Science Direct, Expanded Academic, ESBSCOhost, Scopus and Proquest is cited to create a case for the Clinical Nurse Research Consultant. The Clinical Nurse Research Consultant will address the research/practice gap and assist in facilitating evidence-based clinical practice. To fulfil the responsibilities of this proposed role, the Clinical Nurse Research Consultant must be a doctorally prepared recognized clinical expert, have educational expertise, and possess advanced interpersonal, teamwork and communication skills. This role will enable clinical nurses to maintain and share their clinical expertise, advance practice through research and role model the clinical/research nexus. Critically, the Clinical Nurse Research Consultant must be appointed in a clinical and academic partnership to provide for career progression and role support. The creation of the Clinical Nurse Research Consultant will advance nursing practice and the discipline of nursing. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.
Schwirian, Patricia M.; Byers, Sandra R.
This paper discusses the microcomputer in clinical nursing research. There are six general areas in which computers have been useful to nurses: nursing notes and charting; patient care plans; automated monitoring of high-tech nursing units; HIS and MIS systems; personnel distribution systems; and education.
Allen, Rebecca H; Goldberg, Alisa B
Emergency contraception is defined as a drug or device used to prevent pregnancy after unprotected sexual intercourse (including sexual assault) or after a recognized contraceptive failure. In the United States, 1.5 mg of levonorgestrel, packaged as Plan B, and the Copper T 380A intrauterine device are the most common emergency contraceptives available to women and are effective up to 5 days after unprotected sexual intercourse. In August 2006, Plan B was approved for over-the-counter sale to women aged 18 and older in the United States. It is not yet known whether the increased availability of emergency contraception will decrease unintended pregnancy and induced abortion rates.
Perry, Christina; Henderson, Amanda; Grealish, Laurie
To identify nurses' behaviours that promote student accountability for learning in clinical practice. Health care services are experiencing significant strain in meeting clinical education requirements of increasing numbers of nursing students enrolled in undergraduate nursing programs. Internationally, the transition to university based education for nurses has seen the emergence of issues for busy clinicians trying to manage increasing workloads with responsibility for student learning. An understanding of what types of supervisor behaviours promote student accountability for learning, may support clinicians to more effectively manage their dual roles of clinical care and student support. An integrative approach was adopted for this review. A search of the Cumulative Index of Nursing and Allied Health Literature, Pubmed, Scopus and Embase was undertaken, limited to articles published between 2000 and March 2017. Whittemore and Knafls' (2005) framework for conducting integrative reviews was used to ensure a methodological and rigorous approach. Nine studies were considered. Behaviours emerged in relation to four themes including: belongingness associated with a genuine partnership; empowerment and increasing student self-efficacy; trust linked to increasing and staged independence; and balancing clinical and educational requirements. Behaviours of nurses significantly influence students' accountability for learning and accordingly, their ability to be adequately prepared for professional nursing practice. Understanding behaviours that impact on students' approach to clinical placement can guide nurses in their approach to facilitating student learning, in particular, behaviours that increase student responsibility and independence over the continuum of clinical education. Copyright © 2018 Elsevier Ltd. All rights reserved.
Full Text Available A competent nursing workforce is important for an effective healthcare system. However, concerns on the poor quality of nursing care and poor competencies among nursing students, nurses, and midwives are increasing in Malawi. Anecdotal notes from stakeholders show shortfalls in nursing education. Furthermore, a large gap between theory and practice exists. This study described the role of academic–clinical partnership in strengthening nursing education. A search of ScienceDirect, PubMed, Medline, and PsychINFO on EBCSOhost and Google Scholar was conducted using the following key words: academic–clinical collaboration, academic–clinical partnership, academic practitioner gap, and college hospital partnership or/and nursing. Furthermore, peer reviewed reports on academic–clinical partnership in nursing were included in the search. Thirty-three records from 2002 to 2016 were reviewed. Six themes emerged from the review: mutual and shared goals, evidence-based practice, resource sharing and collaboration, capacity building, partnership elements, and challenges of academic clinical partnership. The review highlighted that academic–practice partnerships promote shared goal development for the healthcare system. The gap between theory and practice is reduced by the sharing of expertise and by increasing evidence-based practice. Academic clinical partnership improves competencies among students and the safety and health outcomes of patients. The study concluded that the nursing education implemented within an academic clinical partnership becomes relevant to the needs and demands of the healthcare system.
Austin, Lynn; Luker, Karen; Roland, Martin; Ronald, Martin
This qualitative study explored the experiences of two groups of clinical nurse specialists--continence advisors and tissue viability nurses--working in primary care in the UK. In particular, the study focused on how clinical nurse specialists' relationships with other health-care professionals had an impact on their role. Clinical nurse specialists are recognized worldwide as having expertise in a given field, which they use to develop the practice of others. Additionally, clinical nurse specialists share many of the characteristics of entrepreneurs, which they use to develop services related to their speciality. However, little research has been conducted in relation to clinical nurse specialists' experiences as they attempt to diversify nursing practice. An ethnographic approach was adopted comprising many elements of Glaserian grounded theory. Data were collected via participant observation and face-to-face interviews with 22 clinical nurse specialists. Services provided by clinical nurse specialists were not static, clinical nurse specialists being the main drivers for service developments. However, clinical nurse specialists encountered difficulties when introducing new ideas. Given their role as advisors, clinical nurse specialists lacked authority to bring about change and were dependent on a number of mechanisms to bring about change, including 'cultivating relationships' with more powerful others, most notably the speciality consultant. The UK government has pledged to 'liberate the talents of nurses' so that their skills can be used to progress patient services. This study highlights the fact that a lack of collaborative working practices between health-care professionals led to clinical nurse specialists being constrained. Health-care organizations need to provide an environment in which the entrepreneurial skills of clinical nurse specialists may be capitalized on. In the absence of an outlet for their ideas regarding service developments, clinical
Schwirian, Patricia M.; Byers, Sandra R.
This paper discusses the microcomputer in clinical nursing research. There are six general areas in which computers have been useful to nurses: nursing notes and charting; patient care plans; automated monitoring of high-tech nursing units; HIS and MIS systems; personnel distribution systems; and education. Three alternative models for the conduct of clinical nursing research in a hospital are described. The first is a centralized model relying on the bureaucratic structure of the hospital. Second is a decentralized network of professional nurses and research support personnel woven together by a Clinical Nurse Researcher, and third is a dedicated clinical nursing research unit. Microcomputers have five characteristics which make them vital tools for nurse researchers: user-friendliness; environment friendliness; low cost; ease of interface with other information systems; and range and quality of software.
Kim, Kyunghee; Han, Yonghee; Kwak, Yeunhee; Kim, Ji-su
Purpose: Clinical competence among nurses is an essential requirement for the provision of safe and effective patient care. This study aims to classify types of professional quality of life experienced by Korean nurses, and examine the relationship between demographic and professional characteristics and clinical competence among nurses experiencing each type. Methods: A total of 335 nurses completed questionnaires assessing professional quality of life, clinical competence, and demographi...
Reform in the South African healthcare and educational system were characterized by the ideals that the country needs to produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Quality clinical ...
Akerjordet, Kristin; Lode, Kirsten; Severinsson, Elisabeth
The aim of this study was to determine clinical nurses' interest in and motivation for research. An additional aim was to identify management and organisational resources in order to improve nurses' research capacity in practice. Clinical nurses find conducting research challenging, which accords with observations of the continuing research-practice gap. This descriptive cross-sectional survey sampled 364 clinical nurses from a university hospital on the west coast of Norway. The response rate was 61%. An increasingly positive attitude towards research emerged (40%), despite the fact that few were engaged in research-based activities. Clinical nurses emphasised that lack of designated time (60%), interest (31%) and knowledge (31%) constituted important research barriers, as did lack of research supervision and support (25%). Research supervision was one of the most significant needs to enhance clinical nurses' research skills, management and organisation of research activities (30%). Conscious efforts strategically built on clinical and academic collaborative networks are required to promote and sustain clinical nurses' research capacity. The findings of this survey should be useful in the building of clinical nurses' research capacity. © 2012 Blackwell Publishing Ltd.
Rohatinsky, Noelle; Chachula, Kathryn; Compton, Roslyn M; Sedgwick, Monique; Press, Madeline M; Lane, Brenda
Clinical experiences are essential in undergraduate nursing student education to develop professionalism and integrate theory into practice. However, little evidence is available to guide curricular planners in determining the appropriate and effective use of different clinical models in nursing education. Nursing students and four schools of nursing in two western Canadian provinces participated in this descriptive exploratory study examining student preference for clinical models. Thematic analysis of qualitative data addressed two research questions: What type of clinical model is preferred by nursing students? and How does clinical structure influence nursing students' perceived learning? Nonblock clinical practice is preferred by students with respect to a balanced lifestyle, concurrent integration of theory and practice, and critical reflection, whereas the block model is preferred for assimilation, consolidation, and socialization. Integration of both clinical models is recommended within undergraduate nursing curricula, as each model can facilitate student learning. [J Nurs Educ. 2017;56(3):152-157.]. Copyright 2017, SLACK Incorporated.
Kelly, Elizabeth K; Hunley, Anne L; Wegner, Jamie L; Grogan, Ann; Walker, Amy; Malone, Kirsten J; LaPerriere, Michelle; Saucier, Lindsay; Girvin, Sally
The collaboration between student nurses and practicing clinical nurses on an evidence-based project is described. This collaboration sought to answer a question pertinent to the needs of the clinical nurses, while providing the students with an excellent practical learning opportunity. The changes in both knowledge and practice resulting from this partnership are described.
Chang, Mei Jen; Chang, Ying-Ju; Kuo, Shih-Hsien; Yang, Yi-Hsin; Chou, Fan-Hao
To examine the relationships between critical thinking ability and nursing competence in clinical nurses. There are few evidance-based data related to the relationship between critical thinking ability and nursing competence of clinical nurses. A cross-sectional and correlation research design was used. A total of 570 clinical nurses at a medical centre in southern Taiwan were recruited into this study. Two self-report questionnaires, the Watson-Glaser Critical Thinking Appraisal (WGCTA) and the Nursing Competence Scale (NCS), were used to collect data. The critical thinking ability of clinical nurses was at the middle level. The highest score for the subscales of the WGCTA was 'interpretation ability' and the lowest was 'inference ability'. The nursing competence of clinical nurses was at the middle level and above. The highest score for the subscales was 'caring ability' and the lowest was 'research ability'. Critical thinking ability had a significantly positive correlation with nursing competence. Critical thinking, working years, educational levels and position/title were the significant predictors of nursing competence, accounting for 32·9% of the variance. Critical thinking ability had a significantly positive correlation with nursing competence. The critical thinking ability of clinical nurses with a master's degree was significantly better than those with a bachelor's degree or a diploma and nurses with over five working years was significantly better than those with under five years. The findings of this study can further serve as a reference for nursing education to improve nursing curricula and teaching strategies for nurse preparation. It could also be a guideline for nursing administration personnel in on-the-job training and orientation programs for nursing staff. © 2011 Blackwell Publishing Ltd.
Tsai, Hsiu-Hsin; Tsai, Yun-Fang; Huang, Hsiu-Li
To explore the experiences of nursing home nurses when they transfer residents from nursing homes to the emergency department in Taiwan. The transfer of residents between nursing homes and emergency departments challenges continuity of care. Understanding nursing home nurses' experiences during these transfers may help to improve residents' continuity of care. However, few empirical data are available on these nurses' transfer experiences worldwide, and none could be found in Asian countries. Qualitative descriptive study. Data were collected from August 2012-June 2013 in audiotaped, individual, in-depth interviews with 25 nurses at five nursing homes in Taiwan. Interview transcripts were analysed by constant comparative analysis. Analysis of interview transcripts revealed that the core theme of nursing home nurses' transfer experience was discontinuity in nursing home to emergency department transitions. This core theme comprised three themes: discontinuity in family involvement, discontinuity in medical resources and expectations, and discontinuity in nurses' professional role. Nursing home nurses need a working environment that is better connected to residents' family members and more immediate and/or easier access to acute care for residents. Communication between nurses and residents' family could be improved by using text messages or social media by mobile phones, which are widely used in Taiwan and worldwide. To improve access to acute care, we suggest developing a real-time telehealth transfer system tailored to the medical culture and policies of each country. This system should facilitate communication among nursing home staff, family members and hospital staff. Our findings on nurses' experiences during transfer of nursing home residents to the emergency department can be used to design more effective transfer policies such as telemedicine systems in Taiwan and other Asian countries or in those with large populations of Chinese immigrants. © 2016 John
The aim of this study was to identify and assess the teaching behaviours (knowledge, attitudes and skills) observed in nurse educators as they taught in the clinical setting. Many quantitative studies have defined and evaluated teaching effectiveness in the clinical area. Some of these studies established instruments to evaluate faculty effectiveness in the clinical setting; however, they tended to be so broad that they were of limited use in understanding clinical teaching behaviours in nursing education. This study explored clinical teaching behaviours in a nursing practicum. Ten nurse educators taught 10 students in the medical-surgical unit at a hospital in Taiwan for about four weeks. Each teacher was observed by the researcher and one other observer for two days during regularly scheduled clinical teaching time. Data collection and analysis were done by a qualitative approach. Content analysis is a process of identifying, coding and categorizing the themes in the data. The themes of clinical teaching that emerged from data analysis included teaching aims (task-oriented and learner-centred), teacher competence (teacher knowledge, instructional strategies, planning learning experience, teaching priorities, feedback and caring) and teaching commitment (professional identity and giving of self). These findings offer a holistic blueprint of clinical teaching for nursing faculty members, which will enhance the quality of nursing education. Complexity in nursing education has increased as it is challenged to meet the needs of diverse populations in rapidly evolving and highly technical health-care settings. Clinical teachers must be enabled and empowered to provide students with appropriate knowledge and skills to meet the needs of patients. To develop students' professional nursing identity now and in the future, nurse educators have to commit themselves to both nursing and teaching in clinical settings. More nurses need to be prepared for careers in education at
Zoromski, Lorraine M.
This study looked for associations between measures of emotional intelligence in an intensive clinical experience for nursing students in their final semester of an associate's degree program. The theory of emotional labor was used to make connections between nursing clinical experience and emotional intelligence. Twenty nursing students from a…
Miller, Elizabeth M; Hill, Pamela D
To examine the relationships and differences in the use of intuition among three categories of practicing nurses from various clinical units at a medical center in the Midwest. Descriptive, correlational, cross-sectional, prospective design. Three categories of nurses were based on the clinical unit: medical/surgical nurses ( n = 42), step-down/progressive care nurses ( n = 32), and critical care nurses ( n = 24). Participants were e-mailed the Rew Intuitive Judgment Scale (RIJS) via their employee e-mail to measure intuition in clinical practice. Participants were also asked to rate themselves according to Benner's (novice to expert) proficiency levels. Nurses practicing at higher self-reported proficiency levels, as defined by Benner, scored higher on the RIJS. More years of clinical experience were associated with higher self-reported levels of nursing proficiency and higher scores on the RIJS. There were no differences in intuition scores among the three categories of nurses. Nurses have many options, such as the nursing process, evidence-based clinical decision-making pathways, protocols, and intuition to aid them in the clinical decision-making process. Nurse educators and development professionals have a responsibility to recognize and embrace the multiple thought processes used by the nurse to better the nursing profession and positively affect patient outcomes.
Rosted, Elizabeth Emilie; Wagner, Lis; Henriksen, Carsten
Aim To describe and test a model for structured nursing assessment and intervention to older people discharged from Emergency Department (ED). Background Older people recently discharged from hospital are at high risk of readmission. This risk may increase when they are discharged straight home...... assessment the nurse made relevant referrals to the geriatric outpatient clinic, community health centre, general practitioner or made arrangements with next-of-kin. Results One hundred and fifty people participated, mean age was 81.7. At discharge they had a mean of 1.9 unresolved problems, after 1 month 0...
Luis,Margarita Antonia Villar; Lunetta,Ana Carolina Fuza; Ferreira,Paulo Sérgio
OBJECTIVES: This work speaks of a pilot test administered in four public services with emergency care (one at a hospital and three at community clinics) in the city of Ribeirão Preto, São Paulo, to test an assessment protocol for Alcohol Withdrawal Syndrome. Involved were auxiliaries, technicians and soon-to-be-nurses. The object was to evaluate the protocol´s potential as a guide to nursing care, and to test whether it was adequate in terms of comprehension and applicability. METHODS: A prot...
Mayckel da Silva Barreto
Full Text Available Objective: to know the perception of the nursing staff about the nurse's role in emergency service. Methods: descriptive study of a qualitative approach. 30 nursing professionals participated and were active in a unit of Emergency. The data were subjected to Content Analysis, thematic modality. Results: the interviewees highlighted as nurses functions, the development of management activities; the leadership and supervision of nursing staff; and the care provided to seriously ill patients. From the perspective of nursing technicians, management activities receive great attention from nurses, rather than direct patient care. However, for nurses, managerial functions and leadership and supervision of staff converge for quality care. Conclusion: the importance of care work of nurses in emergency situations is perceived both by nursing technicians and by nurses. However, perceptions of their role as a manager still show up conflicting.
da Silva, Rafael Celestino; Ferreira, M?rcia de Assun??o; Apostolidis, Th?mistoklis; Brand?o, Marcos Ant?nio Gomes
Objective: to propose a conceptual framework for clinical nursing care in intensive care. Method: descriptive and qualitative field research, carried out with 21 nurses from an intensive care unit of a federal public hospital. We conducted semi-structured interviews and thematic and lexical content analysis, supported by Alceste software. Results: the characteristics of clinical intensive care emerge from the specialized knowledge of the interaction, the work context, types of patients and nu...
Gillespie, Mark; Melby, Vidar
This study was designed to identify the prevalence of burnout among nurses working in Accident and Emergency (A & E) and acute medicine, to establish factors that contribute to stress and burnout, to determine the experiences of nurses affected by it and highlight its effects on patient care and to determine if stress and burnout have any effects on individuals outside the clinical setting. A triangulated research design was used incorporating quantitative and qualitative methods. Maslach Burnout Inventory was used. Nurses working in acute medicine experienced higher levels of emotional exhaustion than their A & E counterparts. The overall level of depersonalization was low. High levels of personal accomplishment were experienced less by junior members of staff. Stress and burnout have far reaching effects both for nurses in their clinical practice and personal lives. If nurses continue to work in their current environment without issues being tackled, then burnout will result. The science of nursing does not have to be painful, but by recognition of the existence of stress and burnout we can take the first steps towards their prevention.
Kim, Hyungyung; Kim, Insook; Chae, Yougmoon
This study a methodological study; to acquire knowledge on the nursing process by steps of knowledge definition, collection, and representation; then, to design a data warehouse and nursing process clinical decision support system.
Rafiee, Ghazanfar; Moattari, Marzieh; Nikbakht, Alireza N; Kojuri, Javad; Mousavinasab, Masoud
Background: The purpose of this qualitative exploratory study was to explore the views of nursing trainers and students about nursing students’ clinical evaluation problems and drawbacks in Shiraz Nursing and Midwifery School. Materials and Methods: A qualitative exploratory approach was used in this study at Shiraz Nursing and Midwifery School in 2012. A purposeful sample of 8 nursing instructors and 40 nursing students was interviewed and the data on their opinions about the problems of the clinical evaluation were collected through semi-structured deep interviews. Initially, four open-ended questions, which were related to the clinical evaluation status, problems, were used to stimulate discussions in the interview sessions. Content analysis was employed in order to analyze the transcribed data. The recorded interviews were initially transcribed, read, and reread on a number of occasions to get an overall feeling of what the participants were saying. Each line or incident was described, and then a code, which reflected the essence of the participants’ comments, was given. Results: The codes were compared for similarity and differences, merged together, and categorized. Finally, five themes emerged: In appropriate clinical evaluation method, problems of clinical evaluation Process, problems related to clinical instructors, unsuitable programming of clinical education, and organizational shortcomings. Conclusion: Besides focusing on upgrading the current clinical evaluation forms, nursing trainers should improve their knowledge about a complete and comprehensive clinical evaluation. They should also apply other appropriate and objective clinical evaluation methods and tools, and perform a formative and summative clinical evaluation. Also, workload adjustment of the nursing trainers needs revision. Therefore, despite using traditional and sometimes limited evaluation methods for assessing nursing students, a co mprehensive and appropriate evaluation of nursing
Porter, Joanne E; Cant, Robyn P; Cooper, Simon J
Non-technical skills (NTS) teamwork training can enhance clinicians' understanding of roles and improve communication. We evaluated a quality improvement project rating teams' NTS performance to determine the value of formal rating and debriefing processes. In two Australian emergency departments the NTS of resuscitation teams were rated by senior nurses and medical staff. Key measures were leadership, teamwork, and task management using a valid instrument: Team Emergency Assessment Measure (TEAM™). Emergency nurses were asked to attend a focus group from which key themes around the quality improvement process were identified. Main themes were: 'Team composition' (allocation of resuscitation team roles), 'Resuscitation leadership' (including both nursing and medical leadership roles) and 'TEAM™ ratings promote reflective practice' (providing staff a platform to discuss team effectiveness). Objective ratings were seen as enabling staff to provide feedback to other team members. Reflection on practice and debriefing were thought to improve communication, help define roles and responsibilities, and clarify leadership roles. Use of a non-technical skills rating scheme such as TEAM™ after team-based clinical resuscitation events was seen by emergency department nurses as feasible and a useful process for examining and improving multi-disciplinary practice, while improving team performance. Copyright © 2018 Elsevier Ltd. All rights reserved.
Bell, Christina Lynn
Bachelors of Science Nursing students at a small liberal arts college in the upper Midwest volunteer with an instructor at a free clinic as part of their curriculum. This study's purpose was to identify the impact of nursing students' free-clinic experiences on their subsequent professional nursing practice and their ability to attend to: (a)…
Argentero, Piergiorgio; Dell'Olivo, Bianca
Burnout phenomenon emerges from a constellation of factors which cannot be described in terms of cause-effect relationships. This study investigated levels of burnout in nurses working in Critical Care Units with a systemic approach, giving evidence of relation between nurses staff burnout and psychosocial workplace factors. The purpose of this study was to examine the relationship between job burnout in emergency and intensive care nurse with specific areas of work life in their organizations, using Maslach and Leiter work life model . A cross-sectional survey was designed using the Italian version of the "Organizational Checkup System" in a sample of 180 Italian nurses. Results showed that high burnout levels were strongly related to high demands, low control, low fairness, lack of social support, and individual disagreement on values in the workplace. High professional efficacy levels were instead correlated to professional reward and leadership involvement. The article concludes by suggesting the possible areas for intervention in order to prevent job burnout and building job engagement.
Nielsen, Kirsten; Pedersen, Birthe D.; Helms, Niels Henrik
Paul Ricoeurs theory of interpretation. This paper reports that the mandatory part promotes consciousness of own learning and competencies in clinical nursing and raises students` consciousness of nurse identity. It gives preceptors the opportunity to differentiate their supervision for individual...
Panizzon, Cristiane; Hecker Luz, Anna Maria; Fensterseifer, Lísia Maria
This exploratory study aimed at determining stress levels and stressors, verifying the association between stress and studied variables, and identifying the predictive stress factors in an emergency nursing team. Data were collected using a socialdemographic questionnaire and a scale of labor pressure sources applied with 98 workers. Chi-square test and Spearman correlation test results showed a high stress level, and identified work load as the main stressor. All pressure sources at work ...
Weiland, Tracey J.; Mackinlay, Claire; Jelinek, George A.
Background The Australian Medical Association is strongly opposed to the nurse practitioner (NP) role with concerns that NPs may become doctor substitutes without the requisite training and education that the medical role demands. Despite this, NPs have been heralded by some as a potential solution to the access block, workforce shortage and increased demand affecting emergency departments (EDs). Aims The purpose of this study was to determine the perception of NPs by medical staff working in...
Ajeigbe, David Oladipo
Background: Teamwork gained momentum in the 1980s. Research studies in the military and aviation demonstrated that teamwork is essential to safety. There were limited studies dealing with the practice of teamwork between nurses and physicians in the Emergence Departments (EDs). Aims: Descriptive aim of the study was to examine differences between staff in the Interventional and Control Groups on perception of staff teamwork. The exploratory aim was to examine staff perception of job satisfac...
Rosted, Elizabeth Emilie
the nurse made relevant referrals to geriatric outpatient clinic, community health centre, primary physician or arrangements with next-of-kin. Results: 150 geriatric patients participated, mean age 81.7 (70-99). At discharge they had in mean 2 (0-9) unresolved problems, after 1 month 0.8 (0-5), and after 6...
Fenton, Mary V.; Brykczynski, Karen A.
A comparison of results of two studies regarding the actual practice of clinical nurse specialists and nurse practitioners revealed a shared core of advanced practice competencies as well as distinct differences between practice roles. (JOW)
Jones, Carolynn Thomas; Hastings, Clare; Wilson, Lynda Law
There has been limited research to document differences in roles between nurses and non-nurses who assume clinical research coordination and management roles. Several authors have suggested that there is no acknowledged guidance for the licensure requirements for research study coordinators and that some non-nurse research coordinators may be assuming roles that are outside of their legal scopes of practice. There is a need for further research on issues related to the delegation of clinical research activities to non-nurses. This study used nominal group process focus groups to identify perceptions of experienced research nurse managers at an academic health science center in the Southern United States about the clinical research activities that are being performed by non-nurse clinical research coordinators without supervision that they believed should only be performed by a nurse or under the supervision of a nurse. A total of 13 research nurse managers volunteered to be contacted about the study. Of those, 8 participated in two separate nominal group process focus group sessions. The group members initially identified 22 activities that they felt should only be performed by a nurse or under the direct supervision of a nurse. After discussion and clarification of results, activities were combined into 12 categories of clinical research activities that participants believed should only be performed by a nurse or under the direct supervision of a nurse. Copyright © 2015 Elsevier Inc. All rights reserved.
The anticipated nursing shortage in the United States is well documented and continues to be a topic of discussion. A nationwide solution has been for nursing programs to increase their enrollment of nursing students. This could be difficult for many nursing schools; as many have a shortage of qualified nursing faculty with which to instruct…
Strobbe, Stephen; Crowley, Melanie
Alcohol and other substance use by nurses potentially places patients, the public, and nurses themselves at risk for serious injury or death. Nursing students are also at risk for problems related to substance use. When viewed and treated as a chronic medical illness, treatment outcomes for substance use disorders are comparable with those of other diseases and can result in lasting benefits. Professional monitoring programs that employ an alternative-to-discipline approach have been shown to be effective in the treatment of health professionals with substance use disorders and are considered a standard for recovery, with high rates of completion and return to practice. It is the position of the Emergency Nurses Association and the International Nurses Society on Addictions that 1. health care facilities provide education to nurses and other employees regarding alcohol and other drug use and establish policies, procedures, and practices to promote safe, supportive, drug-free workplaces; 2. health care facilities and schools of nursing adopt alternative-to-discipline approaches to treating nurses and nursing students with substance use disorders, with stated goals of retention, rehabilitation, and reentry into safe, professional practice; 3. drug diversion, in the context of personal use, is viewed primarily as a symptom of a serious and treatable disease and not exclusively as a crime; and 4. nurses and nursing students are aware of the risks associated with substance use, impaired practice, and drug diversion and have the responsibility and means to report suspected or actual concerns.
Hunter, Sharyn; Arthur, Carol
Graduate nurses may have knowledge and adequate clinical psychomotor skills however they have been identified as lacking the clinical reasoning skills to deliver safe, effective care suggesting contemporary educational approaches do not always facilitate the development of nursing students' clinical reasoning. While nursing literature explicates the concept of clinical reasoning and develops models that demonstrate clinical reasoning, there is very little published about nursing students and clinical reasoning during clinical placements. Semi-structured interviews were conducted with ten clinical educators to gain an understanding of how they recognised, developed and appraised nursing students' clinical reasoning while on clinical placement. This study found variability in the clinical educators' conceptualisation, recognition, and facilitation of students' clinical reasoning. Although most of the clinical educators conceptualised clinical reasoning as a process those who did not demonstrated the greatest variability in the recognition and facilitation of students' clinical reasoning. The clinical educators in this study also described being unable to adequately appraise a student's clinical reasoning during clinical placement with the use of the current performance assessment tool. Copyright © 2016 Elsevier Ltd. All rights reserved.
The Institute of Medicine's Future of Nursing report identifies the clinical nurse leader as an innovative new role for meeting higher health-care quality standards. However, specific clinical nurse leader practices influencing documented quality outcomes remain unclear. Lack of practice clarity limits the ability to articulate, implement and measure clinical nurse leader-specific practice and quality outcomes. Interpretive synthesis design and grounded theory analysis were used to develop a theoretical understanding of clinical nurse leader practice that can facilitate systematic and replicable implementation across health-care settings. The core phenomenon of clinical nurse leader practice is continuous clinical leadership, which involves four fundamental activities: facilitating effective ongoing communication; strengthening intra and interprofessional relationships; building and sustaining teams; and supporting staff engagement. Clinical nurse leaders continuously communicate and develop relationships within and across professions to promote and sustain information exchange, engagement, teamwork and effective care processes at the microsystem level. Clinical nurse leader-integrated care delivery systems highlight the benefits of nurse-led models of care for transforming health-care quality. Managers can use this study's findings to frame an implementation strategy that addresses theoretical domains of clinical nurse leader practice to help ensure practice success. © 2015 John Wiley & Sons Ltd.
Son, Jung Tae; Park, Myonghwa; Kim, Hye Ryoung; Lee, Woo-Sook; Oh, Kasil
The purpose of this study was to investigate RN-BSN students' clinical nursing competency in order to establish baseline data for developing nursing competency based clinical education for RN-BSN students. A survey of 1,453 RN-BSN students from 21 nursing schools was conducted using a self administered questionnaire. The mean score of the clinical nursing competency was 2.93. The scores for competency were shown as 2.91 for nursing management, 2.94 for developing professionalism & legal implementation, 2.95 for critical thinking, 2.96 for teaching & leadership, and data collection, basic nursing care, and communication were above 3.00. The items perceived as insufficient competency were physical examination and observation & monitoring in data collection, cardiopulmonary resuscitation, psycho-social care, spiritual care, hospice in basic nursing care, application of knowledge and theory, formulating nursing diagnosis, nursing care planning in critical thinking, education material development, leadership, delegation in teaching and leadership, analysis of organization, planning, infection control, role & job description, evaluation of nursing activities in nursing management, quality improvement, and research in developing professionalism and legal implementation. This study will contribute to developing a nursing competency based on clinical education for RN-BSN students who have various education needs and clinical backgrounds.
Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi
To report an analysis of the concept of nursing research culture in the context of clinical nursing practice. Nursing research culture should be valued for its contribution to improving patient care and should be considered as a routine hospital activity. However, the demand for efficiency, nurses' barriers to research use and the lack of definition of the concept of nursing research culture make it difficult to establish. Concept analysis. Data were collected through a literature review in PubMed, CINAHL and PsycINFO during March 2016. Walker and Avant's eight-step framework for concept analysis. Five defining attributes of nursing research culture in the context of clinical nursing practice were identified: strong monodisciplinary nursing professionalism, academic thinking and socialization, research use as a part of daily nursing practice, acceptance by colleagues and management and facilitation of resources from management and organization. Although the method of concept analysis has been criticized and heavily debated, the development of nursing research cultures based on the defining attributes and antecedents of the concept will be important to emphasize evidence-based clinical nursing care. Further research should support the development and the implementation of nursing research culture in clinical nursing practice. © 2016 John Wiley & Sons Ltd.
Slaughter-Smith, Cheryl; Helms, Jennifer E; Burris, Rebecca
Because nursing is a practice discipline, students are placed in clinical settings to collaborate with professional nurses in caring for patients. This descriptive study aimed to explore the benefits and limitations of undergraduate nursing students in the clinical setting. A 54-item instrument, Nursing Students' Contributions to Clinical Agencies, was used to collect data from staff nurses (N = 84) at three hospitals. The instrument also provided space for participants to share qualitative data, which revealed perceptions with which staff nurses were likely to agree and three key themes: Eager to Learn, Willing to Help, and Serving Their Time. The major implication for students is that they are often judged on their assertiveness skills and should offer assistance so they appear eager to learn. Faculty must ascertain that students understand their objectives for the clinical rotation and share those objectives with the staff nurses to enhance their learning experience. Copyright 2012, SLACK Incorporated.
Oranye, Nelson Ositadimma; Ahmad, Che'an; Ahmad, Nora; Bakar, Rosnida Abu
The objective structured clinical skills examination (OSCE) has over the years emerged as a method of evaluating clinical skills in most medical and allied professions. Although its validity and objectivity has evoked so much debate in the literature, little has been written about its application in non-traditional education systems such as in distance learning. This study examined clinical skills competence among practising nursing students who were enrolled in a distance learning programme. The study examined the effect of work and years of nursing practice on nurses' clinical skills competence. This study used observational design whereby nursing students' clinical skills were observed and scored in five OSCE stations. Two instruments were used for the data collection - A self-administered questionnaire on the students' bio-demographic data, and a check list on the clinical skills which the examiners rated on a four point scale. The findings revealed that 14% of the nurses had level four competence, which indicated that they could perform the tasks correctly and complete. However, 12% failed the OSCE, even though they had more than 10 years experience in nursing and post basic qualifications. Inter-rater reliability was 0.92 for the five examiners. Factor analysis indicated that five participant factors accounted for 74.1% of the variations in clinical skills performance. An OSCE is a necessary assessment tool that should be continuously applied in nursing education, regardless of the mode of the education program, the student's years of experience or his/her clinical placement. This study validates the need for OSCE in both the design of tertiary nursing degree programs and the assessment of nurses' clinical competency level.
Scott, Kathleen; White, Kathryn; Roydhouse, Jessica K
Clinical trials nurses play a pivotal role in the conduct of clinical research, but the educational and career pathway for these nurses remains unclear. This article reports findings from a survey of nurses working in cancer clinical trials research in Australia. Most participants held postgraduate qualifications (42 of 61); however, clinical trials education was primarily attained through short professional development courses. Interest in pursuing trial-specific postgraduate education was high, but barriers were identified, including cost, time, and unclear benefit for career advancement. Job titles varied substantially, which is indicative of an unclear employment pathway. These findings suggest that initiatives to improve the educational and career pathway for clinical trials nurses are needed and should include the following: formal educational preparation, greater consistency in employment status, and clearer career progression. These strategies should be underpinned by broad professional recognition of the clinical trials nurse as a specialized nursing role. Copyright 2013, SLACK Incorporated.
Rosted, Elizabeth Emilie; Poulsen, Ingrid; Hendriksen, Carsten
to the geriatric outpatient clinic, community health centre, primary physician or arrangements with next-of-kin. Findings: Primary endpoints will be presented as unplanned readmission to ED; admission to nursing home; and death. Secondary endpoints will be presented as physical function; depressive symptoms......Background: Geriatric patients recently discharged from hospital are at risk of unplanned readmissions and admission to nursing home. When discharged directly from Emergency Department (ED) the risk increases, as time pressure often requires focus on the presenting problem, although 80...... % of geriatric patients have complex and often unresolved caring needs. Objective: To examine the effect of a two-stage nursing assessment and intervention to address the patients uncompensated problems given just after discharge from ED and one and six months after. Method: We conducted a prospective...
Wang, Yu-Hsin; Jane, Sui-Whi; Fan, Jun-Yu; Chou, Shieu-Ming
The shortage of working nurses has made Taiwan's low nursing retention rate a critical issue in domestic healthcare. Main reasons for new nurses leaving their jobs include high pressure, overtime work, heavy workload, interpersonal relationship problems with colleagues, and inadequate support from administrators. In response, nursing educators designed the "last mile" program to improve the hands-on competence of nursing students with the goal of increasing post-graduation retention rates. This article introduces the last mile program in its present form and discusses the challenges faced in transitioning the program from the classroom into the clinical training environment. The authors suggest establishing a challenge test prior to implementing the last mile program, recruiting role-model preceptors, adjusting training program / project budgets, and developing partnerships between nursing educators and clinicians to enhance the clinical competence of new nurses and ultimately increase professional nurse retention rates, competence, and accountability.
Arrigoni, C; Grugnetti, A M; Caruso, R; Gallotti, M L; Borrelli, P; Puci, M
Developing clearly defined competencies and identifying strategies for their measurement remain unfortunately a critical aspect of nursing training. In the current international context, which continues to be characterised by deep economic crisis, universities have a fundamental role to play in redefining the educational goals to respond to the expectations of certain geographical areas of interest, as underscored in the Bologna Process (Joint Declaration of the European Ministers of Education Convened in Bologna 19 June 1999). The aim of this observational study was to examine the clinical learning context of nursing students using a tool developed by a team of teachers for the analysis of clinical learning. Redefinition of the clinical learning objectives with reference to the competencies set out in the questionnaire validated by Venturini et al. (2012) and the subsequent use of the tool created by the team of teachers for students in the first, second and third-year courses of the 2013/14 academic year, covering all the internships called for in those years. All nursing students enrolled in the first, second and third year of the nursing undergraduate degree program at the University of Pavia (no. 471) participated in this survey. A total of 1,758 clinical internships were carried out: 461 for the first year, 471 for the second year and 826 for the third year. Setting objectives, beginning with the educational offerings in the several clinical contexts, represents a strong point for this process. The results highlight a level of heterogeneity and complexity intrinsic to the University of Pavia educational system, characterized by clinical settings with different clinical levels (Research hospital and other traditional hospitals) that offering different levels of training. The use of the self-evaluation form for clinical learning made it possible to perform real-time observations of the training activities of the entire student body. An educational model
Dobrowolska, B; McGonagle, I; Jackson, C; Kane, R; Cabrera, E; Cooney-Miner, D; Di Cara, V; Pajnkihar, M; Prlić, N; Sigurdardottir, A K; Kekuš, D; Wells, J; Palese, A
In accordance with the process of nursing globalization, issues related to the increasing national and international mobility of student and qualified nurses are currently being debated. Identifying international differences and comparing similarities for mutual understanding, development and better harmonization of clinical training of undergraduate nursing students is recommended. The aim of the study was to describe and compare the nature of the nursing clinical practice education models adopted in different countries. A qualitative approach involving an expert panel of nurses was adopted. The Nominal Group Technique was employed to develop the initial research instrument for data collection. Eleven members of the UDINE-C network, representing institutions engaged in the process of professional nursing education and research (universities, high schools and clinical institutes), participated. Three data collection rounds were implemented. An analysis of the findings was performed, assuring rigour. Differences and homogeneity are reported and discussed regarding: (a) the clinical learning requirements across countries; (b) the prerequisites and clinical learning process patterns; and (c) the progress and final evaluation of the competencies achieved. A wider discussion is needed regarding nursing student exchange and internalization of clinical education in placements across European and non-European countries. A clear strategy for nursing education accreditation and harmonization of patterns of organization of clinical training at placements, as well as strategies of student assessment during this training, are recommended. There is also a need to develop international ethical guidelines for undergraduate nursing students gaining international experience. © 2015 International Council of Nurses.
Clinical supervision is described as a formal process of professional learning support in the clinical practice. The goal of clinical practice is to prepare nursing students develop and apply the necessary theoretical and empirical knowledge and skills in order for them to practice as safely and effectively as professional nurses.
This study compares quality measures among nursing homes that have adopted different levels of clinical health information technology (HIT) and examines the perceived barriers and benefits of the adoption of electronic health records as reported by Nursing Home Administrators and Directors of Nursing. A cross-sectional survey distributed online to…
Siedlecki, Sandra L; Albert, Nancy M
To develop a theoretical understanding of factors that impact decisions of clinical nurses to conduct a research study. Only a small percentage of all nurses are research-active and even fewer clinical nurses are research-active. Several researchers have explored barriers to research activity by clinical nurses, but few have examined why, in spite of all odds, some clinical nurses are research-active. As the purpose of this study was to develop a theoretical understanding of the research-active nurse, a grounded theory approach was used. The sample interviewed for this study consisted of registered nurses (n = 26) who worked in a hospital or ambulatory setting, had daily direct patient contact and had participated as principal investigator on at least one completed clinical nursing research study that was not in fulfilment of an educational requirement. The interviews were digitally recorded and analysed by two researchers using the constant comparative method. The findings from this study suggest that the conduct of research by clinical nurses was the direct result of a clinical trigger, characteristics and beliefs of the nurse about research and their role in generating knowledge, and the presence of support conditions, such as a research mentor. Clinical nurses can and do conduct research, in spite of constraints due to a lack of time, money and/or knowledge, if they have access to research mentors and are practising in a research-supportive environment. Nurses at the bedside are in a unique position to identify problems most in need of solutions. Findings from this study provide a foundation upon which to develop and test various programmes that seek to increase the number of clinical nurses who are research-active. © 2016 John Wiley & Sons Ltd.
B. B. Ntombela
Full Text Available A study was conducted to assess clinical performance of registered nurses who had recently completed the new comprehensive basic nursing course. This regional project was undertaken because of controversy surrounding clinical competence of the graduates/diplomates of the new regulation course. Senior qualified nurses gave their views according to Likert Scale statements and open-ended questions. Findings were that the sample was of the opinion that clinical performance of the new graduates/diplomates falls short of expectations.
Ahn, Yang-Heui; Choi, Jihea
Understanding the phenomenon of nursing student empowerment in clinical practice is important. Investigating the cognition of empowerment and identifying predictors are necessary to enhance nursing student empowerment in clinical practice. To identify empowerment predictors for Korean nursing students in clinical practice based on studies by Bradbury-Jones et al. and Spreitzer. A cross-sectional design was used for this study. This study was performed in three nursing colleges in Korea, all of which had similar baccalaureate nursing curricula. Three hundred seven junior or senior nursing students completed a survey designed to measure factors that were hypothesized to influence nursing student empowerment in clinical practice. Data were collected from November to December 2011. Study variables included self-esteem, clinical decision making, being valued as a learner, satisfaction regarding practice with a team member, perception on professor/instructor/clinical preceptor attitude, and total number of clinical practice fields. Data were analyzed using stepwise multiple regression analyses. All of the hypothesized study variables were significantly correlated to nursing student empowerment. Stepwise multiple regression analysis revealed that clinical decision making in nursing (t=7.59, ppractice fields (t=2.06, p=0.040). The explanatory power of these predictors was 35% (F=40.71, ppractice will be possible by using educational strategies to improve nursing student clinical decision making. Simultaneously, attitudes of nurse educators are also important to ensure that nursing students are treated as valued learners and to increase student self-esteem in clinical practice. Finally, diverse clinical practice field environments should be considered to enhance experience. Copyright © 2015 Elsevier Ltd. All rights reserved.
Mannix, Judy; Wilkes, Lesley; Daly, John
To explore how aesthetic leadership is embodied by clinical leaders in the nursing workplace. A number of different leadership styles have been developed, theorised and applied to the nursing workforce over the years. Many of these styles lack an explicit moral dimension in their identified leader attributes, due to a shift in theorising of leadership to focus on the impact of leader traits on followers. It is timely to look at aesthetic leadership, with its explicit moral dimension, as a way of improving outcomes for nurses, patients and health care organisations. Qualitative design, using conversation-style interviews with experienced registered nurses in designated clinical leadership roles. Twelve experienced registered nurses who worked in designated clinical leadership roles participated in an individual, digitally recorded, semi-structured conversation-style interview. Narrative data were transcribed and subject to thematic analysis. Three main themes emerged: 'True to their beliefs': embodying principled practice; 'Not all policies fit every patient': ethical leadership in ambiguous situations; and 'Being open to people's concerns': providing fair and just solutions. A strong moral compass shaped and guided participants' day-to-day clinical leadership activities. Participants provided a rich narrative on how aesthetic leadership is embodied in the clinical nursing setting. It was evident that their clinical leadership is shaped and guided by a strong moral compass. By incorporating into their practice an aesthetic world-view with its strong moral purpose, participants in this study have shown how aesthetic leadership can enhance the clinical nursing workplace. Nurses in the clinical setting value clinical leaders who embrace and operate with a strong moral compass. Aesthetic leadership, with its explicit strong moral purpose, offers a way of incorporating morality into clinical leadership in the nursing workplace. © 2015 John Wiley & Sons Ltd.
Haugan, Grethe; Sørensen, Ann-Hallfrid; Hanssen, Ingrid
Develop in-hospital tutorials where the hospital unit's nurse preceptor, the college teacher and student nurses discuss clinical experiences and together acquire knowledge. Literary research combined with examples from a clinical tutorial/discussion group project with B.A. student nurses, clinical nurses and college teacher. Clinical reflection groups may be an important step towards accomplishing stability in a collaborative effort between hospital and college to help students become knowledgeable, perceptive, reflecting, caring and effective nurses. The teacher's role in clinical practice is changing. The learning method described in this text, however resource-demanding, furthers close collaboration between hospital and college, and success depends on the educator's and clinician's collective competency. Our experience is that all parties concerned found that they gained a more holistic view of nurse education through participating in a forum focused on students' experiences through patient histories. Copyright © 2011 Elsevier Ltd. All rights reserved.
Full Text Available Background Scholars believe that if nursing students appreciate the value of their services, their sense of professionalism will increase and performance will improve. Nevertheless, little is known about the relationship between nursing students’ professional self-concept and clinical performance. Objectives This study examines the relationship between nurse self-concept and clinical performance among nursing students. Patients and Methods This cross-sectional analytical study employed the census method. The sample comprised 86 senior and junior nursing students at Jahrom university of medical sciences. Nurse self-concept and clinical performance were measured by using the nurses’ self-concept questionnaire (NSCQ, and the 6-dimension scale of nurse performance (6-DSNP, respectively. Results The mean and standard deviation of nurse self-concept and clinical performance scores were 5.46 ± 1.11 and 2.94 ± 1.45, respectively. Nurse self-concept was related to clinical performance (r = 0.24, P = 0.02. Total NSCQ scores were significantly related to four of the 6-DSNP dimensions: planning and evaluation, interpersonal relations and communication, critical care, and leadership. Conclusions Attempts should be made to enhance students’ nurse self-concept during their education. Counseling, improving public respect for nurses, and implementing measures to enhance students’ professional self-concept are essential for improving their performance.
O'Brien, Anthony; Leonard, Louise; Deering, Daryle
Alcohol misuse is a prevalent problem in New Zealand society, and one that exacts a considerable cost in terms of health, social cohesion, and economic productivity. Despite the burden of alcohol misuse, screening, brief assessment, and interventions for alcohol problems are frequently poorly performed within general health services. In this paper we explore the response to alcohol problems in a New Zealand emergency department and discuss difficulties encountered in improving rates of detection by emergency department personnel. We report the results of a clinical audit of alcohol screening and brief assessment and a staff education programme designed to improve practice in this area, but which met with limited success. The potential role for an advanced practice nurse providing a clinical consultation and liaison service to the emergency department staff is explored. We argue that such a role has potential to reduce the health and social costs of alcohol misuse, and to meet the national policy objective of providing a treatment response to people with alcohol-related problems in contact with health services. © 2012 The Authors. International Journal of Mental Health Nursing © 2012 Australian College of Mental Health Nurses Inc.
Lockwood, Emily B
AIM: Nurses and midwives are expanding the scope of their professional practice, assuming additional responsibilities including the management and prescribing of medications. The aim of the study was to discover the attitudes of clinical nurse specialists (CNSs) in Ireland to nurse prescribing and to examine perceived barriers to engaging in this aspect of future role expansion. BACKGROUND: The expansion of the nursing role in relation to nurse prescribing is an ongoing process and is subject to incremental iterations of legislation and professional policy. Nurse prescribing as an expanded role function has become a reality in many countries. Ireland has addressed the matter in a formal and systematic way through legislation. METHOD: A questionnaire was administered to a sample of 283 CNSs practising in a variety of care settings in Ireland. Attitudes were measured using Likert-type attitudinal scales, designed specifically for the study. RESULTS AND CONCLUSIONS: Findings indicate that the majority of clinical nurse specialists were positively disposed toward nurse prescribing as a future role expansion. The fear of litigation was identified as the most significant barrier to nurse prescribing. The majority of respondents equated nurse prescribing with increased autonomy and holistic care. The findings indicate that there is a need for further examination of the educational requirements of the CNS in relation to nurse prescribing. The legislative implications for nurse prescribing and fear of legal consequences need to be considered prior to any implementation of nurse prescribing. IMPLICATIONS FOR NURSING MANAGEMENT: While senior clinicians are willing to embrace future role expansion in the area of nurse prescribing, their Nurse Managers should recognize that facilitation of nurse prescribing needs to address the legal and educational requirements for such activity. Failure to address these requirements can represent a barrier to role expansion. This paper offers
Dall'Oglio, Immacolata; Biagioli, Valentina; Graziosi, Federica; Vanelli, Elvira; Tiozzo, Emanuela; Gawronski, Orsola; D'Elpidio, Giuliana; Buonomo, Ersilia; Villani, Alberto; Raponi, Massimiliano
. Nurses with pediatricians in pediatric outpatient clinics: a survey on family pediatricians' opinions. Pediatric nurses next to family pediatricians could contribute to several activities, included limiting inappropriate access to the emergency room. To describe the perceived benefit of the activities that could be performed by pediatric nurses in the pediatrician's clinic according to the opinion of family pediatricians. Pilot on-line survey with family pediatricians, using list of activities grouped in four areas: "Care of pediatric patients with illnesses and disabilities", "Health education", "Prevention of diseases" and "Coordination and organizational activities". For each activity a judgement of benefit (1= not useful at all; 6= very useful) was reported. Overall, 178 family pediatricians participated in the survey; 55% of them were female, mean age was 55 years. They rated as very useful both the presence of a pediatric nurse in their clinic (mean 5.37+1.06) and would recommend it to a colleague (5.36+1.05). Health education was perceived as the most important area of activity (4.88+0.97). The more they considered useful the pediatric nurse in their clinic, the higher they rated relevant the activities of the pediatric nurse (r=0.60-0.70). Older and more experienced pediatricians found less useful educational (r=-0.19 ppediatricians. Pediatricians consider very helpful a pediatric nurse in their clinic, for clinical, educational and organizational activities.
Gurney, Diane; Calleja, Paul
Every other year, the International Council of Nurses convenes a conference. In 2011 it was held in Malta, and Diane Gurney, RN, MS, CEN, ENA Past President, attended to represent ENA. In this article Diane and Paul Calleja, MSc(Manchester) Nurs, BSc (Hons) Nurs, Dip Nurs, Malta Emergency Nurses Association (MENA) International Relationship Officer, describe this visit, the significant nursing history in Malta, emergency nursing, and MENA.
Hooper, Crystal; Craig, Janet; Janvrin, David R; Wetsel, Margaret A; Reimels, Elaine
Today the proportion of acute patients entering the health care system through emergency departments continues to grow, the number of uninsured patients relying primarily on treatment in the emergency department is increasing, and patients' average acuities are rising. At the same time, support resources are constrained, while reimbursement and reputation depends increasingly on publicly available measures of patient satisfaction. It is important to understand the potential effect of these pressures on direct care staff. This study explores the prevalence of compassion satisfaction, burnout, and compassion fatigue among emergency nurses and nurses in other selected inpatient specialties. Emergency nurses and nurses from 3 other specialty units self-selected participation in a cross-sectional survey. Participants completed a sociodemographic profile and the Professional Quality of Life: Compassion Satisfaction and Fatigue Subscales, R-IV. Scale scores were summed for compassion satisfaction, burnout, and compassion fatigue for emergency nurses and compared with those of nurses in other specialties. Approximately 82% of emergency nurses had moderate to high levels of burnout, and nearly 86% had moderate to high levels of compassion fatigue. Differences between emergency nurses and those working in 3 other specialty areas, that is, oncology, nephrology, and intensive care, on the subscales for compassion satisfaction, burnout, or compassion fatigue did not reach the level of statistical significance. However, the scores of emergency nurses evidenced a risk for less compassion satisfaction, while intensive care nurses demonstrated a higher risk for burnout and oncology nurses reflected a risk for higher compassion fatigue. ED nurse managers, along with other nurse leaders, are faced with the competing demands of managing the satisfaction of patients, recruitment and retention of experienced nurses, and provision of quality and safe care customized to patients' needs
The effects of stressful incidents on emergency department (ED) staff can be profound. Witnessing aggression, violence or the death of patients, or participating in resuscitation, can be emotionally and physically demanding. Despite the frequency of these events, ED staff do not become immune to the stress they cause, and are often ill prepared and under supported to cope with them. This article reports on a study of nurses\\' and doctors\\' attitudes to, and experiences of, workplace stress in three EDs in Ireland, and offers some suggestions on how stress among ED staff can be reduced.
Lopatina, Elena; Donald, Faith; DiCenso, Alba; Martin-Misener, Ruth; Kilpatrick, Kelley; Bryant-Lukosius, Denise; Carter, Nancy; Reid, Kim; Marshall, Deborah A
Advanced practice nurses (e.g., nurse practitioners and clinical nurse specialists) have been introduced internationally to increase access to high quality care and to tackle increasing health care expenditures. While randomised controlled trials and systematic reviews have demonstrated the effectiveness of nurse practitioner and clinical nurse specialist roles, their cost-effectiveness has been challenged. The poor quality of economic evaluations of these roles to date raises the question of whether current economic evaluation guidelines are adequate when examining their cost-effectiveness. To examine whether current guidelines for economic evaluation are appropriate for economic evaluations of nurse practitioner and clinical nurse specialist roles. Our methodological review was informed by a qualitative synthesis of four sources of information: 1) narrative review of literature reviews and discussion papers on economic evaluation of advanced practice nursing roles; 2) quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials; 3) review of guidelines for economic evaluation; and, 4) input from an expert panel. The narrative literature review revealed several challenges in economic evaluations of advanced practice nursing roles (e.g., complexity of the roles, variability in models and practice settings where the roles are implemented, and impact on outcomes that are difficult to measure). The quality assessment of economic evaluations of nurse practitioner and clinical nurse specialist roles alongside randomised controlled trials identified methodological limitations of these studies. When we applied the Guidelines for the Economic Evaluation of Health Technologies: Canada to the identified challenges and limitations, discussed those with experts and qualitatively synthesized all findings, we concluded that standard guidelines for economic evaluation are appropriate for economic
Bussard, Michelle E
Clinical judgment is an essential skill needed by RNs. Employers expect new graduate nurses to enter the work-force with established clinical judgment skills. Therefore, nurse educators must ensure that prelicensure nursing students develop clinical judgment before graduation. This qualitative, interpretive description study reviewed the reflective journals of 30 prelicensure nursing students who participated in four progressive high-fidelity simulation (HFS) scenarios during a medical-surgical nursing course. Eight themes were identified in the reflective journals: (a) expectations about the patient, (b) recognition of a focused assessment, (c) interpretation of medications, laboratory data, and diagnostics, (d) communication with the patient, (e) collaboration and interprofessionalism, (f) prioritizing interventions, (g) skillfulness with interventions, and (h) incorporation of skills and information into real patient situations. This study indicated that reflective journaling following progressive HFS scenarios may be an effective teaching-learning strategy to assist prelicensure nursing students in the development of clinical judgment. Copyright 2015, SLACK Incorporated.
Kim, Hyun Ju; Choi, Jung Eun; Kim, Mi So; Kim, Su Jin; Chang, Sung Ok
This study was conducted to clarify and conceptualise nurses' clinical decision-making for preserving the remaining abilities of nursing home residents suffering from physical-cognitive functional decline. Older adults experience physical, psychological and social changes, but their remaining abilities differ across individuals. This study used a qualitative research to gain a deeper understanding of nursing homes nurses' clinical decision-making. In-depth interviews with 32 experienced nurses were undertaken. The data were analysed using conventional content analysis. Six categories and 58 subcategories of nursing practice related to managing the remaining abilities of residents with physical-cognitive functional decline were generated. The results of this study revealed five themes: (1) seeing residents' potential, (2) physical, emotional and psychosocial care in daily routines, (3) keeping personalised charts, (4) encouraging, promoting and physical and emotional support and (5) preparing residents for more independent living. The results were categorised into nurses' personal strategies based on their experience, practical nursing knowledge, nursing interventions and nursing evaluation criteria. The themes reflected positive views on the residents' functional abilities and the nursing homes nurses' perception that their goal was to help residents achieve their highest level of independence. Preserving nursing home residents' remaining abilities represents nurses' optimistic view of residents' functional status. Routine care tailored for preserving the remaining abilities of individual nursing home residents with physical-cognitive functional decline is needed. Preserving the remaining abilities of nursing home resident is supported by therapeutic interactions including close contact as well as physical and emotional support. Nurses' main goal in working with residents with remaining abilities is improving their independence. © 2016 John Wiley & Sons Ltd.
Missen, Karen; McKenna, Lisa; Beauchamp, Alison; Larkins, Jo-Ann
The aim of this study was to explore perceptions of qualified nurses on the abilities of newly registered nursing graduates to perform a variety of clinical skills. Evidence from the literature suggests that undergraduate nursing programmes do not adequately prepare nursing students to be practice-ready on completion of their nursing courses. A descriptive quantitative design was used. Participants were recruited through the Australian Nursing and Midwifery Federation, Victorian branch. A brief explanation of the study and a link to the survey were promoted in their monthly e-newsletter. A total of 245 qualified nurses in the state of Victoria, Australia participated in this study. A survey tool of 51 clinical skills and open-ended questions was used, whereby participants were asked to rate new nursing graduates' abilities using a 5-point Likert scale. Overall participants rated new nursing graduates' abilities for undertaking clinical skills as good or very good in 35·3% of skills, 33·3% were rated as adequate and 31·4% rated as being performed poorly or very poorly. Of concern, essential clinical skills, such as critical thinking and problem solving, working independently and assessment procedures, were found to be poorly executed and affecting new registered nurses graduates' competence. The findings from this study can further serve as a reference for nursing education providers to enhance nursing curricula and work collaboratively with healthcare settings in preparing nurses to be competent, safe practitioners on completion of their studies. Identifying key areas in which new nursing graduates are not yet competent means that educational providers and educators from healthcare settings can focus on these skills in better preparing our nurses to be work ready. © 2016 John Wiley & Sons Ltd.
Anna C. van Graan
Full Text Available Higher cognitive skills are essential competencies for nurses joining the technologically and increasingly complex health care environment to provide safe and effective nursing care. Educators and clinical facilitators have recognised that newly qualified nurses do not meet the expectations for entry level clinical judgement and are held accountable for finding adequate learning experiences as preparation for such practice demands. An explorative and descriptive qualitative design was followed in this study to reach an understanding of clinical judgement in the clinical nursing environment from the perspective of professional nurses. Eleven professional nurses (n = 11 working at primary health care clinics, public and private hospitals participated voluntarily. Data was collected by means of the “World Cafe” method, incorporating a combination of techniques such as interviewing, discussions, drawings, narratives and reflection. The focus was on professional nurses' knowledge of the meaning of clinical judgement and factors influencing the development of clinical judgement in the clinical environment. Qualitative thematic content analysis principles were applied during data analysis. The findings were integrated with the relevant literature to culminate in conclusions that should add to the knowledge base of clinical judgement as an essential skill for improving autonomous and accountable nursing care.
Richardson, Hila; Gilmartin, Mattia J; Fulmer, Terry
To address the faculty shortage problem, schools of nursing are reexamining how they provide clinical education to undergraduate students to find ways to use faculty resources more efficiently and to maintain student enrollment. We describe a unique clinical teaching model implemented at the New York University College of Nursing. The new model currently being evaluated shifts from the traditional clinical education model, in which all clinical education is in a hospital or agency setting, to a model that substitutes high-fidelity human patient simulation for up to half of the clinical education experience. This article describes the clinical teaching model and its effects on nurse faculty capacity. Copyright 2012, SLACK Incorporated.
Gore, Teresa N; Johnson, Tanya Looney; Wang, Chih-hsuan
Nurse educators claim accountability to ensure their students are prepared to assume leadership responsibilities upon graduation. Although front-line nurse leaders and nurse executives feel new graduates are not adequately prepared to take on basic leadership roles, professional nursing organizations such as the American Nurses Association (ANA) and the Association of Colleges of Nursing (AACN) deem leadership skills are core competencies of new graduate nurses. This study includes comparison of a leadership-focused multi-patient simulation and the traditional leadership clinical experiences in a baccalaureate nursing leadership course. The results of this research show both environments contribute to student learning. There was no statistical difference in the overall score. Students perceived a statistically significant difference in communication with patients in the traditional inpatient environment. However, the students perceived a statistical significant difference in teaching-learning dyad toward simulation.
Munroe, Belinda; Buckley, Thomas; Curtis, Kate; Murphy, Margaret; Strachan, Luke; Hardy, Jennifer; Fethney, Judith
Emergency nurses must perform accurate and complete comprehensive patient assessments to establish patient treatment needs and expedite care. To evaluate the impact of a structured approach to emergency nursing assessment following triage, on novice emergency nurses' anxiety, self-efficacy and perceptions of control. Thirty eight early career emergency nurses from five Australian hospitals performed an initial patient assessment in an immersive clinical simulated scenario, before and after undertaking training in HIRAID, an evidence-informed patient assessment framework for emergency nurses. Immediately following each scenario the nurses completed a questionnaire scoring anxiety, self-efficacy and perceptions of control levels. Paired sample t-tests and effect sizes were calculated. Participant anxiety levels were lower after HIRAID training compared to before undertaking the training (Mean (SD) = 53.26 (10.76) vs 47.46 (9.96), P = 0.002). Self-efficacy levels in assessment performance increased (189.32 (66.48) vs 214.06 (51.35), P = 0.001). There was no change in perceptions of control (31.24 (7.38) vs 30.98 (8.38), P = 0.829). High levels of anxiety and low levels of self-efficacy are known to be negatively correlated with clinical reasoning skills and performance. The effect of HIRAID training on reducing anxiety and increasing self-efficacy has the potential to improve emergency nurses' assessment performance and the quality and safety of patient care. Copyright © 2016 Elsevier Ltd. All rights reserved.
RAHMATI SHARGHI, NARJES; ALAMI, ALI; KHOSRAVAN, SHAHLA; MANSOORIAN, MOHAMMAD REZA; EKRAMI, ALI
Introduction: High quality of care is one of the requirements of nursing which depends on the nursing competency. In this connection, the aim of this research was to determine the problems related to the academic training (nursing' educational program) and clinical practice to achieve competency from the viewpoint of nurses, faculty members, and nursing students. Methods: the study was an analytical cross-sectional one. The sample consisted of the academic staff, the third and the fourth year nursing students and nurses in practice. The instrument of the study was a two-part researcher-made questionnaire with 22 questions in the theoretical- clinical realm to assess problems related to the theoretical and clinical teaching in nursing, and 23 questions to assess the clinical functions. The questionnaire was validated in terms of both face and content validity. Its reliability, using Cronbach's Alpha coefficient, was 0.72 in the theoretical-clinical and 0.73 in the clinical realm. Both descriptive and analytical statistics were used to analyze the data, using SPSS software. Results: The results of this study indicated that from the participants’ viewpoints, the most important problems in the academic education for nursea to acquire competency were as follows: lack of academic research the clinical period (88.9%), no application of theoretical aspects of the nursing process in practice (85.6%), insufficient knowledgeable and professional educators (81.1%), the use of traditional routine-oriented methods on the wards (75.6%); also insufficient time for performance based on knowledge in relation to the nurse's workload (86.5%), weakness and usefulness of scientific function encouragement systems in clinic (85.2%), and learnt theoretical subjects not coming into practice in clinical fields after graduation (75.6%). Conclusion: Efforts to reduce the gap between the theoretical and practical (clinical function) knowledge in educational and work environment are
Danyelle Lorrane Carneiro Veloso
Full Text Available This study aims to identify the knowledge and attitude towards emergency contraception among nursing students from a public university in Goiás - a state in Brazil. A descriptive and analytical research methodology with a quantitative approach was used, applying, from February to May 2011 a questionnaire on the sexual knowledge and attitude of students regarding emergency contraception. 178 students participated in the study. Knowledge was confirmed through the high frequency of correct answers to the questions, especially those concerning the correct time and the instructions for use (between 86% - 96%. Although many students use this method, there are still some doubts about the mechanism of action, side effects and access availability (frequency of correct answers lower than 50%. We noticed the need to develop educational policies that encourage the promotion of sex education in schools and universities.
Bjørk, Ida Torunn; Hamilton, Glenys A
This study analyzed nurses' perceptions of clinical decision making (CDM) in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.
Zhu, Xuemei; Yang, Li; Lin, Ping; Lu, Guizhi; Xiao, Ningning; Yang, Shufen; Sui, Shujie
The objectives of this study were to develop, implement, and evaluate an innovative modified Objective Structured Clinical Examination (OSCE) model, and to compare students' performance of different clinical skills as assessed by standardized patients and OSCE examiners. Data were obtained from final year undergraduate students undergoing the modified OSCE as a graduation examination. Seventy-seven students rotated through four stations (nine substations). Standardized patients scored students higher than examiners in history taking (9.14 ± 0.92 vs. 8.42 ± 0.85), response to emergency event (8.88 ± 1.12 vs. 7.62 ± 1.54), executive medical orders (8.77 ± 0.96 vs. 8.25 ± 1.43), technical operation (18.21 ± 1.26 vs. 16.91 ± 1.35), nursing evaluation (4.53 ± 0.28 vs. 4.29 ± 0.52), and health education stations (13.79 ± 1.31 vs. 11.93 ± 2.25; p physical examination skills was nonsignificant (8.70 ± 1.18 vs. 8.80 ± 1.27; p > .05). The modified, problem-focused, and nursing process-driven OSCE model effectively assessed nursing students' clinical competencies, and clinical and critical thinking. © The Author(s) 2016.
This article examines challenges and learning outcomes for nursing students from a Central European university of applied sciences who completed 3 months of clinical practice in Norway. The clinical practice was supervised in English by Norwegian nurses and nursing teachers. English is not the primary language in any of the countries. Increases in global migration have contributed to the need for an international dimension in nursing education. Personal mobility is a crucial part of the European Union's goal of becoming a knowledge society. Clinically based experiences pose challenges that are additional to and often more complex than traditional course-based experiences. Students who come from a non-English-speaking country for clinical practice in Norway face challenges regarding language. Accepting incoming students is a way of achieving higher quality and more relevant education in nursing. The study shows that clinical practice in a foreign country gives added value compared with clinical practice at home. Greater self-confidence and understanding of core concepts in nursing is described by the participants. Language differences are not regarded as a problem but as a way of developing personal and professional competence. The ability to compare healthcare systems in the two counties is important in developing competencies in nursing. © 2011 The Author. International Nursing Review © 2011 International Council of Nurses.
Nolet, Kim; Roberts, Tonya; Gilmore-Bykovskyi, Andrea; Roiland, Rachel; Gullickson, Colleen; Ryther, Brenda; Bowers, Barbara J.
Preparing future nurses to care for the growing population of older adults has become a national priority. The demand for long term care services is expected to double between 2000 and 2040, yet the field remains stigmatized as an undesirable place for highly-skilled nurses to work. Recent efforts to increase student preparation in geriatrics have been shown to improve student attitudes toward working with older adults and increase knowledge, but long term care settings remain unattractive to students. This paper reports on development, implementation and evaluation of The Wisconsin Long Term Care Clinical Scholars Program, a nursing home internship for baccalaureate nursing students. The program couples a paid nursing home work experience with an evidence-based long term care nursing curriculum. The program increased student preparation and interest in working with older adults and in nursing homes, while concurrently increasing the capacity of nursing homes to provide a positive student experience. PMID:25162659
Nolet, Kim; Roberts, Tonya; Gilmore-Bykovskyi, Andrea; Roiland, Rachel; Gullickson, Colleen; Ryther, Brenda; Bowers, Barbara J
Preparing future nurses to care for the growing population of older adults has become a national priority. The demand for long term care services is expected to double between 2000 and 2040, yet the field remains stigmatized as an undesirable place for highly skilled nurses to work. Recent efforts to increase student preparation in geriatrics have been shown to improve student attitudes toward working with older adults and increase knowledge, but long term care settings remain unattractive to students. This article reports on the development, implementation, and evaluation of The Wisconsin Long Term Care Clinical Scholars Program, a nursing home internship for baccalaureate nursing students. The program couples a paid nursing home work experience with an evidence-based long term care nursing curriculum. The program increased student preparation and interest in working both with older adults and in nursing homes, while increasing the capacity of nursing homes to provide a positive student experience.
Nespereira-Campuzano, Tatiana; Vázquez-Campo, Miriam
To determine stress levels and to identify if there is a relationship between emotional intelligence and work stress in nurses and healthcare assistants of the Emergency Department. Observational, descriptive and cross-sectional study with a quantitative approach. The population were nurses and healthcare assistants of the Emergency Department of the University Hospital of Ourense. The data were collected between January and May 2016. The tool used was a validated, anonymous, and self-administered questionnaire that included the Trait Meta-Mood Scale and Moreno's Brief Burnout Questionnaire. The study was approved by the Clinical Research Ethics Committee of Galicia. Descriptive and association analyses were performed using the SPSS 15.0 statistics program. A total of 60 professionals participated, of whom 36 were qualified nurses and 24 were auxiliary nurses. The response rate was 68.1%. The results showed a deficiency in emotional care, with a score of 22.87, while emotional clarity and reparation of emotions were situated within normal levels, with values of 26.42 and 26.60, respectively. The burnout levels of the sample were medium-high. The mean score in the depersonalisation dimension was 8.05, whereas emotional fatigue obtained a mean of 6.90, with a value of 7.50 for professional fulfilment. Significant positive correlations were found between the employment situation and emotional clarity (r=.276; P=.033), and between the latter and personal fulfilment (r=.277; P=.032), and organisation (r=.316; P=.014). Nurses and healthcare assistants of the Emergency Department showed medium-high average levels of burnout, with depersonalisation being the symptom that reflects the highest values. Emotional Intelligence is related to work stress and, specifically, the understanding of one's own emotional states influences personal fulfilment. Professionals with more job stability show a better capacity to feel and express their feelings. Copyright © 2017 Elsevier Espa
The recommendations made in the article on nurse educators' perceptions of OSCE as a clinical evaluation method (Chabeli, 2001:84-91) are addressed in this article. The research question: What alternative methods of assessment and evaluation can be used to measure the comprehensive and holistic clinical nursing ...
Temmink, D.; Francke, A.L.; Kerkstra, A.; Huyer Abu-Saad, H.
'Transmural care' can be defined as patient-tailored care provided on the basis of close collaboration and joint responsibility between hospitals and home care organizations. One form of transmural care is transmural nurse clinics for chronically ill. This study describes 62 transmural nurse clinics
Gonge, Henrik; Buus, Niels
AIM: To test the effects of a meta-supervision intervention in terms of participation, effectiveness and benefits of clinical supervision of psychiatric nursing staff. BACKGROUND: Clinical supervision is regarded as a central component in developing mental health nursing practices, but the eviden...
Kjær, Malene; Raudaskoski, Pirkko Liisa; Sørensen, Erik Elgaard
Student nurses are socialised into the clinical profession of being a nurse as they participate in wards in the hospitals as part of their education. Through their clinical training they learn to interact with patient and colleagues. They also experience, how spaces and relations are intertwined...
Kyunghee Kim, PhD
Conclusions: This study demonstrated that it is possible to directly examine the relationship between professional quality of life level and clinical competence among nurses. Thus, interventions to increase nurses' compassion satisfaction and relieve compassion fatigue are needed, as professional quality of life may affect clinical competence.
College of Medicine and Health Sciences, University of Rwanda. Abstract. Clinical supervision is described as a ... preceptor and facilitator model with the added benefit of a. Clinical Nurse Educator who coordinates the ... Rwanda, which offers a Bachelor of Science in Nursing with Honours degree has a modern simulation.
Baernholdt, M; Cottingham, S
This paper describes the development of the Clinical Nurse Leader (CNL ©) role and education, the CNL's impact and potential to improve quality globally. The need for clinical nurse leadership to improve the quality of health care systems while controlling costs is recognized in reports internationally. In the USA, a new nursing role, the CNL, was developed in response to such reports. CNLs are master's level nurse graduates (although not necessarily recruited from a nursing background) with the skills and knowledge to create change within complex systems and improve outcomes while they remain direct care providers. This innovative role can be adapted worldwide to improve the quality of health care systems. © 2010 The Authors. International Nursing Review © 2010 International Council of Nurses.
Jamshidi, Nahid; Molazem, Zahra; Sharif, Farkhondeh; Torabizadeh, Camellia; Najafi Kalyani, Majid
Background/Aim. Clinical learning is a main part of nursing education. Students' exposure to clinical learning environment is one of the most important factors affecting the teaching-learning process in clinical settings. Identifying challenges of nursing students in the clinical learning environment could improve training and enhance the quality of its planning and promotion of the students. We aimed to explore Iranian nursing students' challenges in the clinical learning environment. Materials and Methods. This is a qualitative study using the content analysis approach. The participants consisted of seventeen nursing students and three nursing instructors. The participants were selected through purposive sampling method and attended semistructured interviews and focus groups. Results. Three themes emerged after data analysis, including ineffective communications, inadequate readiness, and emotional reactions. Conclusion. Nursing students in Iran are faced with many challenges in the clinical learning environment. All challenges identified in this study affected the students' learning in clinical setting. Therefore, we recommend that the instructors prepare students with a specific focus on their communication and psychological needs. PMID:27366787
Ruth-Sahd, Lisa A
This paper is a report of a qualitative study of students' experiences of cooperative learning in the clinical setting. Although cooperative learning is often used successfully in the classroom, it has not been documented in the clinical setting with sophomore nursing students being paired with other sophomore nursing students. Using a grounded theory methodology a sample of 64 participants (32 student nurse dyads, eight clinical groups, in two different acute care institutions) were observed on their first day in the clinical setting while working as cooperative partners. Interviews were also conducted with students, patients and staff preceptors. Data were collected in the fall of 2008, spring and fall of 2009 and the spring of 2010 using semi-structured interviews and reflective surveys. Data were analysed using the constant comparative method. A holistic clinical education theory for student nurses was identified from the data. This theory includes a reciprocal relationship among five categories relevant to a community of learning: supportive clinical experience; improved transition into practice; enhanced socialization into the profession; increased accountability and responsibility; and emergence of self-confidence as a beginning student nurse. The use of student dyads creates a supportive learning environment while students were able to meet the clinical learning objectives. Cooperative learning in the clinical setting creates a community of learning while instilling very early in the education process the importance of teamwork. This approach to clinical instruction eases the transition from the classroom to the clinical learning environment, and improves patient outcomes. © 2011 Blackwell Publishing Ltd.
Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Puigoriol-Juvanteny, Emma; Nubó-Puntí, Núria; Chabrera-Sanz, Carolina; Subirana-Casacuberta, Mireia
To describe the profile of patients evaluated by Nurse Care Management in an Emergency Department and identify the type of alternative healthcare resource assigned and report the results of clinical practice. Prospective follow-up, on admission to the Emergency Department in an acute hospital and on discharge from the alternative healthcare resource, of patients assessed by Nurse Care Management, from July to December 2015. The patient characteristics, social environment and results of clinical practice were studied. 190 patients were included of whom 13 were readmitted (6.8%). 122 (59.8%) cases from the Emergency Department were referred to to intermediate care facilities, 71 (34.8%) cases for domiciliary care, 10 (4.9%) cases were referred to an acute care hospital and 1 (0.5%) died. Patients referred to intermediate care were more complex, presented geriatric syndromes as their reason for admission and diagnosed with dementia, while those referred to home care presented more respiratory and cardiovascular illnesses (p <0.05). The mean Barthel Index and polypharmacy before emergency admission were higher than at the time of discharge from the alternative healthcare resource (p <0.05). Patients presenting with advanced age, complexity, comorbidity, are referred to intermediate care facilities or domiciliary care, they are admitted to acute care hospitasl and are readmitted less than other patients. After being discharged from the alternative resource, they lose functional capacity and present less polypharmacy. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Nielsen, Kirsten; Pedersen, Birthe D.; Helms, Niels Henrik
This study reports the use of electronic portfolio in clinical nursing education. The study is part of a larger study investigating learning mediated by ePortfolio. The method takes a phenomenological-hermeneutic approach. The setting was a ten-week clinical course in basic nursing. The participa......This study reports the use of electronic portfolio in clinical nursing education. The study is part of a larger study investigating learning mediated by ePortfolio. The method takes a phenomenological-hermeneutic approach. The setting was a ten-week clinical course in basic nursing...... on practice and one´s own learning process. The principal initiators were emotional involvement in clinical nursing, consciousness of learning through writing; ponder over practice, and a confident and constructive student-preceptor relationship. Inhibitors were vulnerability, a preconception that one learns...
Austria, Mary Jean; Baraki, Katie; Doig, Alexa K
Formal pairing of student nurses to work collaboratively on one patient assignment is a strategy for improving the quality and efficiency of clinical instruction while better utilizing the limited resources at clinical agencies. The aim of this qualitative study was to explore the student nurse and patient experiences of collaborative learning when peer dyads are used in clinical nursing education. Interviews were conducted with 11 students and 9 patients. Students described the process of collaborative learning as information sharing, cross-checking when making clinical decisions, and group processing when assessing the outcomes of nursing interventions. Positive outcomes reported by students and patients included reduced student anxiety, increased confidence and task efficiency. Students' primary concern was reduced opportunity to perform hands-on skills which had to be negotiated within each dyad. Meeting the present and future challenges of educating nurses will require innovative models of clinical instruction such as collaborative learning using student peer dyads.
Mello, Joanna J; Bell, Janice F; Siegel, Elena O; Ward, Deborah H
Despite increasing emergency department (ED) use for psychiatric emergencies, limited evidence exists to clearly identify the competencies necessary of emergency nurses to care for this population. 1. To define the specialized skill and knowledge of emergency nurses by examining the frequency with which recommended psychiatric nursing competencies are performed in the ED setting. 2. To assess emergency nurses' rankings of importance and self-efficacy related to recommended psychiatric nursing competencies in order to explore their relevance to emergency nursing. Emergency nurses (n = 75) completed a survey ranking the frequency, importance and self-efficacy of 15 psychiatric nursing competencies. Data analysis revealed competency relevance and regression analysis demonstrated factors that may contribute to self-efficacy. Nurses reported performing psychiatric competencies frequently (mean scores of 0.64 to 3.04). Importance rankings were highest (mean scores of 1.81 to 3.67). Self-efficacy mean scores ranged from 0.89 to 3.47. Frequency and importance of activities predicted higher self-efficacy scores. Younger age and competencies often, and existing competencies appear applicable. As frequency and importance of competencies influence self-efficacy, practice and interventions to underscore the importance of competencies may improve self-efficacy. Younger and less experienced nurses might require more support. Copyright © 2016 Elsevier Ltd. All rights reserved.
Beortegui Urdánoz, Elena; Vivar, Cristina G; Canga Armayor, Navidad; Oroviogoicechea Ortega, Cristina; Canga Armayor, Anan; Ibarrola Izura, Sagrario
Social and political changes have created an increased in the demand of health care enabling the emergence of diverse professional profiles under the term Advanced Practice Nurse (APN). The APN is a nurse who has acquired a basis of expert knowledge, skills for decision making, and clinical competencies for an extended practice. In Spain, due to the Bologna process and the changes within university, such as postgraduate training, these profiles have begun to emerge. To describe the experience on the implementation of the advanced clinical nursing role in an inpatient oncology unit. Through the nine stages of the model known as Participatory, Evidence-Based Patient-Focused Process for Advanced Practice Nursing (PEPPA) the process of implementation of the Advanced Practice Nursing (APN) in an Oncology unit is described. For this purpose, the change project "Design of a care program for patients carrying a permanent draining catheter for malign ascitis and pleural effusion" was implemented. The project was grounded on the evidence-based theory and practice, and focused on the patient and the family. Its implementation has enabled the development of competences by the APN and the identification of barriers and facilitators. The changes that have taken place in society favor the development of new nursing profiles, which have a positive impact on the institutions, nursing practitioners, patients and families.
Joolaee, Soodabeh; Ashghali Farahani, Mansoureh; Jafarian Amiri, Seyedeh Roghayeh; Varaei, Shokoh
Background Although support is one of the most substantial needs of nursing students during clinical education, it is not clearly defined in the literature. Objectives The current study aimed to explore the concept of support in clinical settings as perceived by nursing students. Materials and Methods A qualitative content analysis was used to explore the meaning of student support in clinical settings. A purposive sampling with maximum variation was used to select the participants among bachelor nursing students in the nursing school of Babol University of Medical Sciences in the north of Iran. Semi-structured interviews were conducted to gather the perceptions and experiences of seventeen nursing students. Conventional content analysis was applied to analyze the data. Results In the current study, the main theme, nurturance, was emerged with seven subthemes of humanistic behavior with the student, respectful communication with students, accepting the student in the clinical setting, sustaining confidence, need based supervision, accepting the profession in the society and empowerment. Conclusions Nursing students support in the clinical education requires a nurturing care; a care that leads to the sense of worthiness and respectability in students and contributes to the improvement of their clinical abilities. PMID:27331057
Lovrić, Robert; Prlić, Nada; Milutinović, Dragana; Marjanac, Igor; Žvanut, Boštjan
Changes in nursing students' expectations of their clinical nursing faculty competences over the course of time are an insufficiently researched phenomenon. To explore what competences BSc nursing students expect from their clinical faculties during their clinical training, and whether their expectations changed during their three-year studies. Furthermore, to survey factors which influenced their expectations and whether the fulfilment levels of their expectations influenced their feelings, learning, and behaviour. A two-phase, mixed-methods design was used. The Higher Nursing Education Institution in Osijek, Croatia, European Union. A cohort of 34 BSc nursing students, who were followed over the course of their three-year studies. In Phase I, in each year, prior to their clinical training, participants responded to the same modified Nursing Clinical Teacher Effectiveness Inventory questionnaire about their expectations of clinical faculties' competences (52 items representing six categories of competences). In Phase II, seven days after their graduation, participants wrote reflections on the aforementioned expectations during their studies. The results show that Clinical faculties' evaluation of student was the category in which participants had the highest expectations in all three years. Results of Wilcoxon signed rank test indicate a significant increase of participants' expectations in all categories of clinical nursing faculties' competences during their study. Participants' reflections confirm these results and indicate that actual competences of clinical faculties and behaviour have the most significant effects on the change in these expectations. Participants reported that expectations, if fulfilled, facilitate their learning and motivation for better performance. BSc nursing students' expectations of clinical nursing faculty competences represent an important concept, as they obviously determine the quality of faculty practice. Hence, they should be
Full Text Available Background: Caring is the core of nursing and should be cultivated in student nurses. However, there are serious concerns about the caring concern in the clinical environment and in nursing education. Clinical instructors are ideally positioned to care for student nurses so that they in turn, can learn to care for their patients. Methods: A descriptive, comparative, cross-sectional and correlational quantitative research design with convenience sampling was conducted to describe the perceptions of junior student nurses (n = 148 and senior student nurses (n = 168 regarding clinicalin structor caring. A structured self administered questionnaire using the Nursing Student Perceptions of Instructor Caring (NSPIC (Wade & Kasper, 2006 was used. Descriptive statistics and hypotheses testing using parametric and non parametric methods were conducted. The reliability of the NSPIC was determined. Results: Respondents had a positive perception of their clinical instructors' caring. No relationship could be found between the course the respondents were registered for, the frequency of contact with a clinical instructor, the ages of the respondents and their perceptions of clinical instructor caring. The NSPIC was found to be reliable if one item each from two of the subscales were omitted. Conclusions: Student nurses perceived most strongly that a caring clinical instructor made them feel confident, specifically when he/she showed genuine interest in the patients and their care, and when he/she made them feel that they could be successful.
Mei-Zhi, Yuan; Jing-Ru, Sun; Tao, Chen; Xiao-Yu, Zhang; Liang-Cai, He; Jia-Song, Wang
To evaluate the effect of the clinical nursing path integrated with the holistic nursing on advanced schistosomiasis patients with ascites. A total of 226 advanced schistosomiasis patients with ascites were randomly divided into a control group and an experimental group (113 cases each group). The subjects in the experimental group were nursed by the clinical nursing path integrated with the holistic nursing, while those in the control group were nursed only by the holistic nursing. Then the clinical relevant indexes of the two groups were observed, and the quality of life of the patients before and after hospital discharge was assessed. The improvement rate, satisfaction degree, and awareness rate of health knowledge of the patients in the experiment group were 93.8%, 100% and 97.4%, respectively, which were significantly higher than those of the control group (all P holistic nursing can effectively improve the improvement rate and decrease the mortality of the advanced schistosomiasis patients with ascites; meanwhile, it can shorten the hospitalization time and save the hospitalization cost. Therefore, this nursing model is suitable for popularization and application in the treatment and nursing work of the advanced schistosomiasis assistance.
Li, Yu-Fang; Chao, Minston; Shih, Chih-Ting
Studies that examined the negative impact of violence in emergency departments on nurses' leave and avoidance behavior are well-documented. However, few studies provided an integrated model of how and when violence influences their leave and avoidance behavior. The study adopted Affective Events Theory to propose and examine a model of violent events, negative emotions, and (leave and avoidance) behaviors on nurses in emergency departments and further analyzed whether the model is salient to nurses' occupational burnout, nursing experience, and nursing rank. The sample included 123 emergency department nurses at a teaching hospital in northern, Taiwan. All participants had experienced violent incidents within the preceding 6 months. Moderated mediation analysis suggested that nurses experienced one of two emotional processes following violent incidents: "violence-negative feelings toward work-intention to resign" or "violence-negative emotion and physical symptoms-avoidance tendencies." Moreover, nurses with high burnout levels expressed weaker intention to resign after violent incidents, while nurses with more experience and higher rank were less likely to avoid violence after violent incidents. Emergency nurses do not simply elect to escape but may engage in avoidance behavior. This study revealed that how violent incidents affect nurses' resignation or avoidance behaviors depends on how they feel. Occupational burnout and nurses' attributes affected their behavior. Copyright © 2017 Elsevier Ltd. All rights reserved.
Pepin, Jacinthe; Dubois, Sylvie; Girard, Francine; Tardif, Jacques; Ha, Laurence
Cognitive modeling of competencies is important to facilitate learning and evaluation. Clinical nursing leadership is considered a competency, as it is a "complex know-act" that students and nurses develop for the quality of care of patients and their families. Previous research on clinical leadership describes the attributes and characteristics of leaders and leadership, but, to our knowledge, a cognitive learning model (CLM) has yet to be developed. The purpose of our research was to develop a CLM of the clinical nursing leadership competency, from the beginning of a nursing program to expertise. An interpretative phenomenological study design was used 1) to document the experience of learning and practicing clinical leadership, and 2) to identify critical-learning turning points. Data was gathered from interviews with 32 baccalaureate students and 21 nurses from two clinical settings. An inductive analysis of data was conducted to determine the learning stages experienced: awareness of clinical leadership in nursing; integration of clinical leadership in actions; active leadership with patient/family; active leadership with the team; and, embedded clinical leadership extended to organizational level and beyond. The resulting CLM could have significant impact on both basic and continuing nursing education. Copyright © 2010 Elsevier Ltd. All rights reserved.
Lamont, Scott; Brunero, Scott; Lyons, Sarah; Foster, Karlie; Perry, Lin
To explore intra-professional collaboration amongst nursing leadership teams at a tertiary referral hospital in Sydney. Effective working within a wide network of alliances is critical to patient outcomes. An understanding of collaboration amongst nursing leadership teams is essential within this context. A sequential explanatory mixed-methods design was used. The Collaborative Behaviour scale was sent to 106 Nurse Unit Managers, Nurse Educators and Clinical Nurse Consultants to measure pairwise collaborative behaviours; two follow-up focus groups with 15 participants were conducted. Data were collected between May 2012 and May 2013. A thematic analysis of focus group data provided a detailed explanation of the questionnaire findings. The findings identified high collaboration between dyad groups. Two themes emerged from the thematic analysis: (1) professional role and expectations; with sub-themes of transparency and clarity of individual roles; and intra/interpersonal aspects of role functioning; and (2) organisational infrastructure and governance. These leadership teams can be effective and powerful vehicles for change and are central to optimum patient outcomes. Organisational strategic planning and evaluation can benefit from understanding how to promote collaborative behaviours in these nurse leaders. To date, little research has explored collaboration amongst nursing leadership teams. Successful collaboration may contribute to the efficient use of nursing resources; improve patient outcomes, and ultimately, nurse satisfaction and retention. © 2014 John Wiley & Sons Ltd.
Xue, Ying; Tuttle, Jane
Nurse practitioners are increasingly being integrated into primary care delivery to help meet the growing demand for primary care. It is therefore important to understand nurse practitioners' productivity in primary care practice. We examined nurse practitioners' clinical productivity in regard to number of patients seen per week, whether they had a patient panel, and patient panel size. We further investigated practice characteristics associated with their clinical productivity. We conducted cross-sectional analysis of the 2012 National Sample Survey of Nurse Practitioners. The sample included full-time primary care nurse practitioners in ambulatory settings. Multivariable survey regression analyses were performed to examine the relationship between practice characteristics and nurse practitioners' clinical productivity. Primary care nurse practitioners in ambulatory settings saw an average of 80 patients per week (95% confidence interval [CI]: 79-82), and 64% of them had their own patient panel. The average patient panel size was 567 (95% CI: 522-612). Nurse practitioners who had their own patient panel spent a similar percent of time on patient care and documentation as those who did not. However, those with a patient panel were more likely to provide a range of clinical services to most patients. Nurse practitioners' clinical productivity was associated with several modifiable practice characteristics such as practice autonomy and billing and payment policies. The estimated number of patients seen in a typical week by nurse practitioners is comparable to that by primary care physicians reported in the literature. However, they had a significantly smaller patient panel. Nurse practitioners' clinical productivity can be further improved. Copyright © 2016 Elsevier Inc. All rights reserved.
Keijzers, Gerben; Thom, Ogilvie; Taylor, David; Knott, Jonathan; Taylor, David McD
To determine the clinical research priorities of Fellows of the Australasian College for Emergency Medicine (ACEM) in order to inform the strategic research agenda specific to multicentre clinical research. An anonymous survey of all ACEM Fellows (FACEMs) listed on the ACEM researcher database was conducted between January and March 2013. Of 108 FACEMs invited to participate, 54 (50%) responded. Over half of respondents (61%) had a higher research degree but only a minority (24%) had funded research positions. The top research categories identified as priorities were resuscitation, trauma, cardiology, ED ultrasound, acute behavioural disturbance and geriatrics. The most common specific sub-categories included anterior chest pain, fluid resuscitation in trauma, and drug therapy for both atrial fibrillation and acute behavioural disturbance. Several specific research questions related to chest pain, resuscitation/sepsis, stroke, paediatrics and pulmonary embolus. The findings provide guidance and support for research areas amenable to collaborative multicentre clinical research within emergency medicine. Discussion rounds are planned to translate these perceived research priorities to actual priorities. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
Hølge-Hazelton, Bibi; Kjerholt, Mette; Berthelsen, Connie Bøttcher
Aim To create awareness among nurse leaders, of what they may need to consider, when integrating nurse researchers as advanced nurse practitioners (ANP) at PhD-level among their staff. Background In a time of transition nurse leaders may be challenged by the change towards evidence-based clinical...... nursing, including integrating nurse researchers in ANP positions. Methods A collective case study including three ANPs took place at a large regional hospital in Denmark. The cases were first analysed by focusing on the generic features, functions and skills of ANPs, and second by focusing...... on the approaches to evidence-based practice seen in the cases. Results Regardless of same position, formal level of research expertise and overall responsibility, different approaches related to each ANPs professional profile, interest, academic ambitions and personality were seen. Conclusion Nurse leaders must...
Berthelsen, Connie Bøttcher; Hølge-Hazelton, Bibi
The call for evidence-based knowledge in clinical nursing practice has increased during recent decades and research in orthopaedic nursing is needed to improve patients' conditions, care and treatment. A descriptive cross-sectional survey was conducted to determine the self-perceived theoretical...... knowledge and practical research competencies among orthopaedic nurses and their interest and motivation to increase these in everyday practice. A newly developed questionnaire was given to a convenience sample of 87 orthopaedic nurses. Forty three orthopaedic nurses (49.4%) completed the questionnaire....... The results indicated that despite the majority of orthopaedic nurses having low self-perceived theoretical knowledge and practical research competencies, their interest and motivation to improve these were high, especially their inner motivation. However, the nurses' inner motivation was inhibited by a lack...
Philip, Susan; Manias, Elizabeth; Woodward-Kron, Robyn
To understand the intercultural communication experiences and associated communication training needs of overseas qualified nurses in the Australian healthcare system from the unique perspectives of nurse educators teaching in accredited bridging programmes. Overseas qualified nurses are an integral part of the nursing workforce in migration destination countries. Communication training needs are more complex when there are cultural, ethnic and language differences between nurses, other health professionals and patients. A qualitative, exploratory research design using semi-structured interviews. All (nine) organisations involved in conducting the Australian Health Practitioner Regulation Agency approved preregistration bridging programmes for overseas qualified nurses within the state of Victoria, Australia, were involved in the study. Participants were 12 nurse educators employed in these organisations. Thematic analysis was undertaken. Three macro themes emerged about the overseas qualified nurses' intercultural communication: (1) pre-existing barriers and enablers to intercultural communication, for example, nurses' reluctance to engage in communicative strategies that build rapport with patients, (2) transitional behaviours and impact on communication, including maintenance of perceived cultural hierarchies between health professionals and (3) development of communicative competence, including expanding one's repertoire of conversational gambits. The findings point to the domains and causes of communication challenges facing overseas qualified nurses in new healthcare settings as well as strategies that the nurse educators and nurses can adopt. Communication cannot be merely regarded as a skill that can be taught in a didactic programme. Comprehensive understanding is needed about the sociocultural dimensions of these nurses' orientation, which can impact on how they communicate in their new healthcare settings. The findings can act as triggers for discussion
Once considered reserved for life-threatening disease or illness, emergency departments in the United States are now described as the primary care clinic and the social work department for many Americans (Grumback, Keane & Bindman, 1993...
Phuma-Ngaiyaye, Ellemes Everret; Adejumo, Oluyinka; Dartey, Anita Fafa
Practice-based learning is important in clinical teaching of nursing and midwifery as students develop the necessary competencies and confidence aligned by the outcomes of their learning programs. However, in Malawi, research shows that clinical teaching in neonatal nursing has not been given adequate consideration. This article reports on challenges faced by educators and students in clinical teaching and learning in neonatal nursing for nurse-midwife technicians. An explorative qualitative study was conducted. Data were collected through 23 focus group discussions with 140 students and 31 clinical teachers from eight nursing colleges. Audiorecorded data were transcribed verbatim and analyzed using Hennink's content analysis stages. Challenges faced by clinical teachers and students were short duration and variation in clinical placements, lack of emphasis in clinical teaching, and lack of skills among clinical staff. Nursing training institutions should maximize student learning opportunities in neonatal nursing practice by creating more practice-based learning opportunities that meet the students' needs. [J Nurs Educ. 2017;56(4):215-221.]. Copyright 2017, SLACK Incorporated.
Mannix, Judy; Wilkes, Lesley; Daly, John
Effective clinical leadership is offered as the key to healthy, functional and supportive work environments for nurses and other health professionals. However, as a concept it lacks a standard definition and is poorly understood. This paper reports on an integrative review undertaken to uncover current understandings of defining attributes of contemporary clinical leadership in nursing. Data collection involved a search of relevant electronic databases for a 10-year period. Keywords for the search were 'clinical leadership' and 'nursing'. Ten research papers met the inclusion criteria for the integrative review. Analysis of these studies indicated clinical leadership attributes had a clinical focus, a follower/team focus or a personal qualities focus; attributes necessary to sustain supportive workplaces and build the capacity and resilience of nursing workforces. The small number of research-based studies yielded for the review indicates the need for further research in the area of clinical leadership.
Spicer, Sherri; Heller, Rebecca; Troth, Sarah
Preparing future nurses to provide appropriate care for patients and their families at the end of life can be a formidable challenge for nurse educators. Most nursing schools thread end-of-life concepts throughout the curriculum. Grand Canyon University includes a 40-hour hospice clinical as a component of a home healthcare practicum. Students' weekly written reflections reveal the depth of affective learning that occurs during this experience. Article includes hospice materials and resources.
Voltelen, Barbara; Konradsen, Hanne; Østergaard, Birte
As part of the Heart Failure Family Trial presently being conducted in Denmark, this qualitative process evaluation explored the perceptions of seven practicing cardiac nurses who offered family nursing therapeutic conversations (FNTC) to families in three heart failure outpatient clinics. FNTC were guided by the Calgary Family Assessment and Intervention Models. Data consisted of 34 case reports written by the nurses which documented the use of FNTC, including family responses to the FNTC. A focus group interview with the six of the nurses about their experience of offering FNTC was also conducted. Content analysis was performed using a combined deductive and inductive process. Nurses reported developing a distinct, closer, and more constructive relationship with the patients and their families and reported FNTC increased family bonding and strengthened family relationships. The nurses considered FNTC to be feasible interventions in the routine care provided in heart failure outpatient clinics. © The Author(s) 2016.
Andrews, Gavin J; Shaw, David
To present a geographical study that highlights the wide ranging spatial features of nursing agency. In turn, illustrate the further potential for geographical research to describe, support, challenge and guide clinical practice - particularly with regard to those 'everyday' activities and actions undertaken on a frequent basis. To provide a focus, and to anchor the study in existing clinical knowledge and debates, the role of nursing in the (re)making of institutional experiences and life is specifically explored. In-depth semi-structured interviews were conducted with 15 nurses working in Buckinghamshire and West London, UK. The following specialties were represented: acute care including emergency (n = 3), midwifery (n = 3), children's nursing (n = 2), elderly care (n = 1), rehabilitation (n = 2), mental health (n = 3) and palliative care (n = 1). Nurses claimed to actively manipulate, normalize and recreate clinical spaces as part of their everyday therapeutic practice. Specifically, the range of agency employed by them falls under the following six categories: adjusting social composition; introducing 'normal' activities; providing private spaces; seeking private spaces; explaining clinical spaces; spaces for personal escape and wellbeing. It is recommended that nurse leaders - including researchers, managers and clinical educators - explore geography as a source of social scientific evidence that sheds light on the complex nature of everyday professional practice. In this regard, some important disciplinary and structural issues are noted.
Bøttcher Berthelsen, Connie; Hølge-Hazelton, Bibi
for efficiency, nurses’ barriers to research use and the lack of definition of the concept of nursing research culture make it difficult to establish. Design Concept analysis. Data sources Data were collected through a literature review in PubMed, CINAHL and PsycINFO during March 2016. Methods Walker and Avant...
Conclusion: The results indicated that the emergency department of the studied hospital is facing with nurse shortage, particularly at night shift. Solutions to fit the number of nurses with patients in this emergency department can be classified in two areas of demand and supply of emergency services at different hours of day. Since only the early hours of the night shift is faced with large numbers of patients, the rational allocation of overtime to the evening shift nursing staff can be helpful. Furthermore, the hospital can correctly implement the triage nursing so that patient with high priority will serve at the best time.
Isfahani, Sara Shahsavari; Hosseini, Mohammad Ali; Khoshknab, Masoud Fallahi; Peyrovi, Hamid; Khanke, Hamid Reza
Background: Creativity and innovation are key elements for organization improvement, particularly in nursing, and for finding alternatives for solving nurses’ occupational problems. Nurses’ creativity is affected by motivation. Although, there are many possible sources of motivation, the Iranian nurses’ creativity is seldom clarified, and the most important factors motivating nurses to be creative in clinical settings has rarely been addressed. Objectives: The aim of this study was to explore Iranian nurses’ experiences regarding the most important factors that motivate their creativity in clinical settings. Methods: This qualitative study was conducted using conventional content analysis approach. A purposive sample of sixteen nurses was recruited from two educational hospitals affiliated to Tehran and Jahrom Universities of Medical Sciences in Iran. Data were gathered through conducting face-to-face semi-structured interviews and were analyzed by qualitative content analysis approach. Findings: Five main themes emerged from the data analysis, including: (a) Intrinsic motivators, (b) Extrinsic motivators, (c) Achievement motivators, (d) Relational or altruistic motivators, and (e) Spiritual motivators. Conclusions: Study findings indicated that nurses are creative and innovative individuals. So nurse managers and health policy makers should consider creativity as an integral part of all health and clinical strategies and policies. They should support creative and innovative efforts of nurses and provide a climate in which nurses engage in more creative and productive behaviors. PMID:26156918
Karimi, Shahnaz; Haghani, Fariba; Yamani, Nikoo; Kalyani, Majid Najafi
Reflection on practical experiences is a key element that enables students to recognize their own strengths and weaknesses and develop nursing skills. Whilst reflection may enhance students' learning in practice, there is little evidence about nursing students' perception of the consequences of reflection in clinical settings. This study aimed to explore Iranian nursing students' perception regarding the consequences of reflection during clinical practices. This qualitative study was conducted by a conventional content analysis approach in two nursing schools at Shiraz and Fasa Universities of Medical Sciences in Iran. Data were collected through in-depth semi-structured interviews during 2015-2016, from 20 students selected by purposive sampling. All the interviews were tape-recorded, transcribed verbatim, and analyzed by content analysis method. Rigor of this study was approved by member check and external audit. Two categories emerged from the data analysis, including movement toward professionalism and self-actualization of emotions. The former consisted of three subcategories of function modification, sharing experiences and generalizing experiences. The latter consisted of two subcategories of inner satisfaction and peace of mind. The results indicated that nursing students' reflection in clinical settings is effective in personal and professional levels. Reflection in a personal level led to positive emotions that increased the quality of care in patients. Accordingly, nursing educators need to create a nurturing climate as well as supporting reflective behaviors of nursing students.
Whalen, Kimberly; Bavuso, Karen; Bouyer-Ferullo, Sharon; Goldsmith, Denise; Fairbanks, Amanda; Gesner, Emily; Lagor, Charles; Collins, Sarah
To understand requests for nursing Clinical Decision Support (CDS) interventions at a large integrated health system undergoing vendor-based EHR implementation. In addition, to establish a process to guide both short-term implementation and long-term strategic goals to meet nursing CDS needs. We conducted an environmental scan to understand current state of nursing CDS over three months. The environmental scan consisted of a literature review and an analysis of CDS requests received from across our health system. We identified existing high priority CDS and paper-based tools used in nursing practice at our health system that guide decision-making. A total of 46 nursing CDS requests were received. Fifty-six percent (n=26) were specific to a clinical specialty; 22 percent (n=10) were focused on facilitating clinical consults in the inpatient setting. "Risk Assessments/Risk Reduction/Promotion of Healthy Habits" (n=23) was the most requested High Priority Category received for nursing CDS. A continuum of types of nursing CDS needs emerged using the Data-Information-Knowledge-Wisdom Conceptual Framework: 1) facilitating data capture, 2) meeting information needs, 3) guiding knowledge-based decision making, and 4) exposing analytics for wisdom-based clinical interpretation by the nurse. Identifying and prioritizing paper-based tools that can be modified into electronic CDS is a challenge. CDS strategy is an evolving process that relies on close collaboration and engagement with clinical sites for short-term implementation and should be incorporated into a long-term strategic plan that can be optimized and achieved overtime. The Data-Information-Knowledge-Wisdom Conceptual Framework in conjunction with the High Priority Categories established may be a useful tool to guide a strategic approach for meeting short-term nursing CDS needs and aligning with the organizational strategic plan.
Thomas, Juliet; Jinks, Annette; Jack, Barbara
Clinical practice is where student nurses are socialised into a professional role and acquire the distinct behaviour, attitudes and values of the nursing profession. Getting it right at the outset can maximise the development of a professional identity and the transmission of robust value systems. To explore the impact of the first clinical placement on the professional socialisation of adult undergraduate student nurses in the United Kingdom. Data of a longitudinal qualitative nature were collected and analysed using grounded theory. First year student nurses in hospital ward placements comprising a rural District General Hospital and a large inner city Hospital kept daily unstructured diaries for six weeks. A total of 26 undergraduate adult student nurses were purposefully sampled between 2008 and 2010 before undertaking their initial clinical placement. Data collection and analysis used grounded theory and the key question asked of the diarists 'tell me what it is like to be a first year nurse on a first placement' was theoretically adjusted during constant comparison and as the theory emerged. Ethical approval and consent was obtained. The theory of finessing incivility comprises a conceptual framework depicting how student nurses deal with professional incivility during their initial clinical placement and sustain a student identity. Being disillusioned with their role as worker rather than learner yields a sense of 'status dislocation'. Despite needing professional benevolence, they remain altruistic and seek recompense from significant others to negotiate for learning opportunities and relocate their student status. Despite the stressful transition into clinical practice rather than 'fit in', the student nurses want to belong as learners. His or her own resilience to learn nursing and be a professional student maintains their resolve, their altruism and strengthens their existing values to be benevolent towards an indifferent profession. This behaviour
Solvoll, Betty-Ann; Heggen, Kristin M
Care has always been a key element of nursing. This paper presents findings from research on the following issue: What opportunities and limitations do nursing students encounter when learning nursing care? The study has a qualitative design with field methodology and the study of documents. Six nursing students have been closely monitored during their clinical studies in hospitals, nursing homes and home-based nursing. The study shows that nursing students are likely to possess the potential to provide care for sick and unknown people. The motivation for their commitment to patients may contain an egoistical orientation and runs contrary to former ideals of the nurse's self-sacrificing altruism. Moreover the study shows that there is a potential in the clinical field and in the university college to reflective considerations on experience of care. While clinical practice often has focus on practical problem-solving and procedures, the college tends to focus on abstract theory. Both of these promote the privatisation and neglect of the students' experience of care. The paper concludes with a call for teaching and learning strategies targeting the use of nursing students' personal experience of care.
Senn, Joanne F
The author in this column highlights aspects of Peplau's theory of interpersonal relations and its use both in emergency nursing and rural nursing. Long and Weinert identified the concepts of rural nursing. Some differences between Peplau's theory and rural nursing can be identified through definitions of theory and conceptual models. Despite these differences, there are some common themes between both theories that are described and compared.
Vuille, Marilène; Foerster, Maryline; Foucault, Eliane; Hugli, Olivier
To investigate the assessment of pain intensity in the specific context of triage. Acute pain affects most patients admitted to emergency departments, but pain relief in this setting remains insufficient. Evaluation of pain and its treatment at the time of patient triage expedites the administration of analgesia, but may be awkward at this time-pressured moment. The assessment of pain intensity by a validated pain scale is a critical initial step, and a patient's self-reporting is widely considered as the key to effective pain management. According to good practice guidelines, clinicians must accept a patient's statement, regardless of their own opinions. A qualitative methodology rooted in interactionist sociology and on the Grounded theory was used to provide an opportunity to uncover complex decision-making processes, such as those involved in assessing pain. A sociologist conducted semi-structured interviews during the 2013-2014 winter months with twelve nurses and trained in the use of an established protocol, focusing on the assessment of pain intensity. The interviews were recorded, fully transcribed and analysed. The most frequently used pain scale was the Verbal Numerical Rating Scale. Discrepancies between self-assessment and evaluation by a nurse were common. To restore congruence between the two, nurses used various tactics, such as using different definitions of the high-end anchor of the scale, providing additional explanations about the scale, or using abnormal vital signs or the acceptance of morphine as a proof of the validity of severe pain ratings. Nurses cannot easily suspend their own judgement. Their tactics do not express a lack of professionalism, but are consistent with the logic of professional intervention. This article presents triage nurses' reality in a time-pressured environment, and understanding this conflict may outline new educational targets to further improve pain management in ED. © 2017 John Wiley & Sons Ltd.
Delaney, Connie W.; Mehmert, Peg
Computerized information systems may offer the most efficient, cost effective approach for maximizing the use of the Nursing Minimum Data Set to meet the data access and comparability demands for validation of nursing diagnoses. This report addressed Phases I and II of a larger study testing the research utility of the NMDS. The utility of the NMDS for retrospective validation of four nursing diagnoses as well as electronic retrieval and transfer of the NMDS from a computerized clinical infor...
Modic, Mary Beth; Canfield, Christina; Kaser, Nancy; Sauvey, Rebecca; Kukla, Aniko
The purpose of this project was to enhance the knowledge of the bedside nurse in diabetes management. A forum for ongoing support and exploration of clinical problems, along with the distribution of educational tools were the components of this program. Diabetes accounts for 30% of patients admitted to the hospital. It has become more challenging to manage as the treatment choices have increased. There are a number of researchers who have identified nurse and physician knowledge of diabetes management principles as suboptimal. DESCRIPTION OF THE INNOVATION: Staff nurses are educated for a role as a Diabetes Management Mentor and are expected to educate/dialogue with peers monthly, model advocacy and diabetes patient education skills, facilitate referrals for diabetes education, and direct staff to resources for diabetes management. Diabetes Management Mentors feel more confident in their knowledge of diabetes and their ability to resolve clinical issues as they arise. The Diabetes Management Mentor role is another avenue for nurses to refine their clinical knowledge base and acquire skills to share with colleagues while remaining at the bedside. The clinical nurse specialist is expertly prepared to foster the professional development of bedside nurses while simultaneously making a positive impact on disease management. Opportunity for future investigation includes efficacy of teaching tools on diabetes mastery, the effect of clinical nurse specialist mentoring on a select group of bedside nurses, and the Diabetes Management Mentor's impact on prevention of near-miss events.
Canty, Louise; Kearney, Anthony
Emergency care settings in Ireland have struggled with a high volume of service users in recent years. This nationwide crisis led to the establishment of the National Emergency Medicine Programme Strategy in 2012, which identified two key performance indicators for efficiency in emergency care: the patient experience time, which should not exceed six hours from the time of registration to the time of discharge; and patients who do not wait for treatment (DNW) should make up less than 5% of those attending emergency care services. This article explores a quality initiative to improve DNW rates using scheduled return clinics, implemented by a group of advanced nurse practitioners in an emergency department in a Dublin hospital. It reviews the literature on scheduled return clinics and discusses the rationale for the initiative, its implementation, barriers to its introduction and an audit of its effectiveness. ©2018 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.
van der Wath, Annatjie; van Wyk, Neltjie; Janse van Rensburg, Elsie
To report a study of emergency nurses' experiences of caring for survivors of intimate partner violence. Emergency nurses have the opportunity to intervene during the period following exposure to intimate partner violence when survivors are most receptive for interventions. The confrontation with the trauma of intimate partner violence can, however, affect emergency nurses' ability to engage empathetically with survivors, which is fundamental to all interventions. The research was guided by the philosophical foundations of phenomenology as founded by Husserl. A descriptive phenomenological inquiry grounded in Husserlian philosophy was used. The phenomenological reductions were applied throughout data collection and analysis. During 2010, concrete descriptions were obtained from interviewing 11 nurses working in emergency units of two public hospitals in an urban setting in South Africa. To arrive at a description of the essence, the data were analysed by searching for the meaning given to the experience of caring for survivors of intimate partner violence. Emergency nurses in South Africa are often witnesses of the emotional and physical effects of intimate partner violence. Exposure to the vulnerability and suffering of survivors elicits sympathy and emotional distress. Emergency nurses are left with the emotional impact and disruptive and recurrent memories. Exploring the tacit internal experiences related to caring for survivors of intimate partner violence revealed emergency nurses' vulnerability to the effects of secondary traumatic stress. The findings generated an opportunity to develop guidelines through which to support and empower emergency nurses. © 2013 Blackwell Publishing Ltd.
Hemphill, J. Claude; White, Douglas B.
Mortality and morbidity remain high from neurological emergencies such as acute stroke, traumatic brain injury, and hypoxic-ischemic encephalopathy after cardiac arrest. Decisions regarding initial aggressiveness of care must be made at the time of presentation and perceived prognosis is often used as part of this decision-making process. However, these decisions are predicated on the accuracy of early outcome prediction. Decisions to limit treatment early after neuro-emergencies must be balanced with avoidance of self-fulfilling prophecies of poor outcome due to clinical nihilism. This article examines the role of prognostication early after neuro-emergencies, the potential impact of early treatment limitations, and how these may relate to communication with patients and surrogate decision makers in the context of these acute neurological events. PMID:19218017
Hsu, Li-Ling; Hsieh, Suh-Ing; Huang, Ya-Hsuan
Nurses must develop competence in evidence-based nursing in order to provide the best practice medical care to patients. Evidence-based nursing uses issue identification, data mining, and information consolidation from the related medical literature to help nurses find the best evidence. Therefore, for medical institutions to provide quality clinical care, it is necessary for nurses to develop competence in evidence-based nursing. This study aims to explore the effect of a fundamental evidence-based nursing course, as a form of educational intervention, on the development of evidence-based nursing knowledge, self-efficacy in evidence-based practice activities, and outcome expectations of evidence-based practice in nurse participants. Further the competence of these nurses in overcoming obstacles in evidence-based nursing practice. This quasi-experimental study used a pre-post test design with a single group of participants. A convenience sample of 34 nurses from a municipal hospital in northern Taiwan received 8 hours of a fundamental evidence-based nursing course over a two-week period. Participants were asked to complete four questionnaires before and after the intervention. The questionnaires measured the participants' basic demographics, experience in mining the medical literature, evidence-based nursing knowledge, self-efficacy in evidence-based practice activities, outcome expectations of evidence-based practice, competence in overcoming obstacles in evidence-based nursing practice, and learning satisfaction. Collected data was analyzed using paired t, Wilcoxon Signed Rank, and McNemar tests to measure the differences among participants' evidence-based nursing knowledge and practice activities before and after the workshop. The nurses demonstrated significantly higher scores from pre-test to post-test in evidence-based nursing knowledge II, self-efficacy in evidence-based nursing practice activities, and outcome expectations of evidence-based practice
Chapman, Rose; Watkins, Rochelle; Bushby, Angela; Combs, Shane
Inconsistencies abound in the literature regarding staff attitudes and perceptions toward family-witnessed resuscitation. Our study builds on previous research by using a validated tool to investigate emergency department staff perceptions of family-witnessed resuscitation. A cross-sectional survey was distributed to 221 emergency department doctors' and nurses'. We found few differences between doctors and nurses perceptions toward family-witnessed resuscitation. Both nurses and doctors who ...
Meeks-Sjostrom, Diana J
A descriptive correlational design was used to examine the clinical decision making of nurses regarding elder abuse. The relationship of the nurses' applied knowledge of elder abuse, years of experience as a Registered Nurse (RN), clinical level of practice status, the use of intuition, and clinical decision outcomes for patients in cases of suspected elder abuse were examined. The convenience sample of 84 RNs consisted of 68 females and 16 males. Results indicated an overall model of two predictors that significantly predicted outcomes. The t-test revealed no difference between RNs who received elder abuse education and those who did not.
Full Text Available Maria Concetta Interrigi,1 Francesca M Trovato,2,3 Daniela Catalano,3,4 Guglielmo M Trovato3,5 1Accident and Emergency Department, Ospedale Cannizzaro, Catania, 2Accident and Emergency Department, Ospedale Civile, Ragusa, 3Department of Clinical and Experimental Medicine, The School of Medicine, University of Catania, 4Postgraduate School of Clinical Ultrasound, Department of Clinical and Experimental Medicine, Azienda Ospedaliero-Universitaria Policlinico, University of Catania, 5Postgraduate School of e-Learning and ICT in Health Sciences, The School of Medicine, University of Catania, Catania, Italy Purpose: Thoracic ultrasound (TUS has been proposed as an easy-option replacement for chest X-ray (CXR in emergency diagnosis of pneumonia, pleural effusion, and pneumothorax. We investigated CXR unforeseen diagnosis, subsequently investigated by TUS, considering its usefulness in clinical risk assessment and management and also assessing the sustainability of telementoring. Patients and methods: This observational report includes a period of 6 months with proactive concurrent adjunctive TUS diagnosis telementoring, which was done using freely available smartphone applications for transfer of images and movies. Results: Three hundred and seventy emergency TUS scans (excluding trauma patients were performed and telementored. In 310 cases, no significant chest pathology was detected either by CXR, TUS, or the subsequent work-up; in 24 patients, there was full concordance between TUS and CXR (ten isolated pleural effusion; eleven pleural effusion with lung consolidations; and three lung consolidation without pleural effusion; in ten patients with lung consolidations, abnormalities identified by CXR were not detected by TUS. In 26 patients, only TUS diagnosis criteria of disease were present: in 19 patients, CXR was not diagnostic, ie, substantially negative, but TUS detected these conditions correctly, and these were later confirmed by computed
Zakari, Nazik M A; Hamadi, Hanadi Y; Salem, Olfat
Effective instruction is imperative to the learning process of clinical nursing instructors. Faculty members are required to provide high-quality teaching and training by using new ways of teaching pedagogical methods to clinical instructors, which have transformed pedagogies from an exclusive clinical model to a holistic model. The purpose of this study was to explore clinical instructors' use of planning, implementation, feedback loops, and reflection frameworks to apply research-based teaching and to examine the pedagogy used during field experience. Data for the qualitative study were obtained from twenty purposefully sampled clinical teachers (n=20) via lists of questioned instructional practices and discussions, semi-structured interviews, observational notes, field notes, and written reflections. Data were analyzed by using a triangulation method to ensure trustworthiness, credibility, and reliability. Three main themes emerged regarding the use of research-based teaching strategies: the need for learning about research-based pedagogy, support mechanisms to implement innovative teaching strategies, and transitioning from nursing student to nursing clinical instructors. It has been well documented that the nursing profession faces a serious shortage of nursing faculty, impacting the quality of clinical teaching. Developing clinical instructor programs to give students opportunities to select instructor pathways, focusing on knowledge promoting critical thinking and life-long professional development, is essential. Nursing colleges must collaborate by using a partnership model to achieve competency in planning, implementation, feedback loops, and reflection. Applying research-based clinical teaching requires the development of programs that integrate low-fidelity simulation and assisted instruction through the use of computers in Nursing Colleges. Copyright © 2014 Elsevier Ltd. All rights reserved.
Kashani, Parvin; Mirbaha, Sahar; Forouzanfar, Mohammad Mehdi; Meschi, Farahnaz; Baratloo, Alireza
The prevalence of behavioral disorders is substantially higher in stressful working environments such as emergency departments. The present study aimed to evaluate the prevalence of personality disorders among emergency nurses. In the present epidemiologic study, the prevalence of personality disorders among emergency nurses of three educational hospitals, Tehran, Iran, were evaluated based on Minnesota Multiphasic Personality Inventory-2 (MMPI-2) test. After the questionnaires were filled, data were entered to a special software for MMPI-2 test and the final result was interpreted based on the opinion of a clinical psychologist. Findings were reported using descriptive statistics. 102 emergency nurses with the mean age of 30.2 ± 5.6 years were enrolled (100% female; 100% with master's degree in nursing). The mean working time and experience of studied nurses were 210.8 ± 47.9 hours/month (130-370) and 4.1 ± 3.6 years (1-20), respectively. 32 (31.4%) cases showed symptoms of personality disorders The most common personality disorder detected in this study was somatization with 8.8%, hysteria with 6.9% prevalence, and pollyannaish with 4.9%. Among the studied factors only recent history of unpleasant event has significant correlation with existence of personality disorders (p = 0.015). The present study showed that somatization, hysteria, and pollyannaish were the most common personality disorders among the emergency nurses. History of an unpleasant event in the past year was the only effective factor in existence of personality disorders in the studied nurses.
Full Text Available Introduction: The prevalence of behavioral disorders is substantially higher in stressful working environments such as emergency departments. The present study aimed to evaluate the prevalence of personality disorders among emergency nurses.Methods: In the present epidemiologic study, the prevalence of personality disorders among emergency nurses of three educational hospitals, Tehran, Iran, were evaluated based on Minnesota Multiphasic Personality Inventory-2 (MMPI-2 test. After the questionnaires were filled, data were entered to a special software for MMPI-2 test and the final result was interpreted based on the opinion of a clinical psychologist. Findings were reported using descriptive statistics.Results: 102 emergency nurses with the mean age of 30.2 ± 5.6 years were enrolled (100% female; 100% with master’s degree in nursing. The mean working time and experience of studied nurses were 210.8 ± 47.9 hours/month (130-370 and 4.1 ± 3.6 years (1-20, respectively. 32 (31.4% cases showed symptoms of personality disorders The most common personality disorder detected in this study was somatization with 8.8%, hysteria with 6.9% prevalence, and pollyannaish with 4.9%. Among the studied factors only recent history of unpleasant event has significant correlation with existence of personality disorders (p = 0.015.Conclusion: The present study showed that somatization, hysteria, and pollyannaish were the most common personality disorders among the emergency nurses. History of an unpleasant event in the past year was the only effective factor in existence of personality disorders in the studied nurses.
Full Text Available Objective: This exploratory, quantitative, descriptive study was undertaken to explore the relationship between clinical performance and anticipated retention in nursing students. Methods: After approval by the university′s Human Subjects Committee, a sample of 104 nursing students were recruited for this study, which involved testing with a valid and reliable emotional intelligence (EI instrument and a self-report survey of clinical competencies. Results: Statistical analysis revealed that although the group average for total EI score and the 6 score subsets were in the average range, approximately 30% of the individual total EI scores and 30% of two branch scores, identifying emotions correctly and understanding emotions, fell in the less than average range. This data, as well as the analysis of correlation with clinical self-report scores, suggest recommendations applicable to educators of clinical nursing students. Conclusions: Registered nurses make-up the largest segment of the ever-growing healthcare workforce. Yet, retention of new graduates has historically been a challenge for the profession. Given the projected employment growth in nursing, it is important to identify factors which correlate with high levels of performance and job retention among nurses. There is preliminary evidence that EI "a nontraditional intelligence measure" relates positively not only with retention of clinical staff nurses, but with overall clinical performance as well.
Marvos, Chelsea; Hale, Frankie B
This exploratory, quantitative, descriptive study was undertaken to explore the relationship between clinical performance and anticipated retention in nursing students. After approval by the university's Human Subjects Committee, a sample of 104 nursing students were recruited for this study, which involved testing with a valid and reliable emotional intelligence (EI) instrument and a self-report survey of clinical competencies. Statistical analysis revealed that although the group average for total EI score and the 6 score subsets were in the average range, approximately 30% of the individual total EI scores and 30% of two branch scores, identifying emotions correctly and understanding emotions, fell in the less than average range. This data, as well as the analysis of correlation with clinical self-report scores, suggest recommendations applicable to educators of clinical nursing students. Registered nurses make-up the largest segment of the ever-growing healthcare workforce. Yet, retention of new graduates has historically been a challenge for the profession. Given the projected employment growth in nursing, it is important to identify factors which correlate with high levels of performance and job retention among nurses. There is preliminary evidence that EI a nontraditional intelligence measure relates positively not only with retention of clinical staff nurses, but with overall clinical performance as well.
Kim, Kyunghee; Han, Yonghee; Kwak, Yeunhee; Kim, Ji-su
Clinical competence among nurses is an essential requirement for the provision of safe and effective patient care. This study aims to classify types of professional quality of life experienced by Korean nurses, and examine the relationship between demographic and professional characteristics and clinical competence among nurses experiencing each type. A total of 335 nurses completed questionnaires assessing professional quality of life, clinical competence, and demographic and professional characteristics. Following identification of the underlying factors of professional quality of life, we classified participants into three clusters. There were significant differences in age, marital status, religion, educational status, and position between clusters. Results also revealed that nurses with high compassion satisfaction and low compassion fatigue (burnout, secondary traumatic stress) tended to have higher clinical competence. This study demonstrated that it is possible to directly examine the relationship between professional quality of life level and clinical competence among nurses. Thus, interventions to increase nurses' compassion satisfaction and relieve compassion fatigue are needed, as professional quality of life may affect clinical competence. Copyright © 2015. Published by Elsevier B.V.
Kuo, Chien-Lin; Turton, Michael; Cheng, Su-Fen; Lee-Hsieh, Jane
Journaling has been incorporated into many nursing courses as an active reflective teaching strategy that can facilitate the learning process, personal growth, and professional development of students. There is limited research support of journaling as an appropriate tool to promote reflection for the purpose of learning caring in nursing education. The aim of this study was to explore the experiences and perceptions of student nurses and instructors who use clinical caring journaling (CCJ) in their clinical practicum. Researchers used a descriptive qualitative research design. The study population was 880 senior student nurses and 90 clinical instructors from a nursing program at a university in Taiwan who used CCJ. After completion of 1 year of clinical practicum, 16 students and 7 instructors participated voluntarily in focus group interviews. Researchers used content analysis to sort interview data into themes. Six themes were categorized that encapsulated student and instructor experiences and perceptions regarding using CCJ in their clinical practicum. These themes were guiding caring behavior toward patients, enabling students' reflective caring abilities, building up students' self-confidence, increasing interaction between students and instructors, enhancing students' self-development, and overcoming writing difficulty. Research findings may serve as a reference for nursing educators to use CCJ strategy in student nurses' clinical practicum.
Marvos, Chelsea; Hale, Frankie B.
Objective: This exploratory, quantitative, descriptive study was undertaken to explore the relationship between clinical performance and anticipated retention in nursing students. Methods: After approval by the university's Human Subjects Committee, a sample of 104 nursing students were recruited for this study, which involved testing with a valid and reliable emotional intelligence (EI) instrument and a self-report survey of clinical competencies. Results: Statistical analysis revealed that although the group average for total EI score and the 6 score subsets were in the average range, approximately 30% of the individual total EI scores and 30% of two branch scores, identifying emotions correctly and understanding emotions, fell in the less than average range. This data, as well as the analysis of correlation with clinical self-report scores, suggest recommendations applicable to educators of clinical nursing students. Conclusions: Registered nurses make-up the largest segment of the ever-growing healthcare workforce. Yet, retention of new graduates has historically been a challenge for the profession. Given the projected employment growth in nursing, it is important to identify factors which correlate with high levels of performance and job retention among nurses. There is preliminary evidence that EI a nontraditional intelligence measure relates positively not only with retention of clinical staff nurses, but with overall clinical performance as well. PMID:27981096
The Humanistic Clinical Care and Nurse Healing series of graduate studies courses at National Yang-Ming University reflects the mission and goals of the master's and doctoral programs to cultivate the core competence of students. The humanistic nursing curriculum is designed to engender nurse subjectivity by integrating multidisciplinary knowledge. Courses focus on humanistic ideals and ontological, epistemological and methodological nurse fitness while cultivating nurses' humanistic caring competence and humanistic knowledge development. The Humanistic Clinical Care and Nursing Healing curriculum addresses core subject areas including psychoanalysis and humanistic caring, humanistic clinical knowledge exploration, western philosophy and humanistic caring, imaging art and humanistic caring, and the humanistic caring aspect of helping others as well as discusses creative and evidence-based ideas in health promotion and humanistic nursing. The curriculum begins with identifying and understanding concepts, then advances toward applying concepts in practice, reflection, and healing. This paper introduces curriculum structure and content, evaluates student learning through focus groups and assignment content analysis, and discusses the future development potential of humanistic clinical care and nurse healing.
Stress impacts negatively and positively depending on how effectively the individual experiencing the phenomenon is able to cope. The objective of this study was to identify the stressors in clinical practice for nursing students and the coping mechanisms used. Eighty-nine (89) students from the Department of Nursing, ...
McKenna, Lisa; McCall, Louise; Wray, Natalie
Many nursing students enter undergraduate programmes with preconceived ideas about their future nursing careers, and intend to practice in particular areas such as midwifery or paediatrics. Through clinical placements, students are exposed to different clinical areas and professional socialization is facilitated. However, little is known about the influence of clinical placements on students' career intentions. This paper reports nursing findings drawn from a large qualitative study conducted in Victoria, Australia that sought to explore the influence of health professional students' clinical placements on their future career intentions. Participants were invited to be involved in either face-to-face or focus group interviews depending upon their own preference. Thematic data analysis revealed three main themes: 're-affirming career choice', 'working in a particular area' and 'work location'. Findings from the study add to our understanding of factors influencing nursing students' planning for their future careers including the impact of clinical placements.
Giddens, Jean Foret; Lauzon-Clabo, Laurie; Morton, Patricia Gonce; Jeffries, Pamela; McQuade-Jones, Bambi; Ryan, Sandra
As the need for primary care providers increases, nursing education programs face significant challenges to meet future workforce needs. A more resource-efficient approach for the clinical education of nurse practitioner students is needed. A think tank involving 20 thought leaders representing multiple disciplines was convened to discuss this issue. This article presents seven themes that emerged from this national leaders' dialog: academic practice co-design, standardized preclinical preparation, standardized student assessment, entrustable professional activities, immersive clinical experiences, interprofessional education for team-based care, and innovative education practices. Copyright © 2014 Elsevier Inc. All rights reserved.
Ennis, Gary; Happell, Brenda; Reid-Searl, Kerry
Clinical leadership is becoming more relevant for nurses, as the positive impact that it can have on the quality of care and outcomes for consumers is better understood and more clearly articulated in the literature. As clinical leadership continues to become more relevant, the need to gain an understanding of how clinical leaders in nursing develop will become increasingly important. While the attributes associated with effective clinical leadership are recognized in current literature there remains a paucity of research on how clinical leaders develop these attributes. This study utilized a grounded theory methodology to generate new insights into the experiences of peer identified clinical leaders in mental health nursing and the process of developing clinical leadership skills. Participants in this study were nurses working in a mental health setting who were identified as clinical leaders by their peers as opposed to identifying them by their role or organizational position. A process of intentional modeling emerged as the substantive theory identified in this study. Intentional modeling was described by participants in this study as a process that enabled them to purposefully identify models that assisted them in developing the characteristics of effective clinical leaders as well as allowing them to model these characteristics to others. Reflection on practice is an important contributor to intentional modelling. Intentional modelling could be developed as a framework for promoting knowledge and skill development in the area of clinical leadership.
Alsaif, Dalia M; Alfaraidy, Maram; Alsowayigh, Kholoud; Alhusain, Awal; Almadani, Osama M
Forensic nursing was recognized as a nursing subspecialty after the perceived need for forensic nurses to bring about their nursing duties while at the same time helping legal authorities to deliver justice. With the increased rate of cases that are presenting to the forensic centers in Saudi Arabia, there was a need for the presence of nurses to work side by side to physicians. This study was aimed at determining the forensic qualifications of nurses working in emergency departments in the area of Dammam and their knowledge about principles of forensic nursing. A self-administered questionnaire was distributed to registered nurses who are working in Emergency departments of secondary hospitals in the area of Dammam. Questions included knowledge, awareness and attitude toward forensic nursing. A total of 96 participants responded to the questionnaire with females representing 78% (n: 75). Diploma was the highest earned nursing degree in 95% (n: 91) of participants. Only 33% (n: 32) were aware of the term forensic nursing and the majority of the respondents gave invalid or didn't know the answers to knowledge questions. A total of 77% (n: 74) agreed that they are not adequately trained for handling forensic cases. Saudi nurses need forensic education. The presence of qualified forensic nurses would help delivering optimal forensic services and would assist in bringing justice. Copyright © 2014 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
N. R. C. TIakula
Full Text Available A descriptive survey was carried out, using convenience and systematic sampling in order to better understand the manner in which student nurses perceive their clinical experience in the hospital. Data were collected from 80 subjects in 4 nursing colleges using a critical incident technique. Positive and negative experiences are described,
N. R. C. TIakula
Full Text Available A descriptive survey was carried out, using convenience and systematic sampling in order to better understand the manner in which student nurses perceive their clinical experience in the hospital. Data were collected from 80 subjects in 4 nursing colleges using a critical incident technique. Positive and negative experiences are described,
Dadgaran, Ideh; Parvizy, Soroor; Peyrovi, Hamid
The aim of this study is description of nursing students' views of sociocultural factors in clinical learning. A qualitative content analysis was conducted to describe nursing students' views of sociocultural factors in clinical learning. The participants consisted of 21 nursing students. Semi-structured and interactive interviews were used to collect data. All the interviews were recorded and transcribed, and then, they were analyzed using Qualitative Content Analysis and Max Qualitative Data Analysis 2010. From the transcripts, a remarkable number of primary themes, main themes, and sub-themes emerged. The main themes consisted of elements related to "society and culture", "family", "staff", and "classmates". The themes encompassed a spectrum of facilitators of and impediments to clinical learning. The findings showed that the administrators of nursing education should coordinate with faculty and staff by adopting interactive and participatory solutions, including the establishment of clinical learning teams and the transformation of hospitals into suitable sociocultural environments for education. © 2012 The Authors. Japan Journal of Nursing Science © 2012 Japan Academy of Nursing Science.
This paper examines Western nursing practices by focusing on their spiritual aspect. The transformation of the informal and poorly trained nurse into the trained and uniform persona of the modern nurse is the subject of many nursing histories and part of nursing mythology. Using the work of Michel Foucault and Marcel Mauss, the nursing that preceded the 19th century reformers is re-examined and continuities between current and quite ancient practices of nursing are explored. The development of practices or technologies for care of the sick originated with the establishment of hospitals in the 4th century as part of pious Christian practice. Current practices of care and the discourse of holistic nursing are argued to have grown from these traditional Christian technologies of care. Humanist or holistic nursing represents the enshrinement of the Christian ethos--freed of doctrine; the discourse of caring a redrafted Christian discipline of love.
Mason, T; Coyle, D; Lovell, A
This study reports on research undertaken to identify the skills and competencies of forensic psychiatric nurses working in secure psychiatric services in the UK. The rationale for this research is the lack of clarity in the role definition of nurses working in these environments and the specific content that may underscore the curriculum for training forensic nurses. Over 3300 questionnaires were distributed to forensic psychiatric nurses, non-forensic psychiatric nurses and other disciplines and information obtained on (1) the perceived clinical problems that give forensic nurses the most difficulty; (2) the skills best suited to overcome those problems; and (3) the priority aspects of clinical nursing care that needs to be developed. A 35% response rate was obtained with 1019 forensic psychiatric nurses, 110 non-forensic psychiatric nurses and 43 other disciplines. The results highlighted a 'top ten' list of main problems with possible solutions and main areas for development. The conclusions drawn include a focus on skills and competencies regarding the management of personality disorders and the management of violence and aggression.
Adriaenssens, Jef; De Gucht, Véronique; Maes, Stan
Burnout is an important problem in health care professionals and is associated with a decrease in occupational well-being and an increase in absenteeism, turnover and illness. Nurses are found to be vulnerable to burnout, but emergency nurses are even more so, since emergency nursing is characterized by unpredictability, overcrowding and continuous confrontation with a broad range of diseases, injuries and traumatic events. This systematic review aims (1) to explore the prevalence of burnout in emergency nurses and (2) to identify specific (individual and work related) determinants of burnout in this population. A systematic review of empirical quantitative studies on burnout in emergency nurses, published in English between 1989 and 2014. The databases NCBI PubMed, Embase, ISI Web of Knowledge, Informa HealthCare, Picarta, Cinahl and Scielo were searched. Seventeen studies were included in this review. On average 26% of the emergency nurses suffered from burnout. Individual factors such as demographic variables, personality characteristics and coping strategies were predictive of burnout. Work related factors such as exposure to traumatic events, job characteristics and organizational variables were also found to be determinants of burnout in this population. Burnout rates in emergency nurses are high. Job demands, job control, social support and exposure to traumatic events are determinants of burnout, as well as several organizational variables. As a consequence specific action targets for hospital management are formulated to prevent turnover and burnout in emergency nurses. Copyright © 2014 Elsevier Ltd. All rights reserved.
Abourbih, Daniel; Armstrong, Sherry; Nixon, Kirsty; Ackery, Alun D
The emergency department (ED) is a challenging and stressful work environment where communication lapses can lead to negative health outcomes. This article offers strategies to Emergency Medicine residents, nurses and staff physicians on how to improve communication to optimize patient care. © 2014 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.
McNamara, Martin S; Fealy, Gerard M; Casey, Mary; Geraghty, Ruth; Johnson, Maree; Halligan, Phil; Treacy, Pearl; Butler, Michelle
To describe Irish nurses' views of clinical leadership and to describe their clinical leadership development needs. Nurses are often unclear about the precise nature of clinical leadership and its impact on the processes and outcomes of care and little is known about their self-perceived clinical leadership development needs. Seventeen focus group interviews were conducted with a purposive sample of 144 nurses from 13 practice settings. A conceptual lens was provided by the work of Bernstein and Young who emphasise the epistemological, practical and relational significance of boundaries and how they relate in fundamental ways to professionals' sense of their distinctive disciplinary identities and membership of specialised communities of practice. Focus group data were collected using semi-structured topic guides. Analysis was facilitated by NVivo 7© and interpretation was informed by a conceptual framework arising from the interplay of emerging themes and the literature review. The implications for clinical leadership development of two critical concepts, 'representing nursing' and 'compensatory action', are discussed in detail. Clinical leadership development should emphasise the development of all nurses as clinical leaders in the context of the delineation, clarification and articulation of their distinctive contribution in multidisciplinary care settings. Clinical leaders are recognised as practice experts and as leaders in their particular fields. Recognition and influence in and beyond the immediate context of care depends greatly on their ability to articulate the distinct nursing contribution to patient care. This ability provides an essential resource to resist the ongoing blurring, effacement and dilution of nurses' roles. © 2011 Blackwell Publishing Ltd.
Codier, Estelle; Kamikawa, Cindy; Kooker, Barbara M; Shoultz, Jan
Emotional intelligence has been correlated with performance, retention, and organizational commitment in professions other than nursing. A 2006 pilot study provided the first evidence of a correlation between emotional intelligence and performance in clinical staff nurses. A follow-up study was completed, the purpose of which was to explore emotional intelligence, performance level, organizational commitment, and retention. A convenience sample of 350 nurses in a large medical center in urban Hawaii participated in this study. This article reports the findings pertaining to the subset of 193 clinical staff nurses who responded. The Mayer-Salovey-Caruso Emotional Intelligence Test instrument was used to measure emotional intelligence abilities. Performance was defined as ranking on a clinical ladder. Commitment was scored on a Likert scale. The following variables measured retention: total years in nursing, years in current job, total years anticipated in current job, and total anticipated career length. Emotional intelligence scores in clinical staff nurses correlated positively with both performance level and retention variables. Clinical staff nurses with higher emotional intelligence scores demonstrated higher performance, had longer careers, and greater job retention.
Patterson, Christopher; Moxham, Lorna; Brighton, Renee; Taylor, Ellie; Sumskis, Susan; Perlman, Dana; Heffernan, Tim; Hadfield, Louise
There exists a need for innovative thinking to identify new clinical placement opportunities for nursing students. Recovery-based clinical placements for mental health nurse students remain unique and require investigation. To examine the learning experience of Bachelor of Nursing students who undertook an innovative mental health clinical placement known as Recovery Camp. This study incorporated qualitative analysis of written reflections. Using Braun and Clarke's (2006) six phases of thematic analysis the corpus of student reflections were reviewed by three members of the research team independent to each other. Four themes emerged. The theme of Pre-placement Expectations incorporates participant foci on pre-conceptions of Recovery Camp. The theme of Student Learning incorporates the ways in which participants recognised the experience of Recovery Camp influenced learning. Reflections themed under the title Placement Setting include discussion of the Recovery Camp as a clinical placement. The theme of Future Practice incorporates students' reflections on how they plan to practice as nurses as a result the learning experiences of Recovery Camp. An immersive clinical placement such as Recovery Camp can influence students' perceptions of people with mental illness, have a positive impact on student learning and influence students' decisions about future practice. The learning experience of nursing students whom attend unique, recovery-orientated clinical placements can be both positive and educative. Copyright © 2016 Elsevier Ltd. All rights reserved.
Malekian, Morteza; Ghiyasvandian, Sharzad; Cheraghi, Mohammad Ali; Hassanzadeh, Akbar
Clinical nurses are in need of being able to adapt to the ever-changing environment of clinical settings. The prerequisite for their successful adaptation is to be lifelong learners. An approach for making nurses lifelong learners is self-directed learning. This study was undertaken to evaluate a group of Iranian clinical nurses' readiness for self-directed learning and its relationship with some of their personal characteristics. This cross-sectional descriptive study was conducted in 2014. A random sample of 314 nurses working in three hospitals affiliated to Isfahan Social Security Organization, Isfahan, Iran, was recruited to complete the Fisher's Self-directed Learning Readiness Scale. In total, 279 nurses filled the scale completely. The mean of their readiness for self-directed learning was 162.50±14.11 (120-196). The correlation of self-directed learning readiness with age, gender, marital status, and university degree was not statistically significant. Most nurses had great readiness for self-directed learning. Accordingly, nursing policy-makers need to develop strategies for promoting their self-directed learning. Moreover, innovative teaching methods such as problem solving and problem-based learning should be employed to prepare nurses for effectively managing the complexities of their ever-changing work environment.
Hood, Kerry; Cant, Robyn; Leech, Michelle; Baulch, Julie; Gilbee, Alana
This study aims to describe how senior nursing students viewed the clinical learning environment and matured their professional identity through interprofessional learning in a student-led hospital 'ward'. Undergraduate nursing and medical student teams participated in a trial of ward-based interprofessional clinical learning, managing patients over 2 weeks in a rehabilitation ward. Qualitative and quantitative program evaluation was conducted using exit student focus groups and a satisfaction survey. Twenty-three nursing and medical students in three placement rounds provided positive feedback. Five main themes emerged describing their engagement in 'trying on' a professional role: 'experiencing independence and autonomy'; 'seeing clearly what nursing's all about'; 'altered images of other professions'; 'ways of communicating and collaborating' and 'becoming a functioning team'. Ward-based interprofessional clinical placements offer senior students authentic ideal clinical experiences. We consider this essential learning for future interprofessional collaboration which should be included in senior nursing students' education. © 2014.
Lydia V. Monareng
Full Text Available Spiritual nursing care is a significant concept for nurses as they are expected to provide holistic care to patients. Many nurses have difficulty to understand and integrate it into practice and consequently neglect this aspect of care. The study was conducted to explore and describe how professional nurses provide spiritual care to patients. A generic qualitative, explorative and descriptive study was conducted based on Symbolic Interactionism as the philosophical base. The population comprised professional nurses from a public hospital. Participants were recruited through purposive and snowball sampling methods. Data were collected through the use of individual, focus group interviews and observation. Data analysis methods utilised included the NUD*ISTcomputer program, coding, constant comparison method and Tesch’s guidelines on data analysis. Findings revealed that nurses struggled to conceptualise spiritual nursing care and to differentiate it from emotional, social or psychological care. However, prayer with or for patients and singing spiritual songs had the highest count of interventions perceived to be effective. Recommendations suggest that the scope of practice and curriculum of training of nurses be reviewed to consider how spiritual nursing care can be evidenced and realised both in the classroom and in the clinical setting. Spiritual nursing care is still a neglected and seemingly complex component of patient care. However, the scientific worldview practices, beliefs and insufficient statutory endorsement of such care hamper its realisation in practice.
Cole, Lisa M; Walker, Theodore J; Nader, Kelly C; Glover, Dennis E; Newkirk, Laura E
A clearly defined role of the Perioperative Clinical Nurse Specialist (PONS) is not identified. The purpose of this study was to provide recommendations for a delineated role of the PONS that will provide role clarity and practice guidance...
Thomas, Lisa Jean; Asselin, Marilyn
Resilience is the ability to overcome adversity and grow stronger from the experience. Increased resilience has been shown to positively impact nurses in practice. With this knowledge, recommendations to incorporate resilience training into nursing education have been made. Research, integrative reviews and a theoretical model of resilience in nursing students are explored in this paper. The authors posit that facilitating resilience is important in the setting of clinical education. Through incorporating resilience training in the clinical setting, educators can better prepare students for challenges in their educational environment and ultimately for nursing practice. Specific strategies for clinical educators to incorporate resilience training are suggested. Strategies are organized into three categories, support, education and reflection. The position of facilitating resilience in clinical education may open a discussion for future educational practices. Copyright © 2017 Elsevier Ltd. All rights reserved.
Yousef Haghighi Moghadam
Full Text Available Introduction: Clinical education is the core component of nursing education. PhD graduated nurses who are faculty members can play a main role in clinical instruction. However, there is not clear understanding about the challenges which they may encounter for accepting their role as clinical educator. The aim of this study was to explore the challenges of role acceptance by PhD aduated nurses who are faculty members. Methods: In this qualitative exploratory study a total of 13 participants (8 PhD graduated in nursing, 3 head of departments of nursing, one educational vice chancellor of nursing school, and one nurse were selected by purposive sampling method. Data were collected by semi-structured, face to face interview and analyzed by conventional content analysis approach developed by Graneheim and Lundman. Results: The main theme emerged from data analysis was "identity threat". This theme had five categories including expectations beyond ability, lack of staff’s rely on the performance of PhD graduated nurses, poor clinical competencies, doubtfulness, and obligation. Conclusion: PhD graduated nurses experienced some worries about their role as clinical educators and argued that they have not been prepared for their role. Therefore, policy makers and authorities of nursing schools should support PhD graduated nurses for accepting their new roles as clinical educators. Moreover, some changes in nursing PhD curriculum is needed to improve the clinical competencies of PhD graduated and prepare them for their role as a clinical educator.
Little is known about the teaching and learning implications of instructional storytelling (IST) in nursing education or its potential connection to nursing theory. The literature establishes storytelling as a powerful teaching-learning method in the educational, business, humanities, and health sectors, but little exploration exists that is specific to nursing. An example of a story demonstrating application of the domains of Tanner's clinical judgment model links storytelling with learning outcomes appropriate for the novice nursing student. Application of Tanner's clinical judgment model offers consistency of learning experience while preserving the creativity inherent in IST. Further research into student learning outcomes achievement using IST is warranted as a step toward establishing best practices with IST in nursing education. [J Nurs Educ. 2017;56(5):305-308.]. Copyright 2017, SLACK Incorporated.
Paixão, Taís Couto Rego da; Campanharo, Cássia Regina Vancini; Lopes, Maria Carolina Barbosa Teixeira; Okuno, Meiry Fernanda Pinto; Batista, Ruth Ester Assayag
To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.
Taís Couto Rego da Paixão
Full Text Available OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three registered nurses and four non-registered nursing for each six hour shift. However, only one registered nurse and four non-registered nurse were available per shift. There was no correlation between triage risk classification and classification of care by the Fugulin Patient Classification System. CONCLUSION A deficit in professional staff was identified in the emergency room. The specificity of this unit made it difficult to measure. To find the best strategy to do so, further studies should be performed.
Leila Dadvar; Ali Dadgari; Malihe Mirzaee; Maryam Rezaee
Introduction: Clinical education is an essential component and the heart of nursing education. Nursing is a practice-based discipline and the evaluation of educational goal achievement of nursing competency is essential. The objective of this study was to identify the achievement of clinical educational goals in fundamental skills among senior nursing students in ICU. Methods: This descriptive-analytical research was conducted on 56 senior nursing students. Subjects of this study were purp...
Keleher, K C
The demands of clinical practice seldom allow for time to pursue academic writing, teaching, or the development of individual advanced skills. The burnout rate in professions such as nurse-midwifery cannot be ignored. This article describes how one nurse-midwifery clinical practice implemented a short, rotating sabbatical; specific goals and guidelines are presented. It concludes that a sabbatical leave can be considered as one of many job-related benefits.
Hwang, Jee-In; Ahn, Jeonghoon
Purpose: To examine levels of teamwork and its relationships with clinical error reporting among Korean hospital nurses. Methods: The study employed a cross-sectional survey design. We distributed a questionnaire to 674 nurses in two teaching hospitals in Korea. The questionnaire included items on teamwork and the reporting of clinical errors. We measured teamwork using the Teamwork Perceptions Questionnaire, which has five subscales including team structure, leadership, situation monitori...
Changiz, Tahereh; Malekpour, Alireza; Zargham-Boroujeni, Ali
Background: Clinical education is a critical and complex component of nursing education that is influenced by many variables. One of them is stress, which may disturb students? learning, too. Stressors may differ according to the learning situation and environment, and recognizing them, seems to be essential for corrective interventions. The present work was performed to identify stressors in clinical nursing education in Iran, according to the published research reports. Materials and Method...
Man, Si Ming
A growing number of Campylobacter species other than C. jejuni and C. coli have been recognized as emerging human and animal pathogens. Although C. jejuni continues to be the leading cause of bacterial gastroenteritis in humans worldwide, advances in molecular biology and development of innovative culture methodologies have led to the detection and isolation of a range of under-recognized and nutritionally fastidious Campylobacter spp., including C. concisus, C. upsaliensis and C. ureolyticus. These emerging Campylobacter spp. have been associated with a range of gastrointestinal diseases, particularly gastroenteritis, IBD and periodontitis. In some instances, infection of the gastrointestinal tract by these bacteria can progress to life-threatening extragastrointestinal diseases. Studies have shown that several emerging Campylobacter spp. have the ability to attach to and invade human intestinal epithelial cells and macrophages, damage intestinal barrier integrity, secrete toxins and strategically evade host immune responses. Members of the Campylobacter genus naturally colonize a wide range of hosts (including pets, farm animals and wild animals) and are frequently found in contaminated food products, which indicates that these bacteria are at risk of zoonotic transmission to humans. This Review presents the latest information on the role and clinical importance of emerging Campylobacter spp. in gastrointestinal health and disease.
This article examines how critical thinking is seen in learning decision making during the clinical lessons in the beginning of nursing students' clinical education. The data has been collected by taping all the clinical lessons (11) of the students (32). The data was analyzed by using content analysis both quantitatively and qualitatively. The phases of the nursing process, in other words the phases of decision making appeared clearly in the discussions. A lot of assessment of the nursing needs of the patient appeared clearly. Physical needs were focused among the nursing problems. The objects of the nursing were defined nurse-centrically and generally. The discussion about the implementation and the evaluation of the nursing received insufficient attention. There were presented neither alternative solutions of the care nor any reasons for proposed solutions. Learning of the students represented mainly superficial, mechanical learning, lacking critical thinking.
Full Text Available Protection of health care workers including students from being infected when caring for high risk patients is a major cause for concern to all promoting occupational health. Safety of every employee is mandatory. Furthermore, universal guidelines for precautions must be used by all interacting with high risk patients and clients to protect themselves and prevent the spread of infection. The aim of this paper was to ascertain the availability of universal guidelines for precautions against the spread of infection in clinical settings and determine the precautions used by OHN students during their clinical placements. To realise these objectives, a quantitative and descriptive design was followed. A purposive sampling method was used to select 45 Occupational health nursing students who participated in the study. Data was collected with the use of a structured questionnaire and the results revealed that: most units where OHN students were placed for clinical experience had guidelines for universal precautions although these were not always accessible to them; regarding compliance to universal precautions, OHN students were reportedly aware of the hazards of failure to comply although in some emergencies and where personal protective material was not available, they had to provide care without using protective equipments. Recommendations made include that employers and staff at all occupational settings must ensure that updated guidelines for universal precautions are available and accessible to every body interacting with high risk patients; health care providers and students must be fully informed about and should always adhere to universal precautions.
Full Text Available Protection of health care workers including students from being infected when caring for high risk patients is a major cause for concern to all promoting occupational health. Safety of every employee is mandatory. Furthermore, universal guidelines for precautions must be used by all interacting with high risk patients and clients to protect themselves and prevent the spread of infection. The aim of this paper was to ascertain the availability of universal guidelines for precautions against the spread of infection in clinical settings and determine the precautions used by OHN students during their clinical placements. To realise these objectives, a quantitative and descriptive design was followed. A purposive sampling method was used to select 45 Occupational health nursing students who participated in the study.Data was collected with the use of a structured questionnaire and the results revealed that: most units where OHN students were placed for clinical experience had guidelines for universal precautions although these were not always accessible to them; regarding compliance to universal precautions, OHN students were reportedly aware of the hazards of failure to comply although in some emergencies and where personal protective material was not available, they had to provide care without using protective equipments. Recommendations made include that employers and staff at all occupational settings must ensure that updated guidelines for universal precautions are available and accessible to every body interacting with high risk patients; health care providers and students must be fully informed about and should always adhere to universal precautions.
Weiland, Tracey J; Mackinlay, Claire; Jelinek, George A
The Australian Medical Association is strongly opposed to the nurse practitioner (NP) role with concerns that NPs may become doctor substitutes without the requisite training and education that the medical role demands. Despite this, NPs have been heralded by some as a potential solution to the access block, workforce shortage and increased demand affecting emergency departments (EDs). The purpose of this study was to determine the perception of NPs by medical staff working in Australian EDs. Semi-structured telephone interviews were conducted with closed and open-ended questions. Participants were drawn from a representative stratified sample of two city, two metropolitan and two provincial hospitals of each State/Territory. A total of 95 doctors from 35 EDs participated in this study including 36 Departmental Directors; 36% of participating Directors indicated having an NP on staff. Doctors were strongly opposed to the statement that NPs could replace either nurses or other prevocational doctors; 71 interviewees commented on the role of NPs in the ED. Thematic analyses revealed polarised views held by doctors. Eight major themes were identified, the most common being that there is a lack of clarity of the NP role definition, their scope of practice and differentiation from the medical role. Although ED NPs represent a highly skilled professional group their role is poorly understood by ED doctors. Opposition to the NP role is a significant barrier to the introduction of great numbers of ED NPs as a strategy to overcome the medical workforce shortage. The online version of this article (doi:10.1007/s12245-010-0214-8) contains supplementary material, which is available to authorized users.
Flott, Elizabeth A; Linden, Lois
The aim of this study was to report an analysis of the clinical learning environment concept. Nursing students are evaluated in clinical learning environments where skills and knowledge are applied to patient care. These environments affect achievement of learning outcomes, and have an impact on preparation for practice and student satisfaction with the nursing profession. Providing clarity of this concept for nursing education will assist in identifying antecedents, attributes and consequences affecting student transition to practice. The clinical learning environment was investigated using Walker and Avant's concept analysis method. A literature search was conducted using WorldCat, MEDLINE and CINAHL databases using the keywords clinical learning environment, clinical environment and clinical education. Articles reviewed were written in English and published in peer-reviewed journals between 1995-2014. All data were analysed for recurring themes and terms to determine possible antecedents, attributes and consequences of this concept. The clinical learning environment contains four attribute characteristics affecting student learning experiences. These include: (1) the physical space; (2) psychosocial and interaction factors; (3) the organizational culture and (4) teaching and learning components. These attributes often determine achievement of learning outcomes and student self-confidence. With better understanding of attributes comprising the clinical learning environment, nursing education programmes and healthcare agencies can collaborate to create meaningful clinical experiences and enhance student preparation for the professional nurse role. © 2015 John Wiley & Sons Ltd.
Tsai, Hsiu-Hsin; Tsai, Yun-Fang
To develop and test the feasibility of an instrument to support patients' nursing home to emergency room transfer. Transfers from a nursing home care facility to an acute care facility such as a hospital emergency room are common. However, the prevalence of an information gap for transferring residents' health data to acute care facility is high. An evidence-based transfer instrument, which could fill this gap, is lacking. Development of a nursing home to emergency room transfer checklist, validation of items using the Delphi method and testing the feasibility and benefits of using the nursing home to emergency room transfer checklist. Items were developed based on qualitative data from previous research. Delphi validation, retrospective chart review (baseline data) and a 6-month prospective study design were applied to test the feasibility of using the checklist. Variables for testing the feasibility of the checklist included residents' 30-day readmission rate and length of hospital stay. Development of the nursing home to emergency room transfer checklist resulted in four main parts: (i) demographic data of the nursing home resident; (ii) critical data for nursing home to emergency room transfer; (iii) contact information and (iv) critical data for emergency room to nursing home transfer. Two rounds of Delphi validation resulted in a mean score (standard deviation) ranging from 4.39 (1.13)-4.98 (.15). Time required to complete the checklist was 3-5 min. Use of the nursing home to emergency room transfer checklist resulted in a 30-day readmission rate of 13.4%, which was lower than the baseline rate of 15.9%. The nursing home to emergency room transfer checklist was developed for transferring nursing home residents to an emergency room. The instrument was found to be an effective tool for this process. Use of the nursing home to emergency room transfer checklist for nursing home transfers could fill the information gap that exists when transferring older adults
Sun, C; Dohrn, J; Omoni, G; Malata, A; Klopper, H; Larson, E
This study reviewed grey literature to assess clinical nursing and midwifery research conducted in southern and eastern African countries over the past decade. The shortage of published nursing research from African countries severely limits the ability of practicing nurses and midwives to base clinical decisions on solid evidence. However, little is known regarding unpublished or unindexed clinical research ('grey literature'), a potentially rich source of information. Identifying these sources may reveal resources to assist nurses in providing evidence-based care. This scoping review of grey literature on clinical nursing and midwifery research in southern and eastern African countries helped to identify gaps in research and assess whether these gaps differ from published research. Systematic searches of grey literature were performed. Research was included if it was conducted by nurses in 1 of 25 southern or eastern African countries, between 2004 and 2014 and included patient outcomes. Data were extracted on location, institution, research topic, institutional connections and author information. Chi-square tests were performed to compare differences between indexed and non-indexed literature. We found 262 studies by 287 authors from 17 southern and eastern African countries covering 13 topics. Although all topics were also found in indexed literature and there were statistically significant differences between the number of times, fewer topics were covered in grey literature vs. indexed. Patient satisfaction and experience and traditional health practices were more likely to be published, whereas chronic disease, assault and paediatric-related research were less often published. Generally, there is a paucity of clinical nursing research in this region. This could reflect the shortage of nurses prepared to conduct research in this region. Nurses may find additional resources for evidence in the grey literature. A complete understanding of the state of nursing
Montezelli, Juliana Helena; Peres, Aida Maris; Bernardino, Elizabeth
To characterize the registered nurse's management activities in an emergency department. Qualitative research, implemented from February to April 2009 by a semi-structured interview with eight nurses from an emergency department at a university hospital in Curitiba, PR. Brazil. The data was submitted to content analyses. Two categories emerged: Management focused on meeting the institutional demands that emphasizes the Registered Nurses' bureaucratic activities required by the hospital; and Management focused on meeting the nursing care demands that prioritizes the care as the main management activity. The study reached its objective and joined the literature findings that the division between care and management does not match with the registered nurse's performance at an emergency department.
Anna C. van Graan
Full Text Available Reform in the South African healthcare and educational system were characterized by the ideals that the country needs to produce independent, critical thinkers. Nurses need to cope with diversity in a more creative way, defining their role in a complex, uncertain, rapidly changing health care environment. Quality clinical judgement is therefore imperative as an identified characteristic of newly qualified professional nurses. The objective of this study was to explore and describe clinical judgement through various data sources and review of literature to clarify the meaning and promote a common understanding through formulating the characteristics and developing a connotative (theoretical definition of the concept. An explorative, descriptive qualitative design was used to discover the complexity and meaning of the phenomenon. Multiple data sources and search strategies were used, for the time frame 1982—2013. A concept analysis was used to arrive at a theoretical definition of the concept of ‘clinical judgement’ as a complex cognitive skill to evaluate patient needs, adaption of current treatment protocols as well as new treatment strategies, prevention of adverse side effects through being proactive rather than reactive within the clinical nursing environment. The findings emphasized clinical judgement as skill within the clinical nursing environment, thereby improving autonomous and accountable nursing care. These findings will assist nurse leaders and clinical nurse educators in developing a teaching-learning strategy to promote clinical judgement in undergraduate nursing students, thereby contributing to the quality of nursing care.
To identify clinical nurses' attitudes towards rotating shift work. Many hospitals worldwide employ rotating shift work patterns to staff their facilities. Attitudes of clinical nurses towards rotating shift work vary. To understand clinical nurses' attitudes towards rotating shift work, Q-methodology, a method for the analysis of subjective viewpoints with the strengths of both qualitative and quantitative methods, was used. Forty-six selected Q-statements from each of the 39 participants were classified into a normal distribution using an 11-point bipolar scale. The collected data were analysed using pc-QUANL program. Three discrete factors emerged as follows: factor I (rotating shift work is frustrating: objectionable perspective), factor II (rotating shift work is satisfactory: constructive perspective) and factor III (rotating shift work is problematic, but necessary: ambivalent perspective). The subjective viewpoints of the three identified factors can be applied in developing various roster designs for nurses engaging in rotating shift work. The findings provide the baseline for nurse leaders in helping nurses adjust and deal with rotating shift work. © 2015 John Wiley & Sons Ltd.
Sawyers, J E
A collaborative practice was established at the University of Southern California/Kenneth Norris Jr. Cancer Hospital utilizing combined roles of the CNS and nurse practitioner. The role was created out of a specific need of the physicians of the gastrointestinal malignancy service. Increased administrative and clinical responsibilities necessitated another clinical expert to be readily available for the management of the acute care private practice patients. As a CNS for both the departments of medicine and nursing, my primary responsibilities are focused within the ambulatory care area. This paper presents the concept for this position, the professional and personal benefits, advantages and disadvantages, and recommendations for nursing practice.
Felton, Anne; Royal, Jan
Rapid changes during the past two decades have seen a growing challenge to prepare newly qualified nurses who are clinically competent and confident to meet the demands of contemporary healthcare. Recent publications emphasise the need to prioritise clinical skills in nurse education (DH 2012a, Francis, 2012). This discussion reports on a project scoping the clinical skills required within pre-registration nursing curricula and considers how this has influenced curriculum development at one Higher Education Institution in the UK. This paper reports on the project analysis of nursing and healthcare policy, identifying six core themes of skills relevant for nursing practice. Furthermore it explores the findings of a series of focus groups with nursing practitioners and managers identifying priorities for clinical skills in the pre-registration curriculum. These highlighted a broad range of skills required of newly qualified practitioners, which pose a challenge for integration within nurse education. How this challenge has been addressed through the incorporation of these skills themes throughout a new pre-registration curriculum is also examined. Copyright © 2014 Elsevier Ltd. All rights reserved.
Bland, Michael; Bridge, Caroline; Cooper, Melanie; Dixon, Deborah; Hay, Lyndsey; Zerbato, Anna
This paper will explore the use of child restraint during common clinical procedures such as venepuncture, cannulation and lumbar puncture. A lack of research, guidelines and protocols on restraining children led a group of student nurses to develop a clinical practice benchmark on procedural restraint for the North West Clinical Practice Benchmarking Group.
Sudeep Sreepad Iyer
Full Text Available Introduction: Physicians and nurses of emergency department are often the first line of qualified health-care providers attending the patient in person or parent's query over phone reporting immediately following the dental avulsion. Prompt action by them becomes the decisive factor in survival and prognosis of the tooth. Although a few researchers have evaluated knowledge of emergency room physicians, there is scanty of reports concerning nurses who play a climacteric role. Materials and Methods: A 10-item questionnaire regarding clinical situation apropos dental injury and tooth avulsion, inquiring knowledge of physicians and nurses was administered to 150 each of nursing professionals and physicians of the emergency department. Results: With 100% response rate, the data obtained was subjected to statistical analysis. Results showed lack of knowledge and confidence in both groups. About 66.7% (n = 100 nurses and 74.7% (n = 112 considered reimplantation of avulsed tooth. There was overbalanced confusion regarding storage/transport media and handling of avulsed tooth. Conclusion: The findings from the results suggested a definite inadequacy in knowledge, demanding need for appropriate training for delivering treatment with more predictability and better prognosis.
Wolf, Lisa A; Perhats, Cydne; Delao, Altair M; Moon, Michael D; Clark, Paul R; Zavotsky, Kathleen E
Moral distress in nursing has been studied in many settings, but there is a paucity of research on moral distress as it manifests in the emergency department. One study suggests a correlation between moral distress and aspects of burnout, and other researchers report that nurses have considered leaving their position or even their profession because of moral distress. Further exploration of these issues may provide insight into their effects on ED patient care and the emergency nursing profession. The purpose of this study was to explore the nature of moral distress as it is experienced and described by emergency nurses. A qualitative, exploratory design was employed using semi-structured focus groups for data collection. Using an iterative process, transcripts were analyzed for emerging themes by the research team. Six researchers analyzed the transcripts using a thematic analysis approach. Themes from the data included dysfunctional practice arena, being overwhelmed, and adaptive/maladaptive coping. Participants described, overall, a profound feeling of not being able to provide patient care as they wanted to. Causes of moral distress in emergency nurses are environment driven, not incident driven, as is described in other settings, and include a high-acuity, high-demand, technical environment with insufficient resources. Interventions should be targeted to improve environmental factors that contribute to the moral distress of emergency nurses. Future research should focus on the development and validation of an instrument to measure moral distress in this setting. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.
Li, Julie; Westbrook, Johanna; Callen, Joanne; Georgiou, Andrew
The disruptive potential of the Nurse Practitioner (NP) is evident in their ability to offer services traditionally provided by primary care practitioners and their provision of a health promotion model of care in response to changing health trends. No study has qualitatively investigated the role of the Emergency NP in Australia, nor the impact of Information and Communication Technology (ICT) on this disruptive workforce innovation. This study aimed to investigate ways in which Nurse Practitioners (NP) have incorporated the use of ICT as a mechanism to support their new clinical role within Emergency Departments. A cross-sectional qualitative study was undertaken in the Emergency Departments (EDs) of two large Australian metropolitan public teaching hospitals. Semi-structured, in-depth interviews were conducted with five nurse practitioners, four senior physicians and five senior nurses. Transcribed interviews were analysed using a grounded theory approach to develop themes in relation to the conceptualisation of the ED nurse practitioner role and the influences of ICT upon the role. Member checking of results was achieved by revisiting the sites to clarify findings with participants and further explore emergent themes. The role of the ENP was distinguished from those of Emergency nurses and physicians by two elements: advanced practice and holistic care, respectively. ICT supported the advanced practice dimension of the NP role in two ways: availability and completeness of electronic patient information enhanced timeliness and quality of diagnostic and therapeutic decision-making, expediting patient access to appropriate care. The ubiquity of patient data sourced from a central database supported and improved quality of communication between health professionals within and across sites, with wider diffusion of the Electronic Medical Record holding the potential to further facilitate team-based, holistic care. ICT is a facilitator through which the disruptive
Lu, Dong-Mei; Sun, Ning; Hong, Su; Fan, Yu-ying; Kong, Fan-ying; Li, Qiu-jie
Emergency department(ED) nurses work in a rapidly changing environment with patients that have wide variety of conditions. Occupational stress in emergency department nurses is a common problem. The purpose of this study was to describe the relationship between coping strategies and occupational stress among ED nurses in China. A correlational, cross-sectional design was adopted. Two questionnaires were given to a random sample of 127 ED nurses registered at the Heilongjiang Nurses' Association. Data were collected from the nurses that worked in the ED of five general hospitals in Harbin China. Occupational stress and coping strategies were measured by two questionnaires. A multiple regression model was applied to analyze the relationship between stress and coping strategies. The stressors of ED nurses mainly come from the ED specialty of nursing (2.97±0.55), workload and time distribution (2.97±0.58). The mean score of positive coping strategies was 2.19±0.35, higher than the norm (1.78±0.52). The mean score of negative coping strategies was 1.20±0.61, lower than the norm (1.59±0.66), both had significant statistical difference (Pwork, criticism, instrument equipment shortage, night shift, rank of professional were the influence factors about occupational stress to positive coping styles. Too much documents work, and medical insurance for ED nurses were the influential factors on occupational stress to negative coping styles. This study identified several factors associated with occupational stress in ED nurses. These results could be used to guide nurse managers of ED nurses to reduce work stress. The managers could pay more attention to the ED nurse's coping strategies which can further influence their health state and quality of nursing care. Reducing occupational stress and enhancing coping strategies are vital not only for encouraging nurses but also for the future of nursing development. Copyright © 2015. Published by Elsevier Inc.
Instefjord, Marit Helen; Aasekjær, Katrine; Espehaug, Birgitte; Graverholt, Birgitte
Quality in nursing documentation facilitates continuity of care and patient safety. Lack of communication between healthcare providers is associated with errors and adverse events. Shortcomings are identified in nursing documentation in several clinical specialties, but very little is known about the quality of how nurses document in the field of psychiatry. Therefore, the aim of this study was to assess the quality of the written nursing documentation in a psychiatric hospital. A cross-sectional, retrospective patient record review was conducted using the N-Catch audit instrument. In 2011 the nursing documentation from 21 persons admitted to a psychiatric department from September to December 2010 was assessed. The N-Catch instrument was used to audit the record structure, admission notes, nursing care plans, progress and outcome reports, discharge notes and information about the patients' personal details. The items of N-Catch were scored for quantity and/or quality (0-3 points). The item 'quantity of progress and evaluation notes' had the lowest score: in 86% of the records progress and outcome were evaluated only sporadically. The items 'the patients' personal details' and 'quantity of record structure' had the highest scores: respectively 100% and 71% of the records achieved the highest score of these items. Deficiencies in nursing documentation identified in other clinical specialties also apply to the clinical field of psychiatry. The quality of electronic written nursing documentation in psychiatric nursing needs improvements to ensure continuity and patient safety. This study shows the importance of the existence of a validated tool, readily available to assess local levels of nursing documentation quality.
Audet, M C
It has been well-documented that the clinical experience is one of the most anxiety-producing aspects of nursing education. When feelings of anxiety become severe, they present a clear threat to the student's success in the program. This article explores the role of "caring" in nursing education as a means of reducing student anxiety. Caring, described at length by Jean Watson, has become one of the most popular trends in the education of young nurses. When caring behaviors are demonstrated in a meaningful way by clinical instructors, the student may experience a sense of comfort and belonging, which may in turn be effective in reducing anxiety and enabling the student to successfully complete a clinical rotation. The aim of this article is to inspire nurses, not only those in the educational setting but in all settings and at all levels of their careers, to reconsider the effects and benefits of displaying a caring attitude.
Nielsen, Kirsten; Pedersen, Birthe D.; Helms, Niels Henrik
-hermeneutic approach. The setting was a ten-week clinical course in Basic Nursing, and participants were 11 first-year students randomly assigned. Data was generated by participant observations, narrative interviews and portfolio documents. The entire data material was interpreted according to the French philosopher...... Paul Ricoeurs theory of interpretation. This paper reports that the mandatory part promotes consciousness of own learning and competencies in clinical nursing and raises students` consciousness of nurse identity. It gives preceptors the opportunity to differentiate their supervision for individual......Literature shows several benefits of implementing ePortfolio and focusing on learning styles within nursing education. However, there is some ambiguity, so the aim was to investigate learning mediated by the mandatory part of ePortfolio in clinical settings. The design takes a phenomenological...
Kjær, Malene; Raudaskoski, Pirkko Liisa; Sørensen, Erik Elgaard
Student nurses are socialised into the clinical profession of being a nurse as they participate in wards in the hospitals as part of their education. Through their clinical training they learn to interact with patient and colleagues. They also experience, how spaces and relations are intertwined...... throughout their learning period. The purpose of this study was to investigate the importance of place for the encounters between students and supervisors in clinical nursing. The paper at hand shows how different spaces such as a hallway, an office and being by the patients’ bedside prompts different...... interactional strategies. Through the use of video ethnography and nexus analysis, we show how the participants’ who orient to them in their interaction treat details in the settings – like a missing chair – or documents, as semiotic fields. Thus we find that the students, nurses and patients co...
Larsson, Inga E; Sahlsten, Monika J M
Registered nurses at the bedside are accountable for and oversee completion of patient care as well as directly leading and managing the provision of safe patient care. These nurses have an informal leadership role that is not associated with any given position. Leadership is a complex and multifaceted concept and its meaning is unclear, especially in the staff nurse context. The aim was to describe registered nurses' perceptions of what it entails to be the leader at the bedside in inpatient physical care. A phenomenographic approach was employed. Interviews were performed with Swedish registered nurses ( n = 15). Five descriptive categories were identified: demonstrating clinical knowledge, establishing a good atmosphere of collaboration, consciously structuring the work in order to ensure patients' best possible nursing care, customized presence in the practical work with patients according to predetermined prerequisites, and monitoring coworkers' professional practice. Registered nurses informal role as leader necessitates a social process of deliberate effort to attain and maintain leader status and authority. Participants used deliberate communicative approaches and interactive procedures. Leader principles grounded in the core values of the nursing profession that ensure nursing values and person-centered attributes were a key aspect.
Sun, Carolyn; Dohrn, Jennifer; Oweis, Arwa; Huijer, Huda Abu-Saad; Abu-Moghli, Fathieh; Dawani, Hania; Ghazi, Cheherezade; Larson, Elaine
As the shortage of nurses and midwives is expected to worsen in the Eastern Mediterranean region concomitantly with a growing focus on achievement of universal health coverage, nurses and midwives are expected to fill major gaps in health care. Hence, the need for a solid evidence base for nursing practice and a clear direction for clinical nursing research are paramount. Therefore, a Delphi survey was conducted to determine clinical (research focused on patient outcomes) nursing and midwifery priorities for research within this region. A Delphi survey, using iterative rounds of an online survey of regional clinical nursing and midwifery research experts, was conducted between January and April 2016. Consensus was determined by percentage agreement on level of priority for topics as determined by participants. Additionally, results were compared between countries within the region by income and mortality levels using Kendall's tau. Critical research topics were focused on public/community/primary care as well as emergency preparedness for disasters, and these priorities are well aligned with gaps in the literature for this region. There were statistically significant differences between priority level and country mortality group for geriatrics, self-management of disease, and sexually transmitted infections. Critical research priorities should focus on population-based health topics. Between-country differences should be analyzed further. A clinical research database for the region may help improve research access for nurses and midwives. Practicing nurses and midwives lack extensive evidence (including culturally relevant evidence) on which to practice. Increasing research in areas identified in this survey may improve patient outcomes and quality of care regionally. © 2017 Sigma Theta Tau International.
Battles, Elizabeth D
As a result of Hurricane Katrina on August 29, 2005, ED nurses were faced with chaos during and after the storm. The purpose of this pilot study was to determine if emergency nurses have experienced signs and symptoms of post-traumatic stress disorder (PTSD) as a result of working in an emergency department of the New Orleans metropolitan area during and immediately after Hurricane Katrina. The research identifies if the nurses perceived satisfaction with measures administrators took to provide Critical Incident Stress Management (CISM). To combat burnout, absenteeism, emotional difficulties, and health problems in nurses, administration must offer adequate crisis management for those affected by a traumatic event in the workplace. Data were captured through a cross-sectional research design using self-reporting questionnaires. A questionnaire captured demographic information as well as information regarding satisfaction with CISM offered by management. The Post Traumatic Checklist (PCL) was utilized to assess PTSD symptoms in the nurse. An emergency department located approximately 40 miles north of downtown New Orleans, Louisiana, served as the setting for this study. The sample included 21 registered nurses who worked in the emergency department. Twenty percent of the nurses has symptoms of PTSD. In addition, 100% of the nurses reported that administrators did not offer CISM. To combat consequences of long-term effects of PTSD, hospital administrators must offer adequate treatment to employees. Further research is needed to expand the sample and gain a wider perspective on PTSD symptoms in nurses who worked during the Hurricane.
Thomson, Heather; Tourangeau, Ann; Jeffs, Lianne; Puts, Martine
The aim of this study was to explore and test factors hypothesized to influence quality of Emergency Department nurse-to-nurse shift handover communication. Nurse-to-nurse shift handover communication includes the transfer of information and responsibility for patients at shift change. The unique environment of the Emergency Department, where there is a high degree of patient unpredictability, increased patient volumes and rapid patient turnover, can create challenges for high quality handover communication. There is considerable literature addressing handover communication and factors that influence quality or effectiveness. However, few studies have empirically tested those factors. A quantitative, cross-sectional design was used to test a conceptual model of factors hypothesized to influence quality of handover communication. In 2014, data were gathered using surveys mailed to Emergency Department nurses across Ontario, Canada. The final eligible sample was 231 of 576 for an overall response rate of 40.1%. Analysis was performed using backwards elimination stepwise multiple linear regression. Four statistically significant explanatory variables were retained in the final multiple regression model, explaining 34% (p quality. Handover quality was increased when patients flowed smoothly through triage, when nurses experienced positive intrusions, in the presence of a positive safety climate and when there were positive relationships between incoming and outgoing nurses. By understanding those factors that contribute to handover quality, it is possible to develop targeted interventions aimed at improving the quality of Emergency Department nurse-to-nurse shift handover. © 2017 John Wiley & Sons Ltd.
Albanese, Madeline P; Evans, Dietra A; Schantz, Cathy A; Bowen, Margaret; Disbot, Maureen; Moffa, Joseph S; Piesieski, Patricia; Polomano, Rosemary C
Nursing performance measures are an integral part of quality initiatives in acute care; however, organizations face numerous challenges in developing infrastructures to support quality improvement processes and timely dissemination of outcomes data. At the Hospital of the University of Pennsylvania, a Magnet-designated organization, extensive work has been conducted to incorporate nursing-related outcomes in the organization's quality plan and to integrate roles for clinical nurses into the Department of Nursing and organization's core performance-based programs. Content and strategies that promote active involvement of nurses and prepare them to be competent and confident stakeholders in quality initiatives are presented. Engaging clinical nurses in the work of quality and performance improvement is essential to achieving excellence in clinical care. It is important to have structures and processes in place to bring meaningful data to the bedside; however, it is equally important to incorporate outcomes into practice. When nurses are educated about performance and quality measures, are engaged in identifying outcomes and collecting meaningful data, are active participants in disseminating quality reports, and are able to recognize the value of these activities, data become one with practice.
Rahkar Farshi Mahni
Full Text Available Introduction: Preparing students to take over job responsibilities is one of the most challenging duties of nursing schools. The focus of nursing education should be on helping students to achieve high levels of competence in nursing care and identify factors for reinforcing it. Since desirable results have not been reported on clinical competencies of nursing students, achieving skills to control their emotions could be effective. Thus, this study aimed to investigate the relationship between emotional intelligence (EI and clinical competencies. Methods: In this correlational study, all nursing students in semesters 6, 7 and 8 were studied after determining the sample size in Tabriz University of Medical Sciences. The data were collected using three questionnaires of demographic data, the Emotional Intelligence Sharing – Sybrya and a short clinical competence. The data analysis was done through descriptive and inferential statistics using SPSS 18. Results: The results of the present study showed that the total EI score and clinical competence of students was more than moderate. The relationship between total EI and clinical competence was significant. Among the subscales of EI, there was a significant relationship between social skills and clinical competence. Conclusion: The relationship between the total emotional intelligence score and clinical competence of students in this study indicated the necessity and importance of emotions in decision-making to act properly within a clinical setting. Therefore, taking part in courses designed for learning skills of emotion perception and stress management in the workplace seem to be essential.
Clement, Catherine M; Stiell, Ian G; Lowe, Maureen A; Brehaut, Jamie C; Calder, Lisa A; Vaillancourt, Christian; Perry, Jeffrey J
We recently conducted a multicentre implementation study on the use of the Canadian C-Spine Rule (CCR) by emergency department (ED) nurses to clear the c-spine in alert and stable trauma patients (n = 4506). The objective of this study was to conduct a survey of nurses, physicians, and administrators to evaluate their views on the facilitators and barriers to the implementation of the CCR. We conducted both a paper-based and an electronic survey of the three different ED hospital staff groups of nine large teaching hospitals in Ontario, including six regional trauma centres. The content of this survey was informed by a qualitative evaluation of the opinions of the study nurses who had participated in the validation study. 57.5% (281/489) ED triage nurses, 50.2% ED physicians, and 82.8% of administrators responded. Nurse responses most often showed support from manager/educators and teamwork between physicians, nurses, and managers as being important facilitators to the use of the CCR. Physician responses most often identified the importance of a nurse leader/champion/educator, and presence of strong physician leaders. Administrator responses indicated the importance of nurse educators/champions, nurse engagement, and educational support. Barriers indicated by all three groups included busy department, lack of physician support, and lack of nursing support. Bringing about change in clinical practice is complex. Strong leadership, effective communication, and senior physician buy-in appear to be very important. Identification of system-specific barriers and facilitators are important components of successful knowledge translation. Copyright © 2015 Elsevier Ltd. All rights reserved.
Duffy, Emer; Avalos, Gloria; Dowling, Maura
Emergency department nurses are required to deal with emotional trauma issues on a daily basis, which may result in them experiencing symptoms of secondary traumatic stress, a consequence of stress experienced when helping or wanting to help a person traumatised or suffering. This study measured emergency department nurses' self-reported levels of secondary traumatic stress. Registered nurses (n = 117) working at three emergency departments in the Western geographical region of Ireland were invited to complete the secondary traumatic stress scale (STSS). A response rate of 90% (n = 105) was achieved. Most participants (n = 67/64%) met the criteria for secondary traumatic stress. A statistically significant finding was that the highest proportion (82%) of secondary traumatic stress existed in the staff nurse group (p = 0.042). Moreover, for those nurses reporting secondary traumatic stress, statistical significance was found for the variables 'change of career considered' (p = 0.017) and 'finds alcohol helpful in alleviating work-related stress' (p = 0.004), when compared with nurses not reporting secondary traumatic stress. The findings suggest the need to examine current crisis management interventions and to introduce new systems to support nurses in Irish emergency departments. Moreover, because different types of traumatic events in the ED require different types of interventions, the prevention and management of STS among emergency department nurses must be tackled using a variety of approaches. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available The South African Qualifications Authority, and the South African Nursing Council are in pursuit of quality nursing education to enable the learners to practise as independent and autonomous practitioners. The educational programme should focus on the facilitation of critical and reflective thinking skills that will help the learner to make rational decisions and solve problems. A way of achieving this level of functioning is the use of assessment and evaluation methods that measure the learners’ clinical competence holistically. This article is focused on the perceptions of twenty nurse educators, purposively selected from three Nursing Colleges affiliated to a university in Gauteng, regarding the use of OSCE (Objective Structured Clinical Examination as a clinical evaluation method within a qualitative and descriptive research strategy. Three focus group interviews were conducted in different sessions. A descriptive content analysis was used. Trustworthiness was ensured by using Lincoln and Guba’s model (1985. The results revealed both positive and negative aspects of OSCE as a clinical evaluation method with regard to: administrative aspects; evaluators; learners; procedures/instruments and evaluation. The conclusion drawn from the related findings is that OSCE does not measure the learners’ clinical competence holistically. It is therefore recommended that the identified negative perception be taken as challenges faced by nurse educators and that the positive aspects be strengthened. One way of meeting these recommendations is the use of varied alternative methods for clinical assessment and evaluation that focus on the holistic measurement of the learners’ clinical competence.
Cervera-Gasch, Águeda; Gonzalez-Chorda, Víctor M; Mena-Tudela, Desirée; Salas-Medina, Pablo; Folch-Ayora, Ana; Macia-Soler, Loreto
To evaluate the level of participation of clinical nurses from Castellón where Universitat JaumeI nursing students do their clinical clerkship. To identify the variables that may influence clinical nurses' participation in students' clinical mentorship. This observational, cross-sectional and descriptive study was conducted by applying the validated Involvement, Motivation, Satisfaction, Obstacles and Commitment (IMSOC) questionnaire. The variables collected were: age, work environment and previous training. The study was conducted between January and December 2014. The sample included 117 nurses. The overall mean questionnaire score was 122.838 (standard deviation: ±18.692; interquartile range 95%: 119.415-126.26). The variable "previous training for mentorship students" was statistically significant in the overall score and for all dimensions (P<.05). Primary care nurses obtained better scores in the dimension Implication than professionals working at other care levels. The level of participation of the clinical nurses from Castellón is adequate. The previous training that professionals receive for mentoring students improves both their level of participation and primary care level. Extending this research to other national and international environments is recommended. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Labouliere, Christa D; Storch, Eric A
Trichotillomania (TTM), or compulsive hair pulling, is a disorder that typically onsets in childhood. It is mistaken to believe that children will "age out" of this behavior, as pediatric TTM often has a chronic, debilitating course that does not remit without treatment, resulting in considerable psychological and physical impairment. Because most children with TTM will be seen initially by nursing professionals in the practices of dermatologists, pediatricians, gastroenterologists, and other disciplines, raising nurses' awareness of this disorder is of the utmost importance for accurate nursing diagnosis and assessment. As the health care providers who spend the greatest amount of time with patients, nurses' detection and diagnosis of TTM can make a critical difference in the initiation of early intervention. Therefore, the purpose of this article is to provide an overview of pediatric TTM, including its epidemiology, clinical presentation, and treatment options, from the perspective of nurses who may interact with such patients in their workplace. Copyright © 2012 Elsevier Inc. All rights reserved.
Liljedahl, Matilda; Boman, Lena Engqvist; Fält, Charlotte Porthén; Bolander Laksov, Klara
This paper explores and contrasts undergraduate medical and nursing students' experiences of the clinical learning environment. Using a sociocultural perspective of learning and an interpretative approach, 15 in-depth interviews with medical and nursing students were analysed with content analysis. Students' experiences are described using a framework of 'before', 'during' and 'after' clinical placements. Three major themes emerged from the analysis, contrasting the medical and nursing students' experiences of the clinical learning environment: (1) expectations of the placement; (2) relationship with the supervisor; and (3) focus of learning. The findings offer an increased understanding of how medical and nursing students learn in the clinical setting; they also show that the clinical learning environment contributes to the socialisation process of students not only into their future profession, but also into their role as learners. Differences between the two professions should be taken into consideration when designing interprofessional learning activities. Also, the findings can be used as a tool for clinical supervisors in the reflection on how student learning in the clinical learning environment can be improved.
Maciá-Soler, María Loreto; González Chordá, Víctor Manuel; Salas Medina, Pablo; Mena Tudela, Desirée; Cervera Gasch, Águeda; Orts Cortés, María Isabel
To determine the level of involvement of clinical nurses accredited by the Universitat Jaume I (Spain) as mentors of practice (Reference Nurses) in the evaluation of competence of nursing students. METHODOLGY: Cross-sectional study, in which the "Clinical Practice Assessment Manual'' (CPAM) reported by reference 41 nurses (n=55) were analyzed. Four quality criteria for completion were established: with information at least 80% of the required data, the presence of the signature and final grade in the right place. Verification of learning activities was also conducted. Data collection was performed concurrently reference for nurses and teachers of the subjects in the formative evaluations of clinical clerkship period in the matter "Nursing Care in Healthcare Processes ", from March to June 2013. 63% of CPAM were completed correctly, without reaching the quality threshold established (80%). The absence of the signature is the main criteria of incorrect completion (21%). Nine learning activities do not meet the quality threshold set (80%) (p Nurse cannot be considered adequate, although strategies to encourage involvement through collaboration and training must be developed.
Lin, Blossom Yen-Ju; Wan, Thomas T H; Hsu, Chung-Ping Cliff; Hung, Feng-Ru; Juan, Chi-Wen; Lin, Cheng-Chieh
Given the limited studies on emergency care management, this study aimed to explore the relationships of emergency department (ED) culture values to certain dimensions of ED physicians' and nurses' work satisfaction and intent to leave. Four hundred and forty-two emergency medical professionals completed the employee satisfaction questionnaire across 119 hospital-based EDs, which had culture value evaluations filed, were used as unit of analysis in this study. Adjusting the personal and employment backgrounds, and the surrounded EDs' unit characteristics and environmental factors, multiple regression analyses revealed that clan and market cultures were related to emergency physicians' work satisfaction and intent to leave. On the other hand, adhocracy, market and hierarchical cultures were related to emergency nurses' work satisfaction. There do exist different patterns among various culture types on various work satisfaction dimensions and intent to leave of emergency physicians and nurses. The findings could offer hospital and ED leaders insights for changes or for building a better atmosphere to enhance the work life of emergency physicians and nurses.
Full Text Available Abstract Background Improving provider performance is central to strengthening health services in developing countries. Because of critical shortages of physicians, many clinics in sub-Saharan Africa are led by nurses. In addition to clinical skills, nurse managers need practical managerial skills and adequate resources to ensure procurement of essential supplies, quality assurance implementation, and productive work environment. Giving nurses more autonomy in their work empowers them in the workplace and has shown to create positive influence on work attitudes and behaviors. The Infectious Disease Institute, an affiliate of Makerere University College of Health Science, in an effort to expand the needed HIV services in the Ugandan capital, established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. This paper evaluates the impact on the nurses from this innovative program to provide more health care in six nurse managed Kampala City Council (KCC Clinics. Methods A mixed method approach was used. The descriptive study collected key informant interviews from the six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Key themes were manually identified from the interviews, and the questionnaire data were analyzed using SPSS. Results Introducing new HIV services into six KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction. Conclusions This community-university HIV
Nankumbi, Joyce; Groves, Sara; Leontsini, Elli; Kyegombe, Nambusi; Coutinho, Alex; Manabe, Yuka
Improving provider performance is central to strengthening health services in developing countries. Because of critical shortages of physicians, many clinics in sub-Saharan Africa are led by nurses. In addition to clinical skills, nurse managers need practical managerial skills and adequate resources to ensure procurement of essential supplies, quality assurance implementation, and productive work environment. Giving nurses more autonomy in their work empowers them in the workplace and has shown to create positive influence on work attitudes and behaviors. The Infectious Disease Institute, an affiliate of Makerere University College of Health Science, in an effort to expand the needed HIV services in the Ugandan capital, established a community-university partnership with the Ministry of Health to implement an innovative model to build capacity in HIV service delivery. This paper evaluates the impact on the nurses from this innovative program to provide more health care in six nurse managed Kampala City Council (KCC) Clinics. A mixed method approach was used. The descriptive study collected key informant interviews from the six nurse managers, and administered a questionnaire to 20 staff nurses between September and December 2009. Key themes were manually identified from the interviews, and the questionnaire data were analyzed using SPSS. Introducing new HIV services into six KCC clinics was positive for the nurses. They identified the project as successful because of perceived improved environment, increase in useful in-service training, new competence to manage patients and staff, improved physical infrastructure, provision of more direct patient care, motivation to improve the clinic because the project acted on their suggestions, and involvement in role expansion. All of these helped empower the nurses, improving quality of care and increasing job satisfaction. This community-university HIV innovative model was successful from the point of view of the nurses
Chao, Yu-Mei Y; Chiang, Hsien-Hsien
Clinical nursing process recording (CNPR) has been shown to be an effective tool for facilitating student-centered teaching and learning in nursing education. Yet, the essence and process of this tool have yet to be sufficiently explored and clarified. To explore the essence of CNPR in the contexts of clinical teaching and learning. Reflective analysis was used as the phenomenological approach to analyze the qualitative data, which were transcribed from the oral responses of the six participants who were attending the Clinical Nursing Education Forum. A total of five sessions of the Clinical Nursing Education Forums were conducted. The content of the Clinical Nursing Education Forums consisted of a series of 12 narrative writings of CNPR that were written by a senior student and read and commented on by the student's clinical instructor. Three groups of the essence and process of clinical teaching and learning were inductively identified as: (a) mobilizing autonomous, self-directed learning behavior from self-writing and re-storying; (b) establishing the student-instructor dialogical relationship from mutual localization; and (c) co-creating a learning environment in education and in clinical practice. When used as an interactive teaching and learning tool, CNPR promotes mutual understanding by re-locating the self in the coexisting roles of student nurse, instructor, and patient in a series of nursing care situations. This re-location facilitates students' self-directed learning, enhances the abilities of asking question, waiting for and accompany with the instructor; and promotes the self-care capabilities of patients.
Martínez Lara, Concepción; Praena Fernández, Juan Manuel; Gil García, Eugenia
Clinical Management Unit (CMU) is currently set in the Andalusian health institutions as the model reference management. This management model aims to make all healthcare professionals a powerful idea: the best performance of health resources is performed to drive clinical practice using the least number of diagnostic and therapeutic resources. The CMU not only aims at saving money, in the Clinical Management Agreement  are measured all the dimensions that make up the UGC: research, training, clinical process, the portfolio of services, objectives, financial management and indicators to control and security. The CMU is to transfer more responsibilities to Health Care Professionals, involving them in the management of the Unit. The CMU sets new approaches that directly affect health professionals and presents advantages and disadvantages for the Doctors and the Nurses, involved in achieving excellence in care work. Nurse Practitioners shows expectant before the changes are generated in health institutions and appears a discussion of skills derived from the CMU. Some Nurses believe that the bur, den of care to which they are subjected in public institutions has increased since the onset of the CMU and yet others believe that they are motivated and rewarded for the results obtained with this model of management. In health institutions, some professionals are more motivated than others and this is found in the outcome of health care activity . Given the positive and negative perceptions that arise in the CMU Professional Nurses, it is considered appropriate to focus the objective of this work in the search for factors that influence job satisfaction of nurses in the CMU. There are few studies about the CMU  but are absent when linked with nursing, so the pursuit of scientific knowledge related to nursing management model based on Clinical and Quality Care can lead to establish new concepts around the nursing profession, a profession in which major changes are
Kodama, Hiromi; Tsuntematsu, Kayoko; Yanai, Keiko
Forensic nursing scientifically obtains and preserves the criminal damage from victims of domestic violence, child abuse, elder abuse, sexual violence and other related forms of violence. This was developed in North America in the 1980s, and has carried out appropriate nursing care while protecting the human rights of victims. Serious crime in Japan has been increasing, and it would seem that forensic nursing opportunities should expand as well. However, in Japan, there hasn't been much discussion about forensic nursing. Theorizing that support for clinical forensic nursing should be recognized and relevant, we carried out a survey of 581 clinical nurses to investigate the development of forensic nursing in Japan. 93 clinical nurses (16.0%) had a low level of familiarity with forensic nursing; however, 324 nurses (56.3%) had encountered patients who had suffered violence. 264 nurses (45.4%) had a feeling of wanting to be involved in forensic nursing, but were not confident with the knowledge and technology, while 144 nurses (24.8%) were concerned about the larger responsibility they would have. 400 nurses (68.8%) hoped to receive specialized knowledge and technical education. It is necessary to establish an education system for forensic nursing in accordance with the educational status-quo while considering the present state of forensic nursing education.
Lee, Hyejung; Kim, Anna; Meong, Anna; Seo, Minjeong
The generic competency domains of advanced nursing practice have been reported on in numerous countries, but rather few studies have examined competencies specific to pediatric nurse practitioners (PNPs). We identified the core clinical competencies of PNPs in South Korea and related these identified competencies to the five patterns of knowing in nursing. Focus group interviews were conducted with five PNP students and four PNPs using two thematic questions, one on clinical competencies required for PNPs and the other on competencies specific to Korean PNPs. A purposive sampling method was used to choose nurses with varying work experience and age from different hospital units. The inclusion criterion for PNP students was having at least two years of clinical experience and that for PNPs was having at least two years of clinical experience as a PNP in pediatric units in tertiary hospitals. The verbatim transcriptions of these interviews were analysed by two researchers using inductive content analysis. Six clinical competency domains were identified including advanced pediatric-specific knowledge and clinical skills, education and counseling, utilization and engagement in research, professional identity development, clinical and professional leadership, and holistic care. Some competencies identified were related to empirical and ethical knowledge that could be taught in nursing, whereas others were based on esthetic and personal knowledge, which can be mastered through professional experience. To provide holistic care for children and families, PNPs must acquire all necessary patterns of knowing through continuing education and individual reflection on personal practice.
Ribeiro, Olivério; Vieira, Margarida; Cunha, Madalena
The Nursing Degree Course (NDC) internships realization is assumed as a pertinent study problem for the teaching and hospital institutions, in a way to improve the learning processes and the efficiency of management. To identify the clinical teaching formation costs of nursing students in hospital institutions it was decided to measure through the analysis of a structure indicator the material resources, through a process indicator the human resources on the time spent by nurses provisioning care to patients, and through a results indicator the degree of citizen satisfaction, always having in mind the comparative analysis of hospital costs between the presence and absence of nursing students in Clinical Teachings. A descriptive-correlational and transversal study was realized on the Hospital, on the year 2011, involving Medicine and Surgery Services, where the Clinical Teachings of the Health School NDC take place. The research protocol included a "Documental Corpus" with a list of 26 consumed supplies of the year, an observation grid, for the registration of time of direct cares provided by nurses during 159 observations, and a Citizen Satisfaction Facing Nursing Care Scale, in a sample of 115 citizens inpatient in the services. The inferences show that the presence of students in Clinical Teachings in the hospitals leads to a positive balance of 21.57 € per day and service, with a positive reinforcement associated to the resulting citizens satisfaction facing student rendered cares. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Nayeri, Nahid Dehghan; Khosravi, Laleh
One goal of continuing education is to improve nurses' performance and the quality of patient care. However, in most cases, nurses do not use the information gained through continuing education in the clinical environment. This study was conducted to explore nurses' experiences with applying new knowledge obtained from these programs in clinical settings. This study used qualitative content analysis. Data were gathered through interviews with participants. After the interviews were transcribed, a coding process was used and continued until categories and subcategories were developed. Five main categories emerged: (1) personal interest and self-confidence; (2) organizational structure and atmosphere; (3) professional nature; (4) opportunity to put education into practice; and (5) design of educational programs. Most of the nurses considered obligatory participation in these classes a way to gain annual educational upgrades. A considerable amount of the annual budget is allocated to continuing education. Therefore, the findings of this study, which described nurses' experience with applying what they learned through continuing education in clinical practice, can offer valuable information to help managers improve continuing education programs and the application of new knowledge in the clinical environment. Copyright 2013, SLACK Incorporated.
Hicks, Frank D; Rosenberg, Lisa
The need to educate nurses at the graduate level and provide them with a different skill set that broadens their view of health and nursing is clearly articulated by the American Association of Colleges of Nursing. Consequently, the role of the clinical nurse leader (CNL) was born. Responding to the need for providing a highly educated and credentialed professional at the bedside, Rush University College of Nursing made the bold move to phase out baccalaureate education and enact a prelicensure, master's entry CNL program. Although there is a clear need for this type of graduate, there is little in the literature to provide guidance to institutions that wish to develop this type of program. This paper describes the factors that came into play in making that decision, the process of curriculum development and implementation, the challenges encountered in implementing this type of program, and the outcomes that the program has evidenced since its inception. Copyright © 2016 Elsevier Inc. All rights reserved.
Zuccarini, Mauro; Ledonne, Giuseppina; Bonetti, Loris
The aim of this study was investigating, analysing and evaluating which aspects of the clinical training would be most useful to newly degreed nurses in carrying out their work activities post-graduation, based on their experience. This is a phenomenological qualitative study, with semi-structured, face-to-face, in depth interviews. We used purposive sample. Recruiting of interviewees stopped at achievement of data saturation. Interviews were all audio recorded and transcribed verbatim and analysed in double blind, in order to identify the main themes that emerged. The Van Kaam method was used to analyse interview content. Fourteen nurses, just graduated from Milan University, were involved in the study. Five themes emerged: the relation between theory-practice and the development of clinical thinking, the "time factor" in clinical training duration, the clinical nurse teacher as a professional model, the first days as a nurse: beautiful, traumatic and with loads of responsibility, and finally improvement strategies for a continuously evolving profession. Clinical training is confirmed as a key moment in the link of theory with practice and to infuse the newly qualified professional with the necessary autonomy, self-confidence and practical knowledge. Novice nurses highlighted many positive aspects of their training obtained by means of the clinical training experience, but also that they need time in order to develop confidence and learn to handle responsibility; in this respect, the clinical nurse teacher is seen as a fundamental figure.
Ji Soo Kim, RN, PhD; Jeong Sil Choi, RN, MPH, PhD, APICN
Purpose: Emergency department (ED) nurses suffer from persistent stress after experiencing the traumatic event of exposure to Middle East respiratory syndrome coronavirus (MERS-CoV), which can subsequently lead to burnout. This study aimed to assess ED nurses' burnout level during an outbreak of MERS-CoV and to identify influencing factors in order to provide basic information for lowering and preventing the level of burnout. Methods: Study participants were ED nurses working in eight hosp...
Johnson, Maree; Jefferies, Diana; Nicholls, Daniel
Clinical handover is the primary source of patient information for nurses; however, inadequate information transfer compromises patient safety. We investigated the content and organization of information conveyed at 81 handovers. A structure that captures and presents the information transferred at handover emerged: identification of the patient and clinical risks, clinical history/presentation, clinical status, care plan and outcomes/goals of care (ICCCO). This approach covers essential information while allowing for prioritization of information when required. Further research into the impact of ICCCO on patient safety is in progress. © 2012 Wiley Publishing Asia Pty Ltd.
Ida Torunn Bjørk
Full Text Available This study analyzed nurses' perceptions of clinical decision making (CDM in their clinical practice and compared differences in decision making related to nurse demographic and contextual variables. A cross-sectional survey was carried out with 2095 nurses in four hospitals in Norway. A 24-item Nursing Decision Making Instrument based on cognitive continuum theory was used to explore how nurses perceived their CDM when meeting an elective patient for the first time. Data were analyzed with descriptive frequencies, t-tests, Chi-Square test, and linear regression. Nurses' decision making was categorized into analytic-systematic, intuitive-interpretive, and quasi-rational models of CDM. Most nurses reported the use of quasi-rational models during CDM thereby supporting the tenet that cognition most often includes properties of both analysis and intuition. Increased use of intuitive-interpretive models of CDM was associated with years in present job, further education, male gender, higher age, and working in predominantly surgical units.
Andreza Cavalcanti Vasconcelos
Full Text Available Objective: to identify the frequency of Nursing Diagnoses of patients in a surgical clinic. Methods: cross-sectional study, performed with 99 patients in the postoperative of general surgery. Data were collected through a questionnaire validated according to domains of NANDA International, including physical and laboratory examination. Results: 17 nursing diagnoses were found; eight had a frequency higher than 50.0% (infection risk, impaired tissue integrity, constipation risk, anxiety, bleeding risk, acute pain, delayed surgical recovery, dysfunctional gastrointestinal motility. It was observed in all patients the Nursing Diagnostics: risk of infection, impaired tissue integrity and risk of constipation. Conclusion: the frequency of the most prevalent diagnosis is inserted in the domains safety/protection and nutrition, which determines the need to redirect nursing care, prioritizing the patient's clinic.
Démeh, Waddah; Rosengren, Kristina
The aim of this study was to describe nursing students' experiences of clinical leadership during their last year of education. Work as a nurse is complex with several demands from stakeholders who are colleagues, managers, patients and relatives. Therefore, it is important to provide students with tools for a forthcoming professional life as a nurse. A qualitative descriptive study was carried out in Jordan. Narratives (n=20) written by nursing students in their last year before graduation as a registered nurse were collected. The data were analysed by a manifest content analysis. The results formed one category: (Clinical leadership-safety in being a nurse), and three subcategories (eye-opener, a role model and bridging the gap) described the students' clinical leadership experiences due to the preparation process for being a nurse. Clinical leadership applies theory to practice by using a holistic view in nursing. Clinical leadership is a valuable tool for bridging the gap between theory and practice in nursing education. Skills within nursing management clarify and simplify nursing activities, which facilitates the transition from student to nurse. Focus on learning needs in nursing management is needed for stakeholders within education and health care organisations to facilitate graduation of well skilled nurses. Copyright © 2015 Elsevier Ltd. All rights reserved.
Aim: Patients often have long waiting time in the Emergency Departments to be seen, which in itself is considered a risk of less successful outcome. The aim of this study was to get the perception of how nurses in Norwegian Emergencies believe task shifts between physicians and nurses can influence the patients waiting time, and if the nurses are willing to take on more responsibilities. The study also aim to investigate how nurses in England, and who are practising task shifts, believe this ...
Kagan, I; Itzhaki, M; Melnikov, S
To examine the influence of nurses' patriotism and organizational commitment on their intention to report for work in a national emergency, in Israel. Healthcare systems need to forecast the number of staff likely to report for work in emergencies and mass casualty events. Patriotism and nurses' commitment to work are factors that prompt nurses to leave their families and report for duty, even knowing that they are putting themselves in danger. However, patriotism as a variable that might affect nurses' intention to report for work in emergencies has not been investigated. A descriptive, cross-sectional survey was used with a convenience sample of 152 registered nurses. Descriptive statistics, Pearson correlation coefficients and t-tests were used to analyse the data. To examine the unique contribution of the independent variables to the explanation of the dependent variable - intention to report to work in emergency - multiple regression analysis was performed. Significant positive correlations were found between age, seniority and research variables (organizational commitment, patriotism and intention to report for emergency work). Patriotism differed by gender, ethnicity and religion. Patriotism and gender explained 23% of the variance regarding intention to report for emergency duty, with patriotism playing a major role. Patriotism has religious and cultural dimensions. Cultural differences explain the discrepancy in organizational commitment between Israeli-born nurses and immigrants. Emergency training drills for nurses should feature discussions on universal ethical principles in emergency planning, preparedness and responses. The willingness of ethnic/religious minorities and immigrants to report for work in a national emergency should be taken into consideration in healthcare system disaster planning, so as to lessen the impact of disparate patriotism. © 2017 International Council of Nurses.
Cicchitti, Chiara; Cannizzaro, Giorgia; Rosi, Fabrizio; Maccaroni, Roberto; Menditto, Vincenzo G
Burnout syndrome (BOS) associated with stress has been documented in health care professionals in many specialties. The emergency department and the pre-hospital healthcare services are highly stressful environments. Little is known about the BOS in critical care nursing staff. The objective of the study is to compare the incidence of BOS and its three domains, namely, emotional exhaustion, depersonalization and reduced professional accomplishment, in two cohorts of critical care nurses: a pre-hospital and a hospital emergency service. A survey using a questionnaire (the Maslach Burnout Inventory-General Survey, MBI-GS), among nurses of two Italian emergency services has been performed: a hospital emergency service (HES, Emergency Department or "Pronto Soccorso") and a pre-hospital emergency service (PHES, territorial healthcare service or "Centrale Operativa 118"). All 60 nurses surveyed (82% female) filled the questionnaires. BOS-related symptoms have been identified in at least 50% of the nurses in the HES: 50% suffered a medium-high emotional exhaustion, 75% had a medium-high depersonalization and 92.5% had a medium-high reduced professional accomplishment. Among the PEHS nurses, BOS-related symptoms have been identified in at least 60% of the respondents: 60% had a medium-high emotional exhaustion, 70% had a medium-high depersonalization and 95% had a medium-high reduced professional accomplishment. Moreover, the likelihood that a nurse has a severe BOS, that is at least one degree of high burnout or ≥2 degrees of medium burnout, is significantly higher in the group of the PHES than in the HES (90% vs 60%, p nursing staff had a severe BOS. The incidence of BOS appeared to be similar among PHES and HES nurses with a higher trend for the former. Further interventional studies are needed to investigate the determinants of BOS among critical care nurses and the potentially preventive strategies.
Fitzpatrick, Joyce J; Modic, Mary Beth; Van Dyk, Jennifer; Hancock, K Kelly
The Leadership Education and Development (LEAD) Program was designed to transform care at the bedside by empowering clinical nurses as leaders. The heart of LEAD was enhancing communication skills of clinical nurses with clinical colleagues and, most importantly, patients and families. Key concepts of leadership/management were included: personal awareness, personal leadership skills/abilities, leading change, leading others individually and in teams, enhancing the patient/provider experience, and the leadership role in outcomes management. A quantitative, longitudinal, survey design was used with 2 cohorts. The program consisted of six 4-hour sessions for 3 to 6 months. Leadership practices were measured before program implementation, at the end of the program, and 3 months after program completion. There were significant increases in leadership practices sustained 3 months after program completion. A range of other outcome measures was included. There is a need for additional leadership development programs for clinical nurses.
L'Ecuyer, Kristine Marie
This dissertation presents a quantitative study of the attitudes of staff nurse preceptors toward nursing students with learning disabilities. There are an increased number of nursing students with learning disabilities. These students may have additional challenges in clinical settings, particularly if clinical settings do not understand or…
Stocker, Joel F.; Reddad, Mohamed
Curriculum development research on nursing English in Taiwan has tended to end at needs analysis, offering little guidance on how to design and implement a course. Our objective was to examine how a course on workplace communication in English for nursing students in Taiwan would emerge in the classroom if teachers and students collaboratively…
Hall, Andrea; McKenna, Brian; Dearie, Vikki; Maguire, Tessa; Charleston, Rosemary; Furness, Trentham
Practicing with trauma informed care (TIC) can strengthen nurses' knowledge about the association of past trauma and the impact of trauma on the patient's current mental illness. An aim of TIC is to avoid potentially re-traumatising a patient during their episode of care. A TIC education package can provide nurses with content that describes the interplay of neurological, biological, psychological, and social effects of trauma that may reduce the likelihood of re-traumatisation. Although mental health nurses can be TIC leads in multidisciplinary environments, the translation of TIC into clinical practice by nurses working in emergency departments (EDs) is unknown. However, before ED nurses can begin to practice TIC, they must first be provided with meaningful and specific education about TIC. Therefore, the aims of this study were to; (1) evaluate the effectiveness of TIC education for ED nursing staff and (2) describe subsequent clinical practice that was trauma informed. This project was conducted as exploratory research with a mixed methods design. Quantitative data were collected with an 18-item pre-education and post-education questionnaire. Qualitative data were collected with two one-off focus groups conducted at least three-months after the TIC education. Two EDs were involved in the study. A total of 34 ED nurses participated in the TIC education and 14 ED nurses participated in the focus groups. There was meaningful change (p TIC education. Two themes, each with two sub-themes, were evident in the data. The themes were based on the perceived effectiveness of TIC education and the subsequent changes in clinical practice in the period after TIC education. Emergency department nurses became more informed of the interplay of trauma on an individual's mental health. However, providing care with a TIC framework in an ED setting was a considerable challenge primarily due to time constraints relative to the day-to-day ED environment and rapid turnover of
Hunsaker, Stacie; Chen, Hsiu-Chin; Maughan, Dale; Heaston, Sondra
The purpose of this study was twofold: (a) to determine the prevalence of compassion satisfaction, compassion fatigue, and burnout in emergency department nurses throughout the United States and (b) to examine which demographic and work-related components affect the development of compassion satisfaction, compassion fatigue, and burnout in this nursing specialty. This was a nonexperimental, descriptive, and predictive study using a self-administered survey. Survey packets including a demographic questionnaire and the Professional Quality of Life Scale version 5 (ProQOL 5) were mailed to 1,000 selected emergency nurses throughout the United States. The ProQOL 5 scale was used to measure the prevalence of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses. Multiple regression using stepwise solution was employed to determine which variables of demographics and work-related characteristics predicted the prevalence of compassion satisfaction, compassion fatigue, and burnout. The α level was set at .05 for statistical significance. The results revealed overall low to average levels of compassion fatigue and burnout and generally average to high levels of compassion satisfaction among this group of emergency department nurses. The low level of manager support was a significant predictor of higher levels of burnout and compassion fatigue among emergency department nurses, while a high level of manager support contributed to a higher level of compassion satisfaction. The results may serve to help distinguish elements in emergency department nurses' work and life that are related to compassion satisfaction and may identify factors associated with higher levels of compassion fatigue and burnout. Improving recognition and awareness of compassion satisfaction, compassion fatigue, and burnout among emergency department nurses may prevent emotional exhaustion and help identify interventions that will help nurses remain empathetic and
Arbon, Paul; Ranse, Jamie; Cusack, Lynette; Considine, Julie; Shaban, Ramon Z; Woodman, Richard J; Bahnisch, Laura; Kako, Mayumi; Hammad, Karen; Mitchell, Belinda
The type of disaster, individual demographic factors, family factors and workplace factors, have been identified in the international, multidisciplinary literature as factors that influence a person's willingness to attend and assist in their workplace during a disaster. However, it is unknown if these factors are applicable to Australasian emergency nurses. The research aims to determine the extent to which Australasian emergency nurses are willing to attend their workplace in a disaster. This research was exploratory and descriptive study design, using online and paper based surveys as a means of data collection. Australasian emergency nurses from two Australasian emergency nursing colleges and four Australian hospitals were recruited to participate. Data analysis was conducted using both descriptive and inferential statistics. In total, 451 Australasian emergency nurses participated in this research. Participants were more willing to attend their workplace during a conventional disaster (p ≤ 0.001), if they worked full-time (p = 0.01), had received formal education pertaining to disasters (p ≤ 0.001), had a family disaster plan (p = 0.008), did not have children (p = 0.001) and worked in an environment in which they perceived their colleagues, managers and organisation to be prepared. The factors that influenced Australasian emergency nurses to attend their workplace in a disaster were similar to that described in the international multidisciplinary literature. Of particular note, improving disaster knowledge and skills, having a family disaster plan and improving the perceptions of the nurses' workplace preparedness can enhance the nurses' willingness to assist in a disaster. Copyright © 2013 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.
Pretorius, Annatjie; Searle, Judy; Marshall, Bob
Pain is the most common reason for presentation to the emergency department (ED). On presentation patients expect rapid pain relief, yet this is often not met. Despite extensive improvements in analgesia medication there are still barriers to nurses' assessment, management, documentation, and reassessment of pain. The aim of this study is to identify barriers, enablers, and current nursing knowledge regarding pain management. Using an anonymous quantitative web-based survey, members of the College of Emergency Nurses New Zealand were invited to complete a questionnaire on pain assessment and management. The questionnaires were analyzed using descriptive statistics. Enablers to ED nurses' improved management of pain were the provision of nurse-initiated analgesic protocols and pain management champions. Common barriers perceived by the respondents were the responsibility of caring for acutely ill patients as well as a patient with pain. Similar barriers to previous research were identified and included lack of time, workload, reluctance of clinicians to prescribe analgesia, and the lack of nursing knowledge regarding opioid administration. Raising awareness that oligoanalgesia exists in the ED is essential. This research suggested that nurses would benefit from ongoing education on the usage of opioids. Nurses' attitude regarding patients' right to expect total pain relief as a consequence of treatment was also an issue. ED nurses, by virtue of their role, are in a unique position to be leaders in pain assessment and pain management. Copyright © 2015 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Full Text Available Workplace violence is present in many work sectors, but in the area of mental health, nurses have a higher risk due to the close relationship they have with users. This study analyzed hostile user statements against nursing professionals of Mental Health Services and Emergency Units in Health Service (MHS hospitals in Murcia, Spain, and determined the frequency of exposure to the different violent user behaviors. The study was carried out with a sample of 518 nursing professionals from four hospital services: Mental Health, Emergency Units, Medical Hospitalization, and Maternal-and-Child. The nursing staff of Mental Health and Emergency Units was the most exposed to violence. Non-physical violence was more frequent in Emergency Units, whereas physical violence was more frequent in Mental Health. Among the consequences of exposure to non-physical violence are workers’ emotional exhaustion and the presence of psychological distress.
O'Driscoll, Mike; Allan, Helen T; Lee, Gay; Savage, Jan; Tapson, Christine; Dixon, Roz
This paper reports the findings from a 2015 survey of the Commissioning Nurse Leaders' Network. Our aim was to understand how governing body nurses perceive their influence and leadership on clinical commissioning groups. An online survey method was used with a census sample of 238 governing body nurses and nurses working in Commissioning Support Units, who were members of the Commissioning Nurse Leaders' Network. The response rate was 40.7% (n = 97). While most governing body nurses felt confident in their leadership role, this was less so for non-executive governing body nurses. Nurses in Commissioning Support Units were much less positive than governing body nurses about their influence on clinical commissioning groups. Governing body nurses were satisfied with their impact on clinical commissioning groups and so could be said to be leading a nursing agenda but this evidence is limited to their own perceptions and more objective or diverse measures of impact are needed. The purpose of such roles to 'represent nursing, and ensure the patient voice is heard' may be a flawed aspiration, conflating nursing leadership and patient voice. This is the first study to explore explicitly the differences between executive and non-executive governing body nurses and nurses working in commissioning support units. Achieving clinical commissioning groups' goals, including developing and embedding nursing leadership roles in clinical commissioning groups, may be threatened if the contributions of governing body nurses, and other nurses supporting clinical commissioning groups, go unrecognised within the profession, or if general practitioners or other clinical commissioning group executive members dominate decision-making on clinical commissioning groups. © 2018 John Wiley & Sons Ltd.
Nielson, Mary Hugo; Strong, Linda; Stewart, Julie G
There are over 243,800 female sexual assaults in the United States annually. Of those who seek healthcare services after being sexually assaulted, 90% present to hospitals. Unfortunately, care and services for women who have been sexually assaulted are inconsistent. Increased burnout, frustration, and feelings of inadequacy can lead healthcare providers to exhibit personal biases or negative attitudes toward their patients. The Joint Commission, responsible for accreditation of healthcare organizations, has stated that nurses must provide competent care to all patients. Therefore, Sexual Assault Nurse Examiner (SANE) training needs to be available for emergency department (ED) nurses who care for patients who have been sexually assaulted. A survey using the Attitude Toward Rape Victims Scale was sent to 1503 ED nurses throughout the United States, from the Emergency Nursing Association's mailing list. The results of the survey showed that there was a significant difference in attitudes toward the patients between SANE-trained emergency nurses and those without training. This study also showed that 35.5% of hospitals represented by the respondents did not have SANE services available for adult patients who had been sexually assaulted, and furthermore, 85.5% of the respondents who cared for adult patients who had been sexually assaulted were not SANE trained. The negative attitudes held toward such patients as found in this study, coupled with a lack of training provides evidence that ED nurses may benefit from education related to appropriate treatment for patients who have been sexually assaulted. As evidence-based practice becomes the gold standard of care, ensuring that nurses are properly trained to care for all patients must be the goal.
Reflective learning is the rational analytical process utilised to develop knowledge from experience. This approach to learning is important in post-basic clinical nursing education for both theoretical and clinical competence. A qualitative, non-empirical study was conducted to develop a model for educating reflective ...
Full Text Available This article seeks to publish the results of nurse educators with regard to how reflective thinking of learners can be facilitated in clinical nursing education. Opsomming Hierdie artikel beoog om die resultate van verpleeg-opvoeders met betrekking tot hoe reflektiewe denke van leerders in kliniese verpleegonderwys gefasiliteer kan word, te publiseer. *Please note: This is a reduced version of the abstract. Please refer to PDF for full text.
Curl, Eileen D; Smith, Sheila; Ann Chisholm, Le; McGee, Leah Anne; Das, Kumar
The focus of this research study was the evaluation of the effectiveness of using high-fidelity simulations to replace 50 percent of traditional clinical experiences in obstetrics, pediatrics, critical care, and mental health nursing. Increasing student admissions to nursing programs require additional clinical learning opportunities to accommodate extra students. Three schools with associate degree nursing programs partnered to identify, implement, and evaluate a creative solution to this dilemma. The resulting quasi-experimental study investigated if substituting half of the conventional clinical experiences with simulations was as effective as traditional clinical activities in obstetrics, pediatrics, mental health, and critical care. One hour of simulation counted for two hours of clinical time. RESULTS Findings indicated combining simulations with conventional clinical experiences resulted in significantly higher scores on the pre-graduation exit exam than traditional clinical experiences alone. Findings have implications for articulation and basic students in associate degree nursing programs.
Thompson, Hilaire J; Kagan, Sarah H
The specific aims were to (1) define fever from the nurse's perspective; (2) describe fever management decision-making by nurses and (3) describe barriers to evidence-based practice across various settings. Publication of practice guidelines, which address fever management, has not yielded improvements in nursing care. This may be related to differences in ways nurses define and approach fever. The collective case study approach was used to guide the process of data collection and analysis. Data were collected during 2006-7. Transcripts were coded using the constant comparative method until themes were identified. Cross-case comparison was conducted. The nursing process was used as an analytical filter for refinement and presentation of the findings. Nurses across settings defined fever as a (single) elevated temperature that exceeded some established protocol. Regardless of practice setting, interventions chosen by nurses were frequently based on trial and error or individual conventions -'what works'- rather than evidence-based practice. Some nurses' accounts indicated use of interventions that were clearly contraindicated by the literature. Participants working on dedicated neuroscience units articulated specific differences in patient care more than those working on mixed units. By defining a set temperature for intervention, protocols may serve as a barrier to critical clinical judgment. We recommend that protocols be developed in an interdisciplinary manner to foster local adaptation of best practices. This could further best practice by encouraging individual nurses to think of protocols not as a recipe, but rather as a guide when individualizing patient care. There is value of specialty knowledge in narrowing the translational gap, offering institutions evidence for planning and structuring the organization of care. © 2010 The Authors. Journal of Advanced Nursing © 2010 Blackwell Publishing Ltd.
Taís Couto Rego da Paixão; Cássia Regina Vancini Campanharo; Maria Carolina Barbosa Teixeira Lopes; Meiry Fernanda Pinto Okuno; Ruth Ester Assayag Batista
OBJECTIVE To verify the adequacy of the professional nursing staff in the emergency room of a university hospital and to evaluate the association between categories of risk classification triage with the Fugulin Patient Classification System. METHOD The classification of patients admitted into the emergency room was performed for 30 consecutive days through the methodology proposed by Gaidzinski for calculating nursing requirements. RESULTS The calculation determines the need for three regist...
Paliadelis, Penny; Wood, Pamela
This paper reports on the learning potential of a reflective activity undertaken by final year nursing students, in which they were asked to recount two meaningful events that occurred during their clinical placements over the duration of their 3-year nursing degree program and reflect on how these events contributed to their learning to become beginning level Registered Nurses (RNs). This descriptive qualitative study gathered narratives from 92 students as individual postings in an online forum created within the University's learning management system. An analysis of the students' reflections are the focus of this paper particularly in relation to the value of reflecting on the identified events. Four themes emerged that clearly highlight the way in which these students interpreted and learned from both positive and negative clinical experiences, their strong desire to fit into their new role and their ability to re-imagine how they might respond to clinical events when they become Registered Nurses. The findings of this study may contribute to developing nursing curricula that better prepares final year students for the realities of practice. Copyright © 2016 Elsevier Ltd. All rights reserved.
Charbachi, Serena Jones; Williams, Claire; McCormack, Dianne
The clinical nurse specialist (CNS) role is often misunderstood and underutilized. Through partnership with the CNS Advisory Committee in the Horizon Health Network and the Masters of Nursing Program at the University of New Brunswick, the authors developed a clear articulation and visual representation of the CNS role in New Brunswick. This paper synthesizes information gleaned from interviews with the clinical nurse specialists working within Horizon Health Network and integrates this information with the published literature and the position statement of the Canadian Nurses Association (CNA). Vision, voice and value emerged as key considerations, as did barriers to, and successes of, the CNS role. This paper contributes to the acquisition of knowledge regarding the role of the CNS according to the CNA and current published literature. It further promotes an understanding of the important role of the CNS in the healthcare system in New Brunswick, and introduces strategies that can be utilized by clinical nurse specialists to demonstrate value and support the continuation of the role.
Missen, Karen; McKenna, Lisa; Beauchamp, Alison
Over the past decade, many questions have been raised about graduates' clinical competence and fitness for practice upon completion of their undergraduate education. Despite the significance of this issue, the perspectives of registered nurses have rarely been examined. This systematic review explores the perceptions of experienced registered nurses regarding the clinical competence of new nursing graduates. Original research studies published between 2004-2014 were identified using electronic databases, reference lists, and by searching "grey literature." Papers were critically reviewed and relevant data extracted and synthesized using an approach based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis. From 153 studies initially identified, 15 original research papers were included. Four main research themes were identified: clinical/technical skills, critical thinking, interaction/communication, and overall readiness for practice. Areas of concern in relation to the clinical competence of new nursing graduates specifically related to two themes: critical thinking and clinical/technical skills. Further research is required on strategies identified within the literature with the ultimate aim of ensuring new nursing graduates are safe and competent practitioners. © 2015 Wiley Publishing Asia Pty Ltd.
Pritchett, Cedric V; Foster Rietz, Melissa; Ray, Amrita; Brenner, Michael J; Brown, David
Tracheostomy is a critical and often life-saving intervention, but associated risks are not negligible. The vulnerability of the pediatric population underlies the importance of caregiver comfort and competence in tracheostomy care. To assess inpatient nursing staff and parental perspectives in managing tracheostomy care. Cross-sectional analysis of survey data from (1) a volunteer sample of inpatient nurses in a tertiary care, freestanding pediatric hospital in the Midwest, assigned to clinical wards that provide care for children with tracheostomy tubes and (2) a consecutive sample of families whose child underwent tracheostomy tube placement at the same institution between March 1 and December 31, 2013. Nurse and parental comfort in managing acute and established tracheostomy tubes. Nursing data were analyzed with attention to years' experience and primary unit of practice. Respondents included 129 of 820 nurses (16% response rate) and family members of 19 of 38 children (50% response rate). When queried about changing established tracheostomies, 59 of 128 nurses (46%) reported being "totally comfortable," including 46 of 82 intensive care unit (ICU) nurses (56%) vs 13 of 46 floor nurses (28%) (P = .002) and 48 of 80 nurses with at least 5 years' experience (60%) vs 12 of 49 less experienced nurses (24%) (P tracheostomy, 61 nurses (47%) described being completely uncomfortable, including 27 of 83 ICU nurses (33%) vs 34 of 46 floor nurses (73%) (P = .006), and 33 of 80 nurses with at least 5 years' experience (41% ) vs 28 of 49 less experienced nurses (57%) (P = .03). Most families felt prepared for discharge (16 of 17 [94%]) and found the health care team accessible (16 of 17 [94%]), although only 5 of 18 families (28%) indicated that tracheostomy teaching was consistent. Nurses' comfort with tracheostomy was higher among nurses with at least 5 years' experience and primary ICU location. Whereas parental comfort with tracheostomy care was high
Pardavila Belio, Miren Idoia; Vivar, Cristina G; Canga Armayor, Navidad
The recent implementation in Spain of post degree in nursing has made possible the emergence of new advanced profiles, which direct clinical practice is the core competence. To analyse and clarify the term of direct clinical practice. A conceptual analysis was carried out based on Rogers's evolutionary approach. A review of the literature was made in the following data bases: PubMed, CINAHL, ISI Web of Knowledge, Psych INFO (Ovid) and Cochrane Library. Furthermore, five books about advanced practice nursing were revised. 7 articles and 4 books based on the inclusion criteria were selected. After their analysis the concept of direct clinical practice is defined. This paper clarifies the concept of direct clinical practice and helps to have a stronger base of knowledge. This will serve as foundation to improve and perfect the conceptualization of this term.
PURPOSE: To examine emergency nurses\\' current practices and understanding of family presence during CPR in the emergency department, Cork University Hospital, Republic of Ireland. METHOD: A quantitative descriptive design was used in the study. A questionnaire developed by ENA was distributed to emergency nurses working in a level I trauma emergency department at Cork University Hospital. The total sample number was 90, including all emergency nurses with at least 6 months\\' emergency nursing experience. RESULTS: Emergency nurses often took families to the bedside during resuscitation efforts (58.9%) or would do so if the opportunity arose (17.8%). A high percentage (74.4%) of respondents would prefer a written policy allowing the option of family presence during CPR. The most significant barrier to family witnessed resuscitation (FWR) was conflicts occurring within the emergency team. The most significant facilitator to FWR was a greater understanding of health care professionals on the benefits of FWR to patients and families, indicating the need for educational development. CONCLUSION: The findings of the study and previously published studies indicate the need for development of written polices and guidelines on the practice to meet the needs of patients, families, and staff by providing consistent, safe, and caring practices for all involved in the resuscitation process. Recommendations of the study include the development of a written policy and an educational programme on the safe implementation and practices of FWR.
Liou, Shwu-Ru; Liu, Hsiu-Chen; Tsai, Hsiu-Min; Tsai, Ying-Huang; Lin, Yu-Ching; Chang, Chia-Hao; Cheng, Ching-Yu
The purpose of the study was to develop and psychometrically test the Nurses Clinical Reasoning Scale. Clinical reasoning is an essential skill for providing safe and quality patient care. Identifying pre-graduates' and nurses' needs and designing training courses to improve their clinical reasoning competence becomes a critical task. However, there is no instrument focusing on clinical reasoning in the nursing profession. Cross-sectional design was used. This study included the development of the scale, a pilot study that preliminary tested the readability and reliability of the developed scale and a main study that implemented and tested the psychometric properties of the developed scale. The Nurses Clinical Reasoning Scale was developed based on the Clinical Reasoning Model. The scale includes 15 items using a Likert five-point scale. Data were collected from 2013-2014. Two hundred and fifty-one participants comprising clinical nurses and nursing pre-graduates completed and returned the questionnaires in the main study. The instrument was tested for internal consistency and test-retest reliability. Its validity was tested with content, construct and known-groups validity. One factor emerged from the factor analysis. The known-groups validity was confirmed. The Cronbach's alpha for the entire instrument was 0·9. The reliability and validity of the Nurses Clinical Reasoning Scale were supported. The scale is a useful tool and can be easily administered for the self-assessment of clinical reasoning competence of clinical nurses and future baccalaureate nursing graduates. Study limitations and further recommendations are discussed. © 2015 John Wiley & Sons Ltd.
Bohman, Doris M; Ericsson, Terese; Borglin, Gunilla
Nowadays, nursing research is seen as an integral part of professional nursing although implementing knowledge derived from nursing research into the practice setting is still problematic. Current research, conducted mainly with a descriptive quantitative design, highlights the struggle experienced by Registered Nurses (RNs) to use and implement research findings in clinical practice. Therefore, the aim of this naturalistic inquiry was to explore nurses' perception of nursing research and its implementation in a clinical context. A qualitative approach was chosen, and four focus group discussions were conducted. The groups comprised a total of 16 RNs (three men and 13 women) working in a secondary care setting. The transcribed texts were analysed, inspired by Burnard's description of content analysis. The texts were interpreted as representing three predominant themes: scholastic, individual and contextual influences highlighted as influential components impacting on the RNs' views on research and its implementation as well as on their readiness to accept and support it. However, the most influential aspect permeating our themes was their educational background--the type of qualification they held. In general, the RNs with a Bachelor of Science in Nursing viewed research and the implementation of knowledge in practice more favourably than those RNs with a diploma. Our findings, although based on a small qualitative study, are congruent with others, indicating that further research is warranted concerning the impact of education on RNs' views of nursing research and its implementation. Hence, it might well be that the RNs' educational point of departure needs to be stressed more than what so far have been anticipated. In the meanwhile, it is possible that a number of strategies could be tested to promote a more favourable view in these issues and where the nursing education has the possibility to influence this endeavour. © 2012 The Authors. Scandinavian Journal of
Nahas, V L; Nour, V; al-Nobani, M
Clinical teaching is a dynamic process that occurs in a variety of sociocultural contexts. The quality of student-teacher interaction in the clinical field can either facilitate or hinder the students' learning in the clinical area. This paper presents the results of a study to explore Jordanian undergraduate nursing students' perceptions of effective clinical teacher characteristics. The results showed that overall, the nursing students rated the professional competence of the clinical teacher as the most important characteristic, which when compared to the Western population was different. When male and female nursing students' perceptions were compared, no significant differences were found. However, responses of nursing students from the three academic years differed significantly in that second-year students rated the clinical teachers' relationship with students as most important and fourth-year students rated personal qualities of the clinical teachers as most important. The results were significant in that they were congruent with the students' level of education and most importantly, their cultural beliefs and values about education.
Sun, Carolyn; Dohrn, Jennifer; Klopper, Hester; Malata, Address; Omoni, Grace; Larson, Elaine
Because of the profound shortage of nurse and midwifery researchers in many African countries, identification of clinical nursing and midwifery research is of highest priority for the region to improve health outcomes. The aim of this study was to gain consensus from experts on the priorities of clinical nursing and midwifery research in southern and eastern African countries. A Delphi survey was conducted among experts in the region. Criteria for "expert" included (a) a professional nurse, (b) a bachelor's degree or higher in nursing, (c) published research, (d) affiliated with a school of nursing with at least a master's level nursing program, and/or (e) identified by the African core collaborators as an expert in the region. A list of candidates was identified through searches of published and gray literature and then vetted by core collaborators in Kenya, Malawi, and South Africa. Core collaborators held leadership roles in a nursing school and a doctoral degree in nursing, had conducted and published nursing research, and resided in an included country. Two rounds of the Delphi survey were required to reach consensus. In total, 40 participants completed both rounds, and at least one participant from each country completed both rounds; 73% and 85% response rates were achieved for each round, respectively. Critical clinical research priorities were infectious disease/infection control and midwifery/maternal health topics. These included subtopics such as HIV/AIDS, tuberculosis, maternal health and mortality, infant mortality, and obstetrical emergencies. Many other topics were ranked as important including patient outcomes, noncommunicable diseases, and rural health. Areas identified as research priorities were consistent with gaps identified in current literature. As evidenced by previous research, there is a lack of clinical nursing and midwifery research in these areas as well as nurses and midwives trained to conduct research; these priorities will help
Whittenburg, Luann; Meetim, Aunchisa
An innovative nursing documentation project conducted at Bumrungrad International Hospital in Bangkok, Thailand demonstrated patient care continuity between nursing patient assessments and nursing Plans of Care using the Clinical Care Classification System (CCC). The project developed a new generation of interactive nursing Plans of Care using the six steps of the American Nurses Association (ANA) Nursing process and the MEDCIN® clinical knowledgebase to present CCC coded concepts as a natural by-product of a nurse's documentation process. The MEDCIN® clinical knowledgebase is a standardized point-of-care terminology intended for use in electronic health record systems. The CCC is an ANA recognized nursing terminology.
Lee, Seung Min; Sung, Kyung Mi
The purpose of this study was to examine the effects of a violence coping program (VCP) based on Polk's middle-range theory of resilience on nursing competency, resilience, burnout, and the ability to cope with violence in nurses working in emergency rooms. A quasi-experimental study, with a nonequivalent control group and a pretest-posttest design, was conducted. Participants were 36 nurses who worked in emergency rooms and had experienced violence; 18 nurses from D hospital and 18 nurses from C hospital were assigned to the experimental and control groups, respectively. The experimental group received the VCP twice per week for 8 weeks. Levels of resilience, F=59.41, pnursing competency, F=59.41 pburnout, F=52.74, pburnout and improving resilience, active coping behavior, and nursing competency. Therefore, it would be a useful intervention for improving the quality of nursing care provided in emergency rooms. © 2017 Korean Society of Nursing Science
Small, Sandra P; Colbourne, Peggy A; Murray, Cynthia L
Background Little attention has been given to in-depth examination of what high-fidelity simulation is like for nursing students within the context of a pediatric emergency, such as a cardiopulmonary arrest. It is possible that such high-fidelity simulation could provoke in nursing students intense psychological reactions. Purpose The purpose of this study was to learn about baccalaureate nursing students' lived experience of high-fidelity simulation of pediatric cardiopulmonary arrest. Method Phenomenological methods were used. Twenty-four interviews were conducted with 12 students and were analyzed for themes. Results The essence of the experience is that it was eye-opening. The students found the simulation to be a surprisingly realistic nursing experience as reflected in their perceiving the manikin as a real patient, thinking that they were saving their patient's life, feeling like a real nurse, and feeling relief after mounting stress. It was a surprisingly valuable learning experience in that the students had an increased awareness of the art and science of nursing and increased understanding of the importance of teamwork and were feeling more prepared for clinical practice and wanting more simulation experiences. Conclusion Educators should capitalize on the benefits of high-fidelity simulation as a pedagogy, while endeavoring to provide psychologically safe learning.
Wallace, Linda; Bourke, Mary P; Tormoehlen, Lucy J; Poe-Greskamp, Marlene V
The Nursing Students' Clinical Stress Scale, a Likert-type survey by Whang (2002), translated from Korean into English, was used to identify perceptions of stress in baccalaureate nursing students. Data was collected from a convenience sample of baccalaureate nursing students at a Midwestern university. Students ranked their perceived stress level from clinical situations. One open-ended item asked students to describe their most stressful clinical experience. Rasch Model analysis/diagnostics were used to check the instrument for validity and reliability. Quantitative data were analyzed for descriptive statistics (means). Information from open-ended question was analyzed for themes. Qualitative themes were consistent with results from quantitative analysis and well-aligned with the literature. Students were stressed by incivility by healthcare staff and instructors, inconsistencies and time constraints. Research shows that stress can interfere with learning. It is imperative to determine causes of stress so educators can help decrease stress and improve student learning.
Garcia, Mayra G; Watt, Jennifer L; Falder-Saeed, Karie; Lewis, Brennan; Patton, Lindsey
Clinical nurse specialists (CNSs) have a unique advanced practice role. This article describes a process useful in establishing a comprehensive orientation and onboarding program for a newly hired CNS. The project team used the National Association of Clinical Nurse Specialists core competencies as a guide to construct a process for effectively onboarding and orienting newly hired CNSs. Standardized documents were created for the orientation process including a competency checklist, needs assessment template, and professional evaluation goals. In addition, other documents were revised to streamline the orientation process. Standardizing the onboarding and orientation process has demonstrated favorable results. As of 2016, 3 CNSs have successfully been oriented and onboarded using the new process. Unique healthcare roles require special focus when onboarding and orienting into a healthcare system. The use of the National Association of Clinical Nurse Specialists core competencies guided the project in establishing a successful orientation and onboarding process for newly hired CNSs.
Matthew-Maich, Nancy; Martin, Lynn; Ackerman-Rainville, Rosemary; Hammond, Cynthia; Palma, Amy; Sheremet, Darlene; Stone, Rose
To explore baccalaureate nursing student perceptions of what makes an effective nurse educator in the clinical practice setting and the influence of effective teaching on student experiences. Online surveys (n=511) and focus groups (n=7) were completed by nursing students enrolled in all four years of the baccalaureate programme. Data were analysed using content analysis. Participants indicated that effective teachers foster positive experiences, motivation, meaningful learning and success. They were perceived to be prepared, person-centred, professional, passionate and positive, and to prepare students for success using active strategies. They adjusted to meet individual students' needs at each level of the programme. Important characteristics and factors in effective clinical teaching were identified. These may be used to develop effective clinical teaching initiatives.
Full Text Available It is well known that in an era of emerging use of ICT in nursing education and health care it is important to have knowledge of the attitudes towards ICT within the profession. However, nursing students and nurses have been notoriously reluctant to embrace/implement ICT in their work and studies.This paper focuses on the construction of ICT-habitus amongst bachelor nursing students displayed by four positions of attitudes that describe the ICT-habitus of the group of nursing students included [under consideration] in the study. Quotes from the students are used to support and illustrate the findings. The methodical approach was based on Pierre Bourdieu’s multi-faceted data collection approach and Steiner Kvale’s technical guidelines for interviewing were used for conducting focus group interviews.In order to carry out the construction a mapping of ICT implementation in the Danish primary and secondary education and nursing education from 1970 – 2001 was undertaken. A questionnaire concerning attitudes towards ICT in Healthcare was conducted amongst first year students and focus group interviews were completed. A bibliography and other sources has been included. These datasets made it possible to construct the field of ICT in nursing education and +to construct nursing students' ICT habitus and ICT capital, which was were categorized in four descriptive positions, called "The endorser", "The sceptic", "The adversary" and "The critical".These positions can be used for developing strategies for implementing ICT and development of e-learning in educational and clinical settings for nursing students, thereby contributing with new knowledge and understanding of the ICT-based learning context and the processes within.
Renolen, Åste; Hjälmhult, Esther
Guidelines recommend the use of evidence-based practice in nursing. Nurses are expected to give patients care and treatment based on the best knowledge available. They may have knowledge and positive attitudes, but this does not mean that they are basing their work on evidence-based practice. Knowledge is still lacking about what is needed to successfully implement evidence-based practice. The aim of this study was to gain more knowledge about what nurses perceive as the most important challenge in implementing evidence-based practice and to explain how they act to face and overcome this challenge. We used classical grounded theory methodology and collected data through four focus groups and one individual interview in different geographical locations in one large hospital trust in Norway. Fourteen registered clinical practice nurses participated. We analysed the data in accordance with grounded theory, using the constant comparative method. Contextual balancing of knowledge emerged as the core category and explains how the nurses dealt with their main concern, how to determine what types of knowledge they could trust. The nurses' main strategies were an inquiring approach, examining knowledge and maintaining control while taking care of patients. They combined their own experienced-based knowledge and the guidelines of evidence-based practice with a sense of control in the actual situation. The grounded theory contextual balancing of knowledge may help us to understand how nurses detect what types of knowledge they can trust in clinical practice. The nurses needed to rely on what they did, and they seemed to rely on their own experience rather than on research. © 2015 Nordic College of Caring Science.
Stanley, David; Stanley, Karen
To explore what we know of the concept of clinical leadership and what the term means. Clues to the definition of clinical leadership, the attributes of effective and less effective clinical leaders, models of clinical leadership and the barriers that hinder clinical leadership development were explored. While nursing leadership and healthcare leadership are terms that have been evident in nursing and health industry literature for many decades, clinical leadership is a relatively new term and is may still be misunderstood. A search was undertaken of formal and informal literature using a library database and a range of search engines for the words "clinical leadership" and "clinical leadership in nursing." In each case, the full search parameters were employed with searches between 1974-2016. Full-text articles were requested, and English was the preferred language. In total, 3,259 publications were located through seven database search tools, although these included a large number of duplications. Following further informal searches and removing irrelevant material, 27 research or literature review focused papers were retained that included 17 qualitative studies, one quantitative study, one mixed method study, one Delphi study and two that compared other research studies. As well, five literature reviews were retained in the synthesis. The data synthesis resulted five categories: definitions of clinical leadership, characteristics most likely or least associated with clinical leadership, models applied to clinical leadership and limits to clinical leadership development. Clinical leaders are recognised for having their values and beliefs parallel their actions and interventions. They are found across the spectrum of health organisations, often at the highest level for clinical interaction, but not commonly at the highest management level in a ward or unit team and they are seen in all clinical environments. Clinical Leadership and an understanding on how
Mary Jo Kreitzer
Full Text Available While the essence of nursing has long been whole person (body, mind, and spirit and whole system-focused, in reality the contemporary practice of nursing in many settings around the globe has become increasingly fragmented and de-stabilized. Nursing shortages in many parts of the world are significant, and hierarchies and bureaucracies often remove nurses from the point of care, be that the bedside, home, or clinic, replacing them with less skilled workers and filling their time with documentation and other administrative tasks. Integrative nursing is a framework for providing whole person/whole system care that is relationship-based and person-centered and focuses on improving the health and wellbeing of caregivers as well as those they serve. It is aligned with what is being called the “triple aim” in the United States—an effort focused on improving the patient experience (quality and satisfaction, improving the health of populations, and reducing the cost of care. The principles of integrative nursing offer clear and specific guidance that can shape and impact patient care in all clinical settings.
Jennings, Natasha; Lutze, Matthew; Clifford, Stuart; Maw, Michael
The emergency nurse practitioner is now a well established and respected member of the healthcare team. Evaluation of the role has focused on patient safety, effectiveness and quality of care outcomes. Comparisons of the role continue to focus on cost, with findings based on incomplete and almost impossible to define, recognition of contribution to service delivery by paralleled practitioners. Currently there is no clear definition as to how nurse practitioners contribute to value in health service delivery. Robust and rigorous research needs to be commissioned taking into consideration the unique hybrid nature of the emergency nurse practitioner role and focusing on the value they contribute to health care delivery.
Assessing clinical judgment for safe nursing practice is a challenge. In this study, the Lasater Clinical Judgment Rubric (LCJR) was used to evaluate clinical judgment of junior and senior nursing students in the clinical setting. Juniors demonstrated an accomplished level on the total scale and all 4 subscales, whereas seniors had exemplary clinical judgment on the total scale and 3 of 4 subscales. The study provides evidence in support of the use of the LCJR to assess students' clinical judgment in the clinical practice setting.
Pinar, Rukiye; Ucmak, Firdevs
The aim of this study was to determine the perceived verbal and physical violence and related factors experienced by nurses in emergency settings. Studies on violence in emergency departments indicate an increasing frequency of these incidents. However, little is known about the violence experienced by the Turkish nurses working in emergency departments. Survey. The study population included 255 nurses. Data were collected using a questionnaire. Verbal violence was reported with a frequency of 91.4%. Of the nurses, 74.9% had been exposed to physical violence in at least several episodes during the previous 12 months. Patients' relatives were the main perpetrators, followed by patients, most of whom were male. After experiencing violence, most of the nurses reported that, they had felt fear and only 3% described that they took sick leave, while 80% did not report the incidences of violence they experienced. The nurses described that, after a violent incident, they sought support mainly from their colleagues in emergency departments rather than from the administration. Over half of the nurses (65%) felt safe 'none of the time' in emergency departments, and 89.8% of them described that patients and patient relatives may potentially exhibit violent behaviours towards the staff when they are first admitted to emergency department, while 73.7% believed that the staffing pattern and physical environment of their emergency departments were not adequate to prevent violence. Most of the nurses (83.5%) stated that they should be provided with the training that will help them prevent and manage violence as part of their in-service education, whereas 82.7% of them had not received any such training. The findings have implications for occupational health and safety from both employer and employee perspective. © 2010 Blackwell Publishing Ltd.
Changiz, Tahereh; Malekpour, Alireza; Zargham-Boroujeni, Ali
Clinical education is a critical and complex component of nursing education that is influenced by many variables. One of them is stress, which may disturb students' learning, too. Stressors may differ according to the learning situation and environment, and recognizing them, seems to be essential for corrective interventions. The present work was performed to identify stressors in clinical nursing education in Iran, according to the published research reports. In this systematic review, all published research reports available in Iranian and International web-based data bases and search engines were searched. Also, the archives of peer reviewed Iranian nursing and medical education journals (published between 1989 and 2009) were hand searched. Out of 1104 retrieved records (by a more general terms of clinical education AND Nursing), after stepwise screening, 15 original research articles were selected for content analysis. Coded data were classified and their frequency was represented in Tables. THE FOLLOWING THEMES WERE OBTAINED TO CLASSIFY MAIN AREAS OF IMPORTANCE FOR FACTORS RELATED TO STRESS IN CLINICAL NURSING EDUCATION: a) clinical competence and ability to play one's roles, b) care load, or stress due to care, c) main area of education, d) interpersonal relationships and interactions, e) clinical environment (facilities and equipments, space, learning opportunities, etc,…). Subthemes were also identified in each theme. Published studies in Iran provide appropriate background evidences for planning and evaluating interventional programs to reduce stress among nursing students and instructors. Each identified theme in this study could be considered as a subject for planned interventions. Among them, it seems that interpersonal relationships and interactions is of the highest priority.
Gousy, Mamood; Green, Kim
Nurses are at the forefront of implementing and managing change, given constantly changing healthcare services and the increase in demand for health care. Therefore, it is important to identify the best style of leadership to engage nurses in implementing service-led improvements. This article explores the effects of transformational leadership in bringing about service-led improvements in health care, using the example of setting up a nurse-led acupuncture clinic to optimise the care of patients with chronic pain. Transformational leadership was used throughout the project - from the initial local planning, training and development, through to liaising with the appropriate staff and deciding on an evaluation strategy. Transformational leadership proved to be an effective way to engage and empower nurses and other members of the chronic pain team to enable them to achieve the project aims.
The aim of the present study was to determine whether social support, burnout, and anger expression are related with each other among emergency nurses working in private- or public-sector hospitals. The sample consisted of 100 emergency nurses working in the private or public sector in Ankara, Turkey. The Maslach Burnout Inventory, The Multidimensional Scale of Perceived Social Support, and The Trait-Anger and Anger Expression Scale were used. The results demonstrated that social support did not differentiate among the nurses working in the private sector or in the public sector according to the burnout subscales' scores. However, nurses in the private sector find it more difficult to express their anger. The state-trait anger levels of the nurses differ according to the burnout levels and also according to the sector that they are working in. The congruence between this study's findings and the literature is discussed.
Sheikhbardsiri, Hojjat; Khademipour, Gholamreza; Nekoei-Moghadam, Mahmoud; Aminizadeh, Mohsen
Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high-quality care to patients. Therefore, due to the importance of this issue, this study aimed to determine job motivation of the nurses in pre-hospital and educational hospitals emergency in the southeast of Iran. In this study, a cross-sectional method was used, and it was conducted in educational hospitals and pre-hospital emergencies under supervision of the Kerman University of Medical Sciences in 2017. Using a valid and reliable questionnaire, we assessed job motivation of the nurses using a census method (N = 275). Data were analyzed by implementing descriptive statistics including mean and standard deviation (SD), and analytical statistics such as Kolmogorov-Smirnov, ANOVA, t-test, X2, Pearson, and multivariate regression tests using SPSS 16 and P ≤ 0.05. Among the pre-hospital emergency nurses, the average of the educational factors was 25.33, financial factors was 6.34, psychological factors was 20.07, welfare factors was 0.63, and administrative factors was 8.16. Among the nurses of the educational hospitals emergency, these factors were 25.33, 6.51, 20.34, 16.55, and 8.39, respectively. Two group's nurses were at the intermediate level of the job motivation. Dynamic and predetermined goals of emergency include providing services as soon as possible and stabilizing patient's condition during the golden and vital time of rescue. Findings suggest that national and local policies in Iran may need to examine factors that contribute to the promotion of the motivation as well as focusing on how to improve them. Copyright © 2017 John Wiley & Sons, Ltd.
To date, there has been no development of a complete, applicable inventory of clinical staff nurse (CSN) leadership role competencies through a valid and reliable methodology. Further, the CSN has not been invited to engage in the identification, definition, or development of their own leadership competencies. Compare existing leadership competencies to identify and highlight gaps in clinical staff nurse leadership role competency development and validation. Literature review. The CSN has not participated in the development of CSN leadership role competencies, nor have the currently identified CSN leadership role competencies been scientifically validated through research. Finally, CSN leadership role competencies are incomplete and do not reflect the CSN perspective. © 2017 Wiley Periodicals, Inc.
Maria Margaretha Bogar
Full Text Available Introduction: Nursing care is integral part of health care and having important role in management of patient with emergency condition. The purpose of this research was to develop nurse performance improvement model based on individual, organization and job characteristics association in Emergency Department of RSUD dr TC Hillers Maumere. Method: This was an explanative survey by cross sectional approach held on July -August 2012. Respondents in this study were 22 nurses and 44 patients were obtained by purposive sampling technique. Data were analyzed by partial least square test and signi fi cant t value > 1.64 (alpha 10%. Result: Results showed that individual characteristic had effect on nurse performance (t = 7.59, organization characteristic had effect on nurse performance (t = 2.03 and job characteristic didn’t have effect on nurse performance (t = 0.88. Nurse performance had effect on patient satisfaction (t = 6.54 but nurse satisfaction didn’t have effect on nurse performance (t = 1.31, and nurse satisfaction didn’t have effect either on patient satisfaction (t = 0.94. Discussion: This research concluded that individual characteristics which in fl uence nurse performance in nursing care were ability and skill, experience, age, sex, attitude and motivation. Organization characteristic that influence nurse performance was reward while job characteristic that include job design and feedback didn’t influence nurse performance in nursing care. Nurse performance influenced patient satisfaction but nurse satisfaction didn’t influence patient satisfaction and nurse performance.
Adriaenssens, Jef; De Gucht, Veronique; Maes, Stan
This longitudinal study examines the influence of changes over time in work and organisational characteristics on job satisfaction, work engagement, emotional exhaustion, turnover intention and psychosomatic distress in emergency room nurses. Organisational and job characteristics of nurses are important predictors of stress-health outcomes. Emergency room nurses are particularly exposed to stressful work-related events and unpredictable work conditions. The study was carried out in 15 emergency departments of Belgian general hospitals in 2008 (T1) and 18 months later (T2) (n = 170). Turnover rates between T1 and T2 were high. Important changes over time were found in predictors and outcomes. Changes in job demand, control and social support predicted job satisfaction, work engagement and emotional exhaustion. In addition, changes in reward, social harassment and work agreements predicted work engagement, emotional exhaustion and intention to leave, respectively. Work-related interventions are important to improve occupational health in emergency room nurses and should focus on lowering job demands, increasing job control, improving social support and a well-balanced reward system. Nursing managers should be aware of the causes and consequences of occupational stress in emergency room nurses in order to enable preventive interventions. © 2013 John Wiley & Sons Ltd.
Suarez-Garcia, Jose-Maria; Maestro-Gonzalez, Alba; Zuazua-Rico, David; Sánchez-Zaballos, Marta; Mosteiro-Diaz, Maria-Pilar
Clinical practice is critical for nursing students to acquire the knowledge and skills needed to properly develop professionally. The presence of stress in clinical practice may negatively affect their training. To understand the extent to which clinical practice can be stressful for nursing students at a Spanish university and to determine the main stressors associated with the practice. Cross-sectional, descriptive, and observational study conducted in 2016 at the two nursing colleges of the University of Oviedo, located in Oviedo and Gijón in the Principality of Asturias, Spain. A total of 450 nursing students at a Spanish university served as participants in this study from January to April 2016. A data collection sheet was developed to track different sociodemographic variables, and was distributed together with the KEZKAK questionnaire, a validated scale adapted to Spanish nursing students. It is composed of 41 items using a 4-point Likert scale, rating how much the described situation worries them from 0 ("Not at all") to 3 ("A lot"). Students were most concerned about issues relating to causing harm to patients and lack of competence. Women found clinical practice to be more stressful than men did, both in general terms (p < 0.001) and with respect to all individual factors included in the questionnaire. In addition, there were associations between the "lack of competence" factor and having a job simultaneously (p = 0.011), the "contact with suffering" factor and the school year (p = 0.018), and the "being harmed by the relationship with patients" factor and the age group (p = 0.013). Nursing students, particularly women, see clinical practice as "rather stressful", with the main stressors being those related to causing harm to patients. Copyright © 2018 Elsevier Ltd. All rights reserved.
Hwang, Jee-In; Ahn, Jeonghoon
To examine levels of teamwork and its relationships with clinical error reporting among Korean hospital nurses. The study employed a cross-sectional survey design. We distributed a questionnaire to 674 nurses in two teaching hospitals in Korea. The questionnaire included items on teamwork and the reporting of clinical errors. We measured teamwork using the Teamwork Perceptions Questionnaire, which has five subscales including team structure, leadership, situation monitoring, mutual support, and communication. Using logistic regression analysis, we determined the relationships between teamwork and error reporting. The response rate was 85.5%. The mean score of teamwork was 3.5 out of 5. At the subscale level, mutual support was rated highest, while leadership was rated lowest. Of the participating nurses, 522 responded that they had experienced at least one clinical error in the last 6 months. Among those, only 53.0% responded that they always or usually reported clinical errors to their managers and/or the patient safety department. Teamwork was significantly associated with better error reporting. Specifically, nurses with a higher team communication score were more likely to report clinical errors to their managers and the patient safety department (odds ratio = 1.82, 95% confidence intervals [1.05, 3.14]). Teamwork was rated as moderate and was positively associated with nurses' error reporting performance. Hospital executives and nurse managers should make substantial efforts to enhance teamwork, which will contribute to encouraging the reporting of errors and improving patient safety. Copyright © 2015. Published by Elsevier B.V.
Nursing and other health professionals are increasingly using simulation as a strategy and a tool for teaching and learning at all levels that need clinical training. Nursing education for decades used simulation as an integral part of nursing education. Recent studies indicated that simulation improves nursing knowledge, clinical practice,…
Reynolds, Joshua C; Abraham, Michael K; Barrueto, Fermin F; Lemkin, Daniel L; Hirshon, Jon M
Procedural sedation and analgesia is a core competency in emergency medicine. Propofol is replacing midazolam in many emergency departments. Barriers to performing procedural sedation include resource utilization. We hypothesized that emergency nursing time is shorter with propofol than midazolam, without increasing complications. Retrospective analysis of a procedural sedation registry for two community emergency departments with combined census of 100,000 patients/year. Demographics, procedure, and ASA physical classification status of adult patients receiving procedural sedation between 2007-2010 with midazolam or propofol were analyzed. Primary outcome was dedicated emergency nursing time. Secondary outcomes were procedural success, ED length of stay, and complication rate. Comparative statistics were performed with Mann-Whitney, Kruskal-Wallis, chi-square, or Fisher's exact test. Linear regression was performed with log-transformed procedural sedation time to define predictors. Of 328 procedural sedation and analgesia, 316 met inclusion criteria, of which 60 received midazolam and 256 propofol. Sex distribution varied between groups (midazolam 3% male; propofol 55% male; P = 0.04). Age, procedure, and ASA status were not significantly different. Propofol had shorter procedural sedation time (propofol 32.5 ± 24.2 minutes; midazolam 78.7 ± 51.5 minutes; P procedural success (propofol 98%; midazolam 92%; P = 0.02). There were no significant differences between complication rates (propofol 14%; midazolam 13%; P = 0.88) or emergency department length of stay (propofol 262.5 ± 132.8 minutes; midazolam 288.6 ± 130.6 minutes; P = 0.09). Use of propofol resulted in shorter emergency nursing time and higher procedural success rate than midazolam with a comparable safety profile. Copyright © 2013 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.
Ernestina M. Caka
Full Text Available The study focused on the clinical learning experiences of Pupil Enrolled Nurses (PENs within the military health service. The purpose of the research was to explore and describe the learning experiences of PENs within the Military health clinical learning environment. An explorative, descriptive, contextual design which is qualitative in nature was used to guide the study. The military as a training institution prides itself on preparing nurses both as soldiers and nurses, this could be both challenging and exasperating for students, as the scopes are diverse. Being notably very hierarchical, the military’s rules constantly take precedence over nursing rules. For the duration of nursing training, students are allocated in the clinical learning area to acquire competencies such as problem solving, cognitive and psychomotor skills (Kuiper & Pesut 2003:383. Students learn how to merge theory and practice and apply theories in the practical sense. This is however, not done in isolation from the military codes, as they are intertwined. Attendance of military parades and drills are incorporated during this phase. This could create missed opportunities from the clinical learning as students are expected to leave the clinical setting for this purpose. Three focus group sessions were conducted and the experiences of the students, as narrated by themselves, yielded valuable insights. The researcher wrote field notes and assisted with the management of the audio tapes for easy retrieval of information. Data was analysed by the researcher, independent of the cocoder. Two themes relating to the PENs’ learning experiences emerged from the data analysed: (1 facilitators of clinical learning, (2 and barriers to clinical learning. The findings obtained depicted those factors which facilitated and obstructed student learning. These findings made it possible for the researcher to make recommendations concerning positive interventions which could be taken to
Nasrullah Nasrullah; Mishbahul Huda Alfarisyi
As one of the health professions, nurse normally does no have independent authority to conduct medical practice. However, according to several regulations, nurse has a chance to establish and run his/her own nursing clinic. So far, there are six individual nursing clinics have been operated in Bantul Regency. By utilizing empirical research method with legislation approach, this research aims at finding out the importance and the permit procedure to establish nursing clinic as well as to know...
Rohatinsky, Noelle; Chachula, Kathryn; Sedgwick, Monique; Press, Madeline M; Compton, Roslyn M; Lane, Brenda
Clinical experiences are the hallmark of prelicensure nursing programs and assist students with applying nursing theory into practice. The literature is limited with respect to nursing student and instructor preferences for type of clinical model to facilitate student learning. This article explores these perceptions in the nursing programs of 5 universities located in 4 Western Canadian provinces. Findings support the use of both nonblock and block clinical models throughout nursing education programs.
Lovrić, Robert; Prlić, Nada; Zec, Davor; Pušeljić, Silvija; Žvanut, Boštjan
The students' assessment of clinical faculty competencies and the faculty members' self-assessment can provide important information about nursing clinical education. The aim of this study was to identify the differences between the students' assessment of the clinical faculty member's competencies and the faculty member's self-assessment. These differences can reveal interesting insights relevant for improving clinical practice.
Llauradó-Serra, M; Güell-Baró, R; Castanera-Duro, A; Sandalinas, I; Argilaga, E; Fortes-Del Valle, M L; Jiménez-Herrera, M F; Bordonado-Pérez, L; Fuentes-Pumarola, C
The implementation of evidence based practice is essential in clinical practice. However, it is still a challenge in critical care patients. To identify the barriers for conducting research that nursing professionals perceive in intensive care and medical emergency departments, as well as to investigate the areas of interest and motivations to carry out research projects. Cross-sectional and multicentre study carried out in 4 intensive care units and in one Medical Emergency Department emergency pre-hospital carein Catalonia on 2014. The instrument used was The Barriers to Research Utilization Scale which had been previously validated into Spanish. A descriptive and bivariate analysis was performed. A statistical significance of P<.05 was assumed. One hundred seventy-two questionnaires were obtained (69.9% response). Of the total, 135 were from critical care, 27 to pre-hospital care, and 10 from both. Just over half (57.3%) had research experience, although 44.4% had related training. The questionnaire dimension considered most relevant was organisational characteristics. The most important barriers were: there is not enough time at work [3.11 (SD 1.21)], physicians do not collaborate in its implementation [2.99 (SD 1.22)], and nurses are isolated with respect to other professionals [2.86 (SD 1.32)]. Significant differences were observed in the barriers according to research experience and work place. The main motivation was to be updated in critical patient care. The main barriers perceived are related to the organisation. There are differences in the barriers according to research experience and work place. Copyright Â© 2016 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Zamanzadeh, Vahid; Jasemi, Madineh; Valizadeh, Leila; Keogh, Brian; Taleghani, Fariba
Graduate nurse transition from college to professional practice is an important matter in a nurse's professional life. In many cases, this period is characterized by unhealthy physical and mental reactions, loss of interest in one's profession, and unacceptable caregiving. By examining the phenomenon from the point of view of experienced nurses, we can recognize the major factors in a successful transition from college life to professional life. This is a qualitative study and was conducted based on conventional qualitative content analysis method; 14 nurses were selected through purposive sampling, and the data were collected using semistructured interviews in teaching hospitals in Iran. Eight subthemes emerged from the analysis of the interviews: lack of practical skills, limited academic knowledge, inadequate social skills, poor self-confidence, lack of independence, frustration, stress, and loneliness. These items, in turn, fall under 3 themes: poor efficiency, low self-assurance, and unhealthy emotional reactions. The findings of this study indicate that the participants were not well prepared to assume their clinical roles, which in turn gives rise to other problems; to eliminate this defect, the curriculum needs to be revised, proper training programs should accompany the students' studies, and management in clinical environments recommended should be improved in order to facilitate nurses' transition from college to practice. Copyright © 2015 Elsevier Inc. All rights reserved.
Kao, Chi-Yin; Huang, Guey-Shiun; Dai, Yu-Tzu; Pai, Ya-Ying; Hu, Wen-Yu
Clinical research nurses (CRNs) play an important role in improving the quality of clinical trials. In Taiwan, the increasing number of clinical trials has increased the number of practicing CRNs. Understanding the role responsibilities of CRNs is necessary to promote professionalism in this nursing category. This study investigates the role responsibilities of CRNs in conducting clinical trials / research. A questionnaire survey was conducted in a medical center in Taipei City, Taiwan. Eighty CRNs that were registered to facilitate and conduct clinical trials at this research site completed the survey. "Subject protection" was the CRN role responsibility most recognized by participants, followed by "research coordination and management", "subject clinical care", and "advanced professional nursing". Higher recognition scores were associated with higher importance scores and lower difficulty scores. Participants with trial training had significantly higher difficulty scores for "subject clinical care" and "research coordination and management" than their peers without this training (p research coordination and management" (p clinical practice.
Mannix, Judy; Wilkes, Lesley; Daly, John
This paper reports the results of an online descriptive survey that sought to determine nurses' perceptions of aesthetic leadership among clinical leaders in nursing. Clinical leadership has been identified as an essential component to ensuring the delivery of safe, high-quality health care. Leadership has been increasingly linked in the literature to aesthetics. However, little consideration has been given to aesthetics in relation to clinical leadership in nursing. A mixed-method, online descriptive survey. Participants were recruited via e-learning platforms and social media. A total of 66 surveys were completed, including 31 written accounts of aesthetic leadership in practice. Aesthetic leadership characteristics in clinical leaders most valued are support, communication and the approach taken to colleagues. Taking risks and challenging processes were least likely to be evident among effective clinical leaders. Aesthetic leadership is multi-dimensional and a style of leadership to positively influence the clinical workplace. Support, effective communication and taking into consideration the feelings of colleagues are important dimensions of aesthetic leadership. Aesthetic leadership represents a way for clinical leaders to create and sustain a calm and positive clinical workplace. © 2015 John Wiley & Sons Ltd.
Current evidence suggests emerging shortages of nurses available or willing to fill some vacant positions in hospitals, nursing homes, and home care. Total employment of registered nurses (RNs) per capita and the national unemployment rate for RNs have declined, and providers from around the country report growing difficulty recruiting and…
Heydari, Abbas; Yaghoubinia, Fariba; Roudsari, Robab Latifnejad
Student-teacher relationship is a salient issue in nursing education and has long-lasting implication in professional development of nursing students. Nowadays, this relationship in clinical settings is different from the past due to changing in nursing education paradigm. The purpose of this qualitative study was to explore the experiences of students and teachers about student-teacher relationship in the context of clinical nursing education in Iran. In this qualitative study that has been carried out adopting conventional qualitative content analysis approach, six bachelor nursing students and six clinical teachers in school of Nursing and Midwifery, were selected through purposive sampling. Semi-structured interview and participant observation were used for data collection. Interviews transcribed verbatim and analyzed using conventional content analysis through the process of data reduction and condensation, coding and also generating the categories and themes. Results of the study showed the existence of a type of relationship in clinical education in which supportive actions of clinical teachers were prominent. These supportive actions appeared as three major categories including educational support, emotional support and social support which emerged from data. The results of this study explicit the ways that support could be provided for students in their relationship with clinical teachers. It also determines the teachers' need to know more about the influence of their supportive relationship on students' learning and the best possible outcomes of their education in clinical settings.
Full Text Available Emergency nursesâ€™ performances remains long standing determinates of quality services rendered for patients admitted to get emergency treatments in the hospitals. It has been viewed as a dimension of professional services excellence. The purpose of this study focused on the predictive correlation of five predictors; namely human resources management, transformational leadership, incentives, hospital structure, and job rotation on the emergency nursesâ€™ performance. This descriptive quantitative study used total sampling technique of 100 nurses in the Emergency Department, in four Government Hospital in Banjarmasin, Bajarbaru, and Martapura. All data obtained by administering questionnaires to the participances. The analytical procedure of multiple linear regression was utilized to determine the predicting strength correlation between the dependent and the independent variables. The result of Pearson productâ€‘moment correlation coefficients revealed that positive correlation established between emergency nursesâ€™ performances and human resources management, transformational leadership, incentives, hospital structure, and job rotation, as the independent variables. The summary of multiple linear regression analysis of all independent variables indicated that incentives was the most strongly predictor to the emergency nursesâ€™ performances.
Pimmer, Christoph; Brühlmann, Florian; Odetola, Titilayo Dorothy; Dipeolu, Oluwafemi; Gröhbiel, Urs; Ajuwon, Ademola J
Although learning in clinical settings is a key element of nursing education, for many learners these are challenging developmental contexts often marked by isolation and a lack of belongingness. Despite the massive appropriation of mobile instant messaging (MIM) platforms and the connective properties attendant to them, very little is known about their role in and impact on nursing students' clinical learning experiences. To address this gap, the study, which was part of a multinational research project on the use of mobile social media in health professions education in developing countries, examined the use of the instant messaging platform WhatsApp by nursing students during placements and potential associations with socio-professional indicators. The survey involved a total number of 196 nursing students from 5 schools in Oyo State, Nigeria. The findings suggest that students used WhatsApp relatively frequently and they perceived that this platform strongly enhanced their communication with other students and nurses. WhatsApp use during placements was positively associated with students' maintained social capital with peer students, the development of a professional identity, placement satisfaction and with reduced feelings of isolation from professional communities. The determinants that influenced WhatsApp use during placements were perceived usefulness and perceived ease of use. No associations were found between WhatsApp use during placement and age, attitude, subjective norms and placement duration. This study is one of the first of its kind that points to the relevance of mobile instant messaging as part of nursing students' (inter)personal learning environments in clinical settings and, particularly, in the development setting under investigation. Further research is needed to corroborate these findings, to enhance the understanding of the impact mechanisms, and to evaluate a more systematic use of MIM in clinical learning contexts. Copyright © 2018
Ríos-Risquez, M Isabel; García-Izquierdo, Mariano
Patient satisfaction is considered a measure of the status of the interaction between health- care professionals and service users. The level of this measure indicates the quality of the care received. Burnout is a common phenomenon in nursing professionals and it is a response to the chronic occupational stress. Different studies have shown a link between patient satisfaction and stress and burnout syndrome experienced by nursing personnel in various hospital units. The main objective of this study was to analyze the associations between patients' satisfaction with emergency services and perception of work stress and burnout by the nursing professionals who looked after these patients at a group level. The study followed a descriptive and cross-sectional design; the data were collected by means of questionnaires. Emergency services at two general hospitals in Murcia (Spain). Two samples, one formed of emergency service nursing professionals (n=148) and the other formed by patients (n=390), who were grouped in 48 units of analysis. To evaluate perception of stress and burnout of the nursing personnel, we used the Spanish adaptation of the Nursing Stress Scale for hospital emergency nursing personnel, and the Spanish adaptation of the Maslach Burnout Inventory, respectively. A Spanish adaptation of the La Mónica-Obsert Patient Satisfaction Scale was used to define the patients' feelings about their nursing care. Moreover, some socio-demographic variables and the length of stay in the emergency unit were included in the protocol. Before statistical analysis, the data were collated at a group level. The intraclass correlation coefficients and the Average Deviation Index support the aggregation of these data at a unit level. Neither perception of stress nor the various elements of burnout experienced by nursing staff were related to patients' levels of satisfaction. We observed a significant and positive association between stress perception among the nurses and two
Shiu, Ann T Y; Lee, Diana T F; Chau, Janita P C
This article is a report on a study to explore the development of expanding advanced nursing practice in nurse-led clinics in Hong Kong. Nurse-led clinics serviced by advanced practice nurses, a common international practice, have been adopted in Hong Kong since 1990s. Evaluations consistently show that this practice has good clinical outcomes and contributes to containing healthcare cost. However, similar to the international literature, it remains unclear as to what the elements of good advanced nursing practice are, and which directions Hong Kong should adopt for further development of such practice. A multiple-case study design was adopted with six nurse-led clinics representing three specialties as six case studies, and including two clinics each from continence, diabetes and wound care. Each case had four embedded units of analysis. They included non-participant observation of nursing activities (9 days), nurse interviews (N = 6), doctor interviews (N = 6) and client interviews (N = 12). The data were collected in 2009. Within- and cross-case analyses were conducted. The cross-case analysis demonstrated six elements of good advanced nursing practice in nurse-led clinics, and showed a great potential to expand the practice by reshaping four categories of current boundaries, including community-hospital, wellness-illness, public-private and professional-practice boundaries. From these findings, we suggest a model to advance the scope of advanced nursing practice in nurse-led clinics. The six elements may be applied as audit criteria for evaluation of advanced nursing practice in nurse-led clinics, and the proposed model provides directions for expanding such practice in Hong Kong and beyond. © 2011 Blackwell Publishing Ltd.
Obizoba, Cordelia O.
The purpose of this phenomenological study was to gain an understanding of nursing faculty members' lived experiences of Objective Structured Clinical Examination (OSCE) in undergraduate nursing education. As owners of their programs' curriculum, nursing faculties are charged with the responsibility of providing needed knowledge, skills, and…
Shaw-Battista, Jenna; Belew, Cynthia; Anderson, Deborah; van Schaik, Sandrijn
This article describes childbirth simulation design and implementation within the nurse-midwifery education program at the University of California, San Francisco. Nurse-midwife and obstetrician faculty coordinators were supported by faculty from multiple professions and specialties in curriculum review and simulation development and implementation. The primary goal of the resulting technology-enhanced simulations of normal physiologic birth and obstetric emergencies was to assist learners' development of interprofessional competencies related to communication, teamwork, and patient-centered care. Trainees included nurse-midwifery students; residents in obstetrics, pediatrics, and family medicine; medical students; and advanced practice nursing students in pediatrics. The diversity of participant types and learning levels provided benefits and presented challenges to effective scenario-based simulation design among numerous other theoretical and logistical considerations. This project revealed practical solutions informed by emerging health sciences and education research literature, faculty experience, and formal course evaluations by learners. Best practices in simulation development and implementation were incorporated, including curriculum revision grounded in needs assessment, case- and event-based clinical scenarios, optimization of fidelity, and ample time for participant debriefing. Adequate preparation and attention to detail increased the immersive experience and benefits of simulation. Suggestions for fidelity enhancement are provided with examples of simulation scenarios, a timeline for preparations, and discussion topics to facilitate meaningful learning by maternity and newborn care providers and trainees in clinical and academic settings. Pre- and postsimulation measurements of knowledge, skills, and attitudes are ongoing and not reported. This article is part of a special series of articles that address midwifery innovations in clinical practice
Bruyneel, Luk; Thoelen, Tom; Adriaenssens, Jef; Sermeus, Walter
The aim of this study was to explore the association between the quality of the work environment, job characteristics, demographic characteristics and a pathway of job satisfaction, emotional exhaustion and turnover intention among nurses in emergency departments and perform subgroup analyses. Turnover intention among nurses is high. Multiple causes have been described, mostly in large studies of nurses working on general wards, often without considering complementarity of conceptual models and showing scant interest in the consistency of associations across subgroups of nurses. Cross-sectional multicentre survey. Convenience sample of 294 nurses in 11 Belgian emergency departments during 2014-2015. Indirect effects in the form of mediation and serial mediation were estimated to assess the association between work environment (Magnet model), job characteristics (Job Demand Control Support model) and turnover intention via job satisfaction and emotional exhaustion. Consistency of these indirect effects across subgroups of nurses was examined using moderated mediation analysis (conditional indirect effects). Several Magnet and Job Demand Control Support dimensions were related to turnover intention, either via job dissatisfaction (mediation) or via job satisfaction and emotional exhaustion (serial mediation). In the case of social support from supervisor, these indirect effects were only significant for female nurses, among whom turnover intention was higher. Last, nurses with more years of experience were less likely to indicate turnover intention. To maximize prevention of turnover intention at emergency departments, interventions could target early career nurses, work environment and job characteristics. Female nurses in particular may also benefit from improved social support from their supervisor. © 2016 John Wiley & Sons Ltd.
Henly, Susan J; McCarthy, Donna O; Wyman, Jean F; Alt-White, Anna C; Stone, Patricia W; McCarthy, Ann Marie; Redeker, Nancy S; Dunbar-Jacob, Jacqueline; Titler, Marita G; Conley, Yvette P; Heitkemper, Margaret M; Moore, Shirley M
We respond to commentaries from the American Academy of Nursing, the American Association of Colleges of Nursing, and the National Institute of Nursing Research on our thoughts about integrating emerging areas of science into nursing PhD programs. We identify areas of agreement and focus our response on cross-cutting issues arising from cautions about the unique focus of nursing science and how best to proceed with incorporation of emerging areas of science into nursing PhD programs. Copyright © 2015 Elsevier Inc. All rights reserved.
Nielsen, Kirsten; Pedersen, Birthe D.; Helms, Niels Henrik
Literature shows several benefits of implementing ePortfolio and focusing on learning styles within nursing education. However, there is some ambiguity, so the aim was to investigate learning mediated by the mandatory part of ePortfolio in clinical settings. The design takes a phenomenological...
Wei, Chun-Wang; Lin, Yi-Chun; Lin, Yen-Ting
Clinical resources in nursing schools are always insufficient for satisfying the practice requirements of each student at the same time during a formal course session. Although several studies have applied information and communication technology to develop computer-based learning tools for addressing this problem, most of these developments lack…
Dong Yanfen; Pan Xiaoxia; Luan Shaoliang; Wei Ren
Objective: To discuss the standardized clinical nursing measures for patients receiving endovascular treatment of renal artery aneurysms. Methods: The clinical data of 9 patients with renal artery aneurysm, who were admitted to authors' hospital during the period from Jan. 2010 to Aug. 2011 and received endovascular treatment, were retrospectively analyzed. The related nursing points as well as the received endovascular. Results: A total of 9 cases with renal artery aneurysm were treated nursing measures were summarized. Results: A total of 9 cases with renal artery aneurysm were with interventional management, including embolization (n = 6), stent implantation (n = 2) and stent implantation together with coil embolization (n = 1). The mean hospitalization time was (10±2) days. Postoperative retention of urine was observed in one patient and postoperative retroperitoneal hemorrhage occurred in another patient. Neither nursing-related nor operation-related complications occurred. Conclusion: Standardized perioperative nursing care for patients with renal artery aneurysm can surely help enhance the patient's tolerance to the surgery, and effectively prevent the complications. (authors)
Lim, Ji Young; Noh, Wonjung
In this study, we identified key components of financial-analysis education for clinical nurses. We used a literature review, focus group discussions, and a content validity index survey to develop key components of financial-analysis education. First, a wide range of references were reviewed, and 55 financial-analysis education components were gathered. Second, two focus group discussions were performed; the participants were 11 nurses who had worked for more than 3 years in a hospital, and nine components were agreed upon. Third, 12 professionals, including professors, nurse executive, nurse managers, and an accountant, participated in the content validity index. Finally, six key components of financial-analysis education were selected. These key components were as follows: understanding the need for financial analysis, introduction to financial analysis, reading and implementing balance sheets, reading and implementing income statements, understanding the concepts of financial ratios, and interpretation and practice of financial ratio analysis. The results of this study will be used to develop an education program to increase financial-management competency among clinical nurses. © 2015 Wiley Publishing Asia Pty Ltd.
Full Text Available Introduction Self-efficacy in clinical performance had an important role in applying competencies; also competencies and self-efficacy in clinical performance influenced to quality care of nursing and midwifery students. So the present study aimed to define the relationship between clinical competencies and clinical self-efficacy among nursing and midwifery students. Materials and Methods This is a cross-sectional study conducted on 150 of nursing and midwifery students in Isfahan University of Medical Science, selected through two stage sampling in 2014. The participant completed questionnaires about personal/ educational characteristics and nursing competencies questionnaire (18 items and clinical self-efficacy scale (37 items. The data were analyzed by, Pearson statistical test, t-test, variance analysis through SPSS version16. Results The results showed that 50% (n=75 and 37.4% (n=56 of nursing and midwifery students had good clinical competence and clinical Self-Efficacy, respectively. Also the mean competencies and self-efficacy in clinical performance scores were 35.05± 1.2 and 76.03± 0.4 respectively. Pearson correlation coefficient showed that there was a positive linear correlation between the score of clinical competence and clinical self-efficacy (P
Yan, P; Zhang, L; Li, F Y; Yang, Y; Wang, Y N; Huang, A M; Dai, Y L; Yao, H
Objective: To evaluate the ergonomic load of clinical nursing procedures and to provide evidence for the prevention and management of work-related musculoskeletal disorders (WMSDs) in nurses. Methods: Based on the nursing unit characteristics and the common departments involving patient-turning procedures, 552 nurses were selected from 6 clinical departments from July to September, 2016. The ergonomic load of four types of patient-turning procedures, i.e., turning the patient's body, changing the bed linen of in-bed patients, moving patients, and chest physiotherapy, was evaluated by the on-site inspectors and self-evaluated by the operators using the Quick Exposure Check. The exposure value, exposure level, and exposure rate of WMSDs were assessed based on the procedure-related physical loads on the back, shoulders/arms, wrists/hands and neck, as well as the loads from work rhythm and work pressure. Results: All surveyed subjects were females who were aged mostly between 26-30 years (49.46%) , with a mean age of 29.66±5.28 years. These nurses were mainly from the Department of Infection (28.99%) and Spine Surgery (21.56%) . There were significant differences in the back, shoulders/arms, neck, work rhythm, and work pressure scores between different nursing procedures ( F =16.613, 5.884, 3.431, 3.222, and 5.085, respectively; P Patient-turning nursing procedures resulted in high to intermediate physical load in nurses. Procedures with high to low level of WMSDs exposure were patient turning (72.69%) , bed linen changing (67.15%) , patient transfer (65.82%) , and chest physiotherapy (58.34%) . In particular, patient turning was considered as very high-risk procedure, whereas others were considered as high-risk procedures. Conclusion: Patient-turning nursing procedures result in high ergonomic load in the operators. Therefore, more focus should be placed on the ergonomics of the caretakers and nurses.
Li, Hong; Cheng, Bin; Zhu, Xiao Ping
Previous studies showed increased levels of absenteeism, drug abuse, depression, and symptoms allied with burnout in emergency nurses. This meta-analysis aimed to quantify the three dimensions of burnout in emergency nurses and estimate the proportion of nurses who experience higher than tolerable levels of burnout. A systematic search was conducted on PubMed, Scielo, Xueshu Baidu and Informa databases with a cut-off time between 1997 and 2017 to retrieve published papers in any language that had estimated the burnout levels in emergency nurses by using MBI scale. We identified a total of 11 eligible studies. The total mean estimate was moderate for emotional exhaustion (25.552), but clearly trending towards higher level, whereas depersonalization (10.383) and lack of personal accomplishment (30.652) showed higher burnouts levels. The proportion of emergency nurses suffering from high emotional exhaustion, high depersonalization, and low personal accomplishment was 40.5%, 44.3%, and 42.7%, respectively. Burnout is detrimental to achieving high-quality healthcare services and causes a loss of productivity. It is high time for nursing leader and management personnel to identify appropriate measures to counteract burnout. Copyright © 2017 Elsevier Ltd. All rights reserved.
Perrin, Mary; Kim, Teresa; Stan, Rodica; Giesie, Pamela; Tabor, Jason; Le Verche, Virginia; Johnson, Shirley; Lomax, Geoffrey P; Zaia, John A
The California Institute for Regenerative Medicine has formed a group of clinics called the Alpha Stem Cell Clinics Network. Its goal is to accelerate clinical trials of stem cell-based therapies for diseases with unmet medical needs. In this report, we describe our experience in establishing an Alpha Stem Cell Clinic at City of Hope. Implementation and integration of the clinic into the existing institutional structures required collaboration and cooperation with clinical trial units, nursing administration, and creation of new positions. The highlight of this process and the centerpiece to our success has been the definition of the role of the "hybrid nurse," a person with nursing competencies in both clinical care and research. Stem Cells Translational Medicine 2018;7:6-10 Abstract Video Link: https://youtu.be/WOeZrNyXkGU. © 2017 The Authors Stem Cells Translational Medicine published by Wiley Periodicals, Inc. on behalf of AlphaMed Press.
Ebersole-Berkstresser, Kristie Anne
Nurse educators, at every level of pre-licensure nursing education, are charged with developing critical thinking skills within their students. Post-clinical conference is one teaching strategy that nurse educators can employ to help promote the development of critical thinking skills in pre-licensure nursing students. However, traditional…
Manzon, Cyril; Barrot, Loïc; Besch, Guillaume; Barbot, Olivier; Desmettre, Thibaut; Capellier, Gilles; Piton, Gaël
The triage nurse is involved in the early identification of the most severe patients at emergency department (ED) presentation. However, clinical criteria alone may be insufficient to identify them correctly. Measurement of capillary lactate concentration at ED presentation may help to discriminate these patients. The primary objective of this study was to identify the prognostic value of capillary lactate concentration measured by the triage nurse among patients presenting to the ED. This was a prospective observational study, performed in the ED of a university hospital. At ED presentation, capillary lactate measurement was performed by the triage nurse among patients presenting with a clinical criteria of systemic inflammatory response syndrome (SIRS). Clinical variables usually used to determine severity were collected at presentation. Twenty-eight-day mortality and MEDS score were recorded. One hundred seventy-six patients with clinical SIRS presented to the ED. Median age was 72 years, and 28-day mortality was 16%. Capillary lactate at ED presentation was significantly higher among 28-day non-survivors than among survivors (5.7 mmol.L(-1) [3.2 to 7.4] vs 2.9 mmol.L(-1) [1.9 to 5.2], p = 0.003). A score based on mottling and capillary lactate concentration >3.6 mmol.L(-1) was significantly associated with 28-day mortality (area under curve, AUC = 0.75), independently of the MEDS score (AUC = 0.79) for the prediction of 28-day mortality (AUC global model 0.87). A high capillary lactate concentration measured by the triage nurse among patients presenting to the ED with clinical SIRS is associated with a high risk of death. A score calculated by the triage nurse, based on mottling and capillary lactate concentration, appears to be useful for identifying the most severe patients.
Ríos Rísquez, María Isabel; Sánchez Meca, Julio; Godoy Fernández, Carmen
In this study, the predictive power of hardy personality and generalized self-efficacy on general health perception was investigated in a sample of nursing personnel working in emergency and intensive care services. A cross-sectional retrospective design was used, and the following measurement instruments were applied: a sociodemographic and work questionnaire, Goldberg's GHQ-28 Health Questionnaire, the Baessler and Schwarzer General Self-efficacy Questionnaire, and the Hardy Personality Subscale of Moreno's Nursing Burnout Questionnaire (CDPE). The results revealed a positive and statistically significant relationship between the individual variables of generalized self-efficacy and hardy personality. A canonical correlation analysis carried out on the psychological distress symptoms with self-efficacy and hardy personality as predictor variables, led us to emphasize the relevance of the construct total hardy personality as a predictor and, consequently, as a protective factor against the onset of psychological distress symptoms in the sample of professionals studied. Lastly, the implications of the results for clinical practice are discussed.
To explore the relationship between multiple variables within a model of critical thinking and moral reasoning. A quantitative descriptive correlational design using a purposive sample of 200 emergency nurses. Measured variables were accuracy in clinical decision-making, moral reasoning, perceived care environment, and demographics. Analysis was by bivariate correlation using Pearson's product-moment correlation coefficients, chi square and multiple linear regression analysis. The elements as identified in the integrated ethically-driven environmental model of clinical decision-making (IEDEM-CD) corrected depict moral reasoning and environment of care as factors significantly affecting accuracy in decision-making. The integrated, ethically driven environmental model of clinical decision making is a framework useful for predicting clinical decision making accuracy for emergency nurses in practice, with further implications in education, research and policy. A diagnostic and therapeutic framework for identifying and remediating individual and environmental challenges to accurate clinical decision making. © 2012, The Author. International Journal of Nursing Knowledge © 2012, NANDA International.
Long, Elizabeth; Dowdell, Elizabeth B
Human trafficking is estimated to surpass the drug trade as the leading illegal industry in the world. According to a recent study, over 87.8% of trafficking survivors came into contact with a healthcare professional while they were enslaved and were not identified as a victim of human trafficking. The aims of this study are to understand the perceptions of emergency nurses about human trafficking, victims of violence, and prostitution. A qualitative, descriptive study using a semi-structured interview approach was done with ten registered nurses in a large, urban Emergency Department in the northeastern U.S. Interviews were recorded and transcribed; thematic analysis was performed. Six themes emerged from the interviews including, "human trafficking exists in the patient population" yet no nurse has screened or treated a victim; human trafficking victims are perceived to be "young, female, and foreign born"; all of the emergency nurses reported having worked with or screened a victim of violence; victims of violence were viewed as patients who present as "sad and grieving"; prostitutes are seen as "hard and tough"; and emergency nurses did not have education on human trafficking victims' needs or resources. Emergency nurses should be more aware about victims of human trafficking. The media portrayal of human trafficking victims had influenced the nurses' perceptions of this population. Victims of violence are perceived to be very different from prostitutes, but there is a desire for education about violence as well as information about specific resources open to victims. Copyright © 2017 Elsevier Inc. All rights reserved.
Ali Akbar Vaezi
Full Text Available Background: Nurses are the main members in nursing cares and nursing managers can improve their clinical competency by applying better leadership skills. This study carried out to determine the effect of nursing management program on clinical competency of nurses in a coronary care unit (CCU.Methods: A quasi-experimental study was carried out in two educational hospitals in Yazd- Iran. These hospitals were allocated randomly in case and control hospitals. 25 matched nurses were selected by convenience sampling from both case and control hospitals. The clinical competency of nurses was measured by related questioners consisted of two dimensions caring and care management behaviors by self-evaluation and head nurse evaluation in case and control groups. Then, the intervention was implemented in four stages including nurse's development, managers' development, adaptation and supervision period during four months in the case group. After intervention, clinical competency of nurses was measured in both groups.Results: The results showed that before intervention more than 80% of nurses in two groups was in the moderate clinical competency level and they were proficient based on Benner's skill acquisition model. After intervention, nurses' clinical competency improved to higher level in case group but it didn't change in control group (P<0.05. Conclusion: Creating necessary modifications in nursing environments through the management development program by head nurses may improve nurses' clinical competency.
Perbøll, Penille Wimmer; Hammer, N. M.; Østergaard, Birte
was applied. Nurses from seven emergency departments (EDs) in a region in Denmark were asked to complete the Danish version of Attitudes towards Deliberate Self-Harm Questionnaire (ADSHQ). RESULTS: Of the 254 eligible nurses working in the ED, 122 returned the questionnaires, leaving the response rate at 48...... on self-harm, and this education seems to produce more positive attitudes and a greater self-efficacy in relation to managing the patient group. CONCLUSION: Nurses working in the ED generally hold positive attitudes toward patients with acetaminophen poisoning. It is suggested that education on self......AIM: The aim of this study was to examine Danish emergency nurses' attitudes toward people hospitalized after an acetaminophen poisoning. Furthermore, the study examined the relationship between attitudes and factors such as age, gender, and education on self-harm. METHODS: A cross-sectional design...
Two of the nurses had no recollection of any emotions, while one stated that, after an unsuccessful resuscitation, she or he “felt terribly traumatised and heartsore after the death of the child”, and another stated that, after a successful resuscitation, she or he “felt good, extremely good, because something was done to help ...
Grady, Janet L
The Virtual Clinical Practicum (VCP) involves a clinical nursing education delivery strategy that uses video teleconferencing technology to address time, distance, and resource barriers. Technology-delivered education can augment the existing curriculum by increasing student access to clinical experts in specialty areas, thus supporting efficient use of faculty resources. This article describes the implementation of the VCP process and student perceptions of its effectiveness and usefulness. The VCP was shown to be a successful method of clinical nursing education, offering students exposure to clinical situations not available by other means. Opportunities for dialogue, critical reflection, and synthesis allowed students to experience the benefits of a traditional experience, enhanced through technology and tailored to the specific needs of the students. Respondents overwhelmingly recommended further use of the VCP to augment existing clinical nursing education methods.
Andressa Midori Sakai
Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.
Andressa Midori Sakai
Full Text Available Objective: to reveal feelings of nurses who host with risk assessment and classification in an emergency room of a pubic hospital. Methods: it is a qualitative research approach with 12 nurses interviewed. The data were analyzed, categorized and discussed according to the theoretical framework of work psychodynamics. Results: the nurses expressed feelings of satisfaction in meeting the user needs assistance. They reported feeling as fear, stress and fatigue due to the sharp pace of work, gaps in health care network and situations of violence. They highlighted coping strategies to reduce the burden of this assignment, how to share the completion of the screening with the nursing staff. Conclusion: the host with risk assessment and classification favors the autonomy of nurses and provide greater accountability to this professional users, but the limitations of available resources to solve the complaint of patients generate physical and psychological burden to this worker.
Lane, Sandi J; McGrady, Elizabeth
Introduction Disasters often overwhelm a community's capacity to respond and recover, creating a gap between the needs of the community and the resources available to provide services. In the wake of multiple disasters affecting nursing homes in the last decade, increased focus has shifted to this vital component of the health care system. However, the long-term care sector has often fallen through the cracks in both planning and response. Problem Two recent reports (2006 and 2012) published by the US Department of Health and Human Services (DHHS), Office of Inspector General (OIG), elucidate the need for improvements in nursing homes' comprehensive emergency preparedness and response. The Center for Medicare and Medicaid Services (CMS) has developed an emergency preparedness checklist as a guidance tool and proposed emergency preparedness regulations. The purpose of this study was to evaluate the progress made in nursing home preparedness by determining the level of completion of the 70 tasks noted on the checklist. The study objectives were to: (1) determine the preparedness levels of nursing homes in North and South Carolina (USA), and (2) compare these findings with the 2012 OIG's report on nursing home preparedness to identify current gaps. A survey developed from the checklist of items was emailed to 418 North Carolina and 193 South Carolina nursing home administrators during 2014. One hundred seventeen were returned/"bounced back" as not received. Follow-up emails and phone calls were made to encourage participation. Sixty-three completed surveys and 32 partial surveys were received. Responses were compared to data obtained in a 2010 study to determine progress. Progress had been made in many of the overall planning and sheltering-in-place tasks, such as having contact information of local emergency managers as well as specifications for availability of potable water. Yet, gaps still persisted, especially in evacuation standards, interfacing with emergency
Jessup, Melanie; Fulbrook, Paul; Kinnear, Frances B
To utilise multidisciplinary staff feedback to assess their perceptions of a novel emergency department nurse navigator role and to understand the impact of the role on the department. Prolonged emergency department stays impact patients, staff and quality of care, and are linked to increased morbidity and mortality. One innovative strategy to facilitate patient flow is the navigator: a nurse supporting staff in care delivery to enhance efficient, timely movement of patients through the department. However, there is a lack of rigorous research into this emerging role. Sequential exploratory mixed methods. A supernumerary emergency department nurse navigator was implemented week-off-week-on, seven days a week for 20 weeks. Diaries, focus groups, and an online survey (24-item Navigator Role Evaluation tool) were used to collect and synthesise data from the perspectives of multidisciplinary departmental staff. Thematic content analysis of cumulative qualitative data drawn from the navigators' diaries, focus groups and survey revealed iterative processes of the navigators growing into the role and staff incorporating the role into departmental flow, manifested as: Reception of the role and relationships with staff; Defining the role; and Assimilation of the role. Statistical analysis of survey data revealed overall staff satisfaction with the role. Physicians, nurses and others assessed it similarly. However, only 44% felt the role was an overall success, less than half (44%) considered it necessary, and just over a third (38%) thought it positively impacted inter-professional relationships. Investigation of individual items revealed several areas of uncertainty about the role. Within-group differences between nursing grades were noted, junior nurses rating the role significantly higher than more senior nurses. Staff input yielded invaluable insider feedback for ensuing modification and optimal instigation of the navigator role, rendering a sense of departmental