Anderson, Jane A; Willson, Pamela
Almost everything we do in nursing is based on our knowledge. In 1984, Benner (From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley; 1984) described nursing knowledge as the culmination of practical experience and evidence from research, which over time becomes the "know-how" of clinical experience. This "know-how" knowledge asset is dynamic and initially develops in the novice critical care nurse, expands within competent and proficient nurses, and is actualized in the expert intensive care nurse. Collectively, practical "know-how" and investigational (evidence-based) knowledge culminate into the "knowledge of caring" that defines the profession of nursing. The purpose of this article is to examine the concept of knowledge management as a framework for identifying, organizing, analyzing, and translating nursing knowledge into daily practice. Knowledge management is described in a model case and implemented in a nursing research project.
Dorr, David A.; Tran, Hanh; Gorman, Paul; Wilcox, Adam B.
Unmet information needs of physicians and patients are common, but those of nurse care managers – defined as collaborative care planners for with chronic conditions – are less well understood. We taped and transcribed daily activities and conducted semi-structured interviews of 7 care managers, and analyzed questions elicited through this work through a variety of frameworks. PMID:17238532
Home care nursing (HCN) improves the management of symptoms in breast and colorectal cancer patients who take the oral chemotherapy drug capecitabine, according to a study published online November 16 in the Journal of Clinical Oncology.
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.
ÖZCANLI, Derya; İLGÜN, Seda
Time is not like other resources, because it can not be bought, sold, stolen, borrowed, stored, saved, multiplied or changed. All it can be done is spent. Time management means the effective use of resources, including time, in such a way that indi- viduals are effective in achieving important personal goals. With the increasing emphasis on efficiency in health care, how a nurse manages her time is an important consideration. Since intensive care nurs- ing is focused on the care and tr...
Lammintakanen, Johanna; Kivinen, Tuula; Saranto, Kaija; Kinnunen, Juha
The aim of this study is to describe nurse managers' perceptions of the strategic management of information systems in health care. Lack of strategic thinking is a typical feature in health care and this may also concern information systems. The data for this study was collected by eight focus group interviews including altogether 48 nurse managers from primary and specialised health care. Five main categories described the strategic management of information systems in health care; IT as an emphasis of strategy; lack of strategic management of information systems; the importance of management; problems in privacy protection; and costs of IT. Although IT was emphasised in the strategies of many health care organisations, a typical feature was a lack of strategic management of information systems. This was seen both as an underutilisation of IT opportunities in health care organisations and as increased workload from nurse managers' perspective. Furthermore, the nurse managers reported that implementation of IT strengthened their managerial roles but also required stronger management. In conclusion, strategic management of information systems needs to be strengthened in health care and nurse managers should be more involved in this process.
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...
Peng, Xiao; Liu, Yilan; Zeng, Qingsong
Nursing is acknowledged as being the art and science of caring. According to the theory of nursing as caring, all persons are caring but not every behaviour of a person is caring. Caring behaviours in the relationship between first-line nurse managers and Registered Nurses have been studied to a lesser extent than those that exist between patients and nurses. Caring behaviour of first-line nurse managers from the perspective of Registered Nurses is as of yet unknown. Identifying caring behaviours may be useful as a reference for first-line nurse managers caring for nurses in a way that nurses prefer. To explore first-line nurse managers' caring behaviours from the perspective of Registered Nurses in mainland China. Qualitative study, using descriptive phenomenological approach. Fifteen Registered Nurses recruited by purposive sampling method took part in in-depth interviews. Data were analysed according to Colaizzi's technique. Three themes of first-line nurse managers' caring behaviours emerged: promoting professional growth, exhibiting democratic leadership and supporting work-life balance. A better understanding of the first-line nurse managers' caring behaviours is recognised. The three kinds of behaviours have significant meaning to nurse managers. Future research is needed to describe what first-line nurse managers can do to promote nurses' professional growth, increase the influence of democratic leadership, as well as support their work-life balance. © 2015 Nordic College of Caring Science.
A. Aziz Alimul Hidayat; M. Kes
Model documentation of assessment and nursing diagnosis in the practice of nursing care management is an integration model in nursing care records, especially records nursing assessment and diagnosis in one format. This model can reduce the duration of the recording in nursing care, and make it easier for students to understand the nursing diagnosis, so that nursing interventions more effective. The purpose of this paper was to describes the form integration documentation of nursing assessmen...
Eryl Zac Maunder
Full Text Available This article explores the emotional labor involved for nurses providing palliative care for children/young people living with life-limiting illnesses/conditions, and their families. It highlights the challenges nurses face in managing their emotion when caring for children/young people and their families, and explores strategies to enable nurses to cope with this aspect of their role without compromising their personal wellbeing. It suggests that emotional labor within nursing goes largely unrecorded, and remains undervalued by managers and health care services.
Veenstra, Petra; Kollen, Boudewijn J.; de Jong, Gosse; Baarveld, Frans; van den Berg, J. S. Peter
Introduction Migraine is a common disorder with a high burden. Adequate treatment results in improvement of quality of life. Migraine patients are mainly treated by general practitioners (GPs), but there is still room for improvement. This study investigated whether primary care nurses could improve
Oosterhouse, Kimberly J; Vincent, Catherine; Foreman, Marquis D; Gruss, Valerie A; Corte, Colleen; Berger, Barbara
Delirium, the most frequent complication of hospitalized older adults, particularly in intensive care units (ICUs), can result in increased mortality rates and length of stay. Nurses are neither consistently identifying nor managing delirium in these patients. The purpose of this study was to explore ICU nurses' identification of delirium, actions they would take for patients with signs or symptoms of delirium, and beliefs about delirium assessment and management. In this cross-sectional study using qualitative descriptive methods guided by the theory of planned behavior, 30 ICU nurses' responses to patient vignettes depicting different delirium subtypes were explored. Descriptive and content analyses revealed that nurses did not consistently identify delirium; their actions varied in different vignettes. Nurses believed that they needed adequate staffing, balanced workload, interprofessional collaboration, and established policy and protocols to identify and manage delirium successfully. Research is needed to determine if implementing these changes increases recognition and decreases consequences of delirium. ©2016 American Association of Critical-Care Nurses.
Lazure, G; Vissandjée, B; Pepin, J; Kérouac, S
This paper aims to illustrate how Leininger's Theory of Culture Care Diversity and Universality has influenced the research process of a study that emerged from a care management partnership between Canadian nursing teachers and Tunisian nurses. The purpose of the study was to investigate the meanings of care as viewed by university hospital-based Tunisian nurses. The qualitative analysis of data gathered through observation-participation and interviews highlights recurrent patterns and reveals three major professional care themes. For Tunisian nurses care means to secure the patient's cooperation towards the medical regimen within established rules in the hospital; to contribute to curing the patient by using current technology as well as by maintaining their technical skills and improving their medical knowledge; to take charge of the patient to assist the physician in treating disease. This study showed that Tunisian nurses emphasize curing rather than widely shared community values such as interdependence, intercommunication, understanding, presence and responsibility for others. Discussion of the study's findings draws upon the perspective provided by Freire's Oppressed Group Theory. In order to promote cultural congruence within the Care Management Partnership Project in Tunisia, the three predicted modes of care within Leininger's theory guide the decisions and actions for future nursing research and partnership activities.
Heydari, Abbas; Najar, Ali Vafaee; Bakhshi, Mahmoud
Nurses are the main users of supplies and equipment applied in the Intensive Care Units (ICUs) which are high-priced and costly. Therefore, understanding ICU nurses' experiences about resource management contributes to the better control of the costs. This study aimed to investigate the culture of nurses' working environment regarding the resource management in the ICUs in Iran. In this study, a focused ethnographic method was used. Twenty-eight informants among ICU nurses and other professional individuals were purposively selected and interviewed. As well, 400 hours of ethnographic observations as a participant observer was used for data gathering. Data analysis was performed using the methods described by Miles and Huberman (1994). Two main themes describing the culture of ICU nurses regarding resource management included (a) consumption monitoring and auditing, and (b) prudent use. The results revealed that the efforts for resource management are conducted in the conditions of scarcity and uncertainty in supply. ICU nurses had a sense of futurism in the supply and use of resources in the unit and do the planning through taking the rules and guidelines as well as the available resources and their values into account. Improper storage of some supplies and equipment was a reaction to this uncertain condition among nurses. To manage the resources effectively, improvement of supply chain management in hospital seems essential. It is also necessary to hold educational classes in order to enhance the nurses' awareness on effective supply chain and storage of the items in the unit stock.
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...
Wlody, Ginger Schafer
This article describes organizational ethics issues involved in nursing management of an intensive care unit. The intensive care team and medical center management have the dual responsibility to create an ethical environment in which to provide optimum patient care. Addressing organizational ethics is key to creating that ethical environment in the intensive care unit. During the past 15-20 yrs, increasing costs in health care, competitive markets, the effect of high technology, and global business changes have set the stage for business and healthcare organizational conflicts that affect the ethical environment. Studies show that critical care nurses experience moral distress and are affected by the ethical climate of both the intensive care unit and the larger organization. Thus, nursing moral distress may result in problems related to recruitment and retention of staff. Other issues with organizational ethics ramifications that may occur in the intensive care unit include patient safety issues (including those related to disruptive behavior), intensive care unit leadership style, research ethics, allocation of resources, triage, and other economic issues. Current organizational ethics conflicts are discussed, a professional practice model is described, and multidisciplinary recommendations are put forth.
Gabriela Marcellino de Melo Lanzoni
Full Text Available The study aimed to understand the experience of managing medical-surgical inpatient units in a general hospital, highlighting the meaning of being a nursing manager, with the intention to qualify and instrument nurses for caring management practice in this scenario. This is a Grounded Theory research, conducted from August 2010 to August 2012, through interviews with 19 participants from the nursing team, distributed in 3 sampling groups. From the analysis emerged the phenomenon “Becoming a nursing manager in the nested and complex border of caring and management dimension”. To exercise caring management, nurses use management instruments as essential tools, they become capable theoretically and enhances, based on his experience, professional skills and personal characteristics. We conclude that competency mobilization beyond the clinical aspect is needed; allowing the use of management instruments to make caring viable and to improve relational and interactive processes.
Roth, Carol P; Ganz, David A; Nickles, Lorraine; Martin, David; Beckman, Robin; Wenger, Neil S
We evaluated the quality of care provided to older patients with complex needs in a dual-eligible, community-based Medicare Special Needs Plan that used a nurse care manager model. Care provided by physicians was substantially supplemented by nurse care managers, as measured by Assessing Care of Vulnerable Elders quality indicators. We describe selected nurse care manager activities for six geriatric conditions (falls, dementia, depression, nutrition, urinary incontinence, and end-of-life care) during provision of patient care coordination and management for patients in the highest decile of clinical complexity. We identify areas of high nurse performance (i.e., falls screening, functional assessment, behavioral interventions for dementia problems, advance care planning) and areas of potential missed opportunities (i.e., follow up for new memory problems, targeted dementia counseling, nutrition, and behavioral approaches to urinary incontinence). Increasing the collaborative interaction between nurses providing care in this model and physicians has the potential to enhance nurses' contributions to primary care for vulnerable older adults.
Faeda, Marília Silveira; Perroca, Márcia Galan
analyze agreement between nursing prescriptions recorded in medical files and patients' care needs; investigate the correlation between the nurses' professional background and agreement of prescriptions. descriptive study with quantitative and documentary approach conducted in the medical clinic, surgical, and specialized units of a university hospital in the interior of São Paulo, Brazil. The new validated version of a Patient Classification Instrument was used and 380 nursing prescriptions written at the times of hospital admission and discharge were assessed. 75% of the nursing prescriptions items were compatible with the patients' care needs. Only low correlation between nursing prescription agreement and professional background was found. the nursing prescriptions did not fully meet the care needs of patients. The care context and work process should be analyzed to enable more effective prescriptions, while strategies to assess the care needs of patients are recommended. analisar a concordância entre prescrições de enfermagem, registradas nos prontuários, e as necessidades de cuidados dos pacientes; investigar a correlação entre o perfil profissional dos enfermeiros e a concordância das prescrições. estudo descritivo com abordagem quantitativa e documental, realizado em unidades de clínica médica, cirúrgica e especializada de um hospital de ensino, no interior do Estado de São Paulo. Foi aplicada a nova versão validada do Instrumento de Classificação de Pacientes e, posteriormente, investigadas 380 prescrições de enfermagem no momento da admissão e alta hospitalar. foi identificado que 75% dos itens das prescrições de enfermagem estavam compatíveis com as necessidades cuidativas dos pacientes. Encontrou-se baixa correlação entre a concordância da prescrição de enfermagem e o perfil profissional. as prescrições de enfermagem não estão sendo realizadas, em sua totalidade, em consonância com as necessidades dos pacientes. Para
Wang, Hsiang-Ling; Tsai, Yun-Fang
To explore nurses' knowledge and barriers regarding pain management in intensive care units. Pain is a common and treatable condition among intensive care patients. Quality care of these patients depends on the pain knowledge and pain management skills of critical care nurses. However, no single study has explored these nurses' knowledge of and perceived barriers to pain management in Taiwan. A cross-sectional study. Intensive care unit nurses (n = 370) were recruited from 16 hospitals chosen by stratified sampling across Taipei County in Taiwan. Data were collected on nurses' knowledge of pain management using the Nurses' Knowledge and Attitudes Survey-Taiwanese version, on perceived barriers to pain management using a researcher-developed scale and on background information. The overall average correct response rate for the knowledge scale was 53.4%, indicating poor knowledge of pain management. The top barrier to managing pain identified by these nurses was 'giving proper pain prescription needs doctor's approval; can't depend on me'. Knowledge of pain management was significantly and negatively related to perceived barriers to pain management. In addition, scores for knowledge and perceived barriers differed significantly by specific intensive care unit. Knowledge also differed significantly by nurses' education level, clinical competence level (nursing ladder) and hospital accreditation category. Our results indicate an urgent need to strengthen pain education by including case analysis for intensive care nurses in Taiwan. Pain education should target knowledge deficits and barriers to changing pain management approaches for Taiwanese nurses in intensive care units. © 2010 Blackwell Publishing Ltd.
Ogbolu, Yolanda; Scrandis, Debra A; Fitzpatrick, Grace
To examine chief nurse executives' perspectives on: (1) the provision of culturally and linguistically appropriate services in hospitals and (2) to identify barriers and facilitators associated with the implementation of culturally and linguistically appropriate services. Hospitals continue to face challenges providing care to diverse patients. The uptake of standards related to culturally and linguistically appropriate services into clinical practice is sluggish, despite potential benefits, including reducing health disparities, patient errors, readmissions and improving patient experiences. A qualitative study with chief nurse executives from one eastern United States (US). Data were analysed using content analysis. Seven themes emerged: (1) lack of awareness of resources for health care organisations; (2) constrained cultural competency training; (3) suboptimal resources (cost and time); (4) mutual understanding; (5) limited workplace diversity; (6) community outreach programmes; and (7) the management of unvoiced patient expectations. As the American population diversifies, providing culturally and linguistically appropriate services remains a priority for nurse leaders. Being aware and utilizing the resources, policies and best practices available for the implementation of culturally and linguistically appropriate services can assist nursing managers in reaching their goals of providing high quality care to diverse populations. Nurse managers are key in aligning the unit's resources with organisational goals related to the provision of culturally and linguistically appropriate services by providing the operational leadership to eliminate barriers and to enhance the uptake of best practices related to culturally and linguistically appropriate services. © 2017 John Wiley & Sons Ltd.
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.
Market forces present the nursing profession with an urgency to prepare gerontological nurses to assume significant roles in the managed care industry. An understanding of the current managed care environment underscores the need for training. Nurses require a "managed care" skill-set encompassing a firm grasp of the organization, financing, delivery, and policy implications of managed care as well as advanced practice clinical skills and a sound business orientation. The importance of the consumer as a significant player in managed care is highlighted.
Subramanian, Pathmawathi; Allcock, Nick; James, Veronica; Lathlean, Judith
To explore nurses' challenges in managing pain among ill patients in critical care. Pain can lead to many adverse medical consequences and providing pain relief is central to caring for ill patients. Effective pain management is vital since studies show patients admitted to critical care units still suffer from significant levels of acute pain. The effective delivery of care in clinical areas remains a challenge for nurses involved with care which is dynamic and constantly changing in critically ill. Qualitative prospective exploratory design. This study employed semi structured interviews with nurses, using critical incident technique. Twenty-one nurses were selected from critical care settings from a large acute teaching health care trust in the UK. A critical incident interview guide was constructed from the literature and used to elicit responses. Framework analysis showed that nurses perceived four main challenges in managing pain namely lack of clinical guidelines, lack of structured pain assessment tool, limited autonomy in decision making and the patient's condition itself. Nurses' decision making and pain management can influence the quality of care given to critically ill patients. It is important to overcome the clinical problems that are faced when dealing with pain experience. There is a need for nursing education on pain management. Providing up to date and practical strategies may help to reduce nurses' challenges in managing pain among critically ill patients. Broader autonomy and effective decision making can be seen as beneficial for the nurses besides having a clearer and structured pain management guidelines. © 2011 Blackwell Publishing Ltd.
Farin, E; Hauer, J; Schmidt, E; Kottner, J; Jäckel, W H
The demands being made on quality assurance and quality management in ambulatory care nursing and inpatient nursing facilities continue to grow. As opposed to health-care facilities such as hospitals and rehabilitation centres, we know of no other empirical studies addressing the current state of affairs in quality management in nursing institutions. The aim of this investigation was, by means of a questionnaire, to analyse the current (as of spring 2011) dissemination of quality management and certification in nursing facilities using a random sample as representative as possible of in- and outpatient institutions. To obtain our sample we compiled 800 inpatient and 800 outpatient facilities as a stratified random sample. Federal state, holder and, for inpatient facilities, the number of beds were used as stratification variables. 24% of the questionnaires were returned, giving us information on 188 outpatient and 220 inpatient institutions. While the distribution in the sample of outpatient institutions is equivalent to the population distribution, we observed discrepancies in the inpatient facilities sample. As they do not seem to be related to any demonstrable bias, we assume that our data are sufficiently representative. 4 of 5 of the responding facilities claim to employ their own quality management system, however the degree to which the quality management mechanisms are actually in use is an estimated 75%. Almost 90% of all the facilities have a quality management representative who often possesses specific additional qualifications. Many relevant quality management instruments (i. e., nursing standards of care, questionnaires, quality circles) are used in 75% of the responding institutions. Various factors in our data give the impression that quality management and certification efforts have made more progress in the inpatient facilities. Although 80% of the outpatient institutions claim to have a quality management system, only 32.1% of them admit to
Lalleman, Pcb; Smid, G. A C; Dikken, Jeroen; Lagerwey, M. D.; Schuurmans, M J
Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A
Caralise W HuntAuburn University School of Nursing, Auburn, AL, USAAbstract: Nurses provide care for individuals living with diabetes in a variety of areas. Nursing interventions assist individuals living with diabetes to manage diabetes and can positively affect outcomes. This article describes an integrated literature review conducted to evaluate and summarize nursing interventions and research in self-management of type 2 diabetes mellitus. PubMed, PsycINFO, CINAHL, and the Cochrane databa...
Kallas, Kathryn D
The purpose of this research was to identify the profile of an excellent nurse manager who can lead effective health care teams. Leadership attributes and competencies that characterize an excellent nurse manager and tools to identify them are lacking in the literature but are required to efficiently and effectively address the growing shortage of registered nurses (RNs) in health care team leadership roles and the critical linkage of these roles to patient outcomes. A profile of an excellent nurse manager was developed on the basis of the responses of nurse managers across the United States who had been identified as excellent or competent by chief nurse executive assessment or/and the Nurse Manager Ability, Leadership, and Support of Nurses staff survey to the Kouzes and Posner Leadership Practices Inventory: Self Instrument. Statistically significant distinctions exist between nurse managers who are excellent and those who are competent as assessed by the Five Practices of Exemplary Leadership, which together comprise the profile of an excellent nurse manager. The Kouzes and Posner Leadership Practices Inventory: Self Instrument can be used to identify, recruit, and develop RNs in the nurse manager role as excellent leaders of effective health care teams.
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
Alfieri, Emanuela; Ferrini, Anna Chiara; Gianfrancesco, Francesca; Lise, Gianluca; Messana, Giovanni; Tirelli, Lorenzo; Lorenzo, Ana; Sarli, Leopoldo
Since the recent introduction of the Case/Care Manager's professional figure, it is quite difficult to identify properly his/her own particular features, which could be mainly be found revising mainly in American studies. Therefore, the present study intended to identify the Case/Care Manager's skills and professional profile in an Intensive Care Unit experience, taking into consideration the staff's activities, perception and expectations towards the Case/Care Manager. In particular, it has been compared the experience of an Intensive Care Units where the Case/Care Manager's profile is operational to a different Unit where a Case/Care Manager is not yet in force. a Levati's model was used to map the Case/Care Manager's skills, involving each unit whole working staff, executives and caregivers through semi-structured interviews. It has been taken into consideration the Anaesthesia Unit and Emergency Unit of Cesena's healthcare organisation (AUSL of Romagna) and a Cardiology Intensive Care Unit of Piacenza's healthcare organisation, where the Case/Care Manager's profile has not been experimented yet. Firstly, it a data collection in each healthcare organization has been organised. Subsequently, semi-structured interviews to doctors, unit nurses, caregivers, nurses' coordinators and medical staff have been used to compare each healthcare system. The interviewees' described their expectations in relation to the Case/Care Manager working in a critical area. Then, every data collected during interviews has been organised to map a Case/Care Manager's essential professional profile to work in a critical area together with medical staff. Piacenza's O.U. critical area experience reported a major demand for patients' and patient's families' assistance. On the other hand, the very same aspects seem to have been better achieved in Cesena's O.U., where a Case/Care Manager's recent introduction has actually helped to overcome the void in organising systems. a Case/Care Manager
Lalleman, Pcb; Smid, Gac; Dikken, J; Lagerwey, M D; Schuurmans, M J
Nurse middle managers are in an ideal position to facilitate patient-centred care. However, their contribution is underexposed in literature due to difficulties to articulate this in practice. This paper explores how nurse middle managers contribute to patient-centred care in hospitals. A combination of time-use analysis and ethnographic work was used to disclose their contribution to patient-centred care at a micro level. Sixteen nurse managers were shadowed for over 560 hours in four hospitals. Some nurse middle managers seldom contribute to patient-centred care. Others are involved in direct patient care, but this does not result in patient-centred practices. At one hospital, the nurse middle managers did contribute to patient-centred care. Here balancing between "organizing work" and "caring work" is seen as a precondition for their patient-centeredness. Other important themes are feedback mechanisms; place matters; with whom to talk and how to frame the issues at stake; and behavioral style. Both "hands-on" and "heads-on" caring work of nurse middle managers enhances their patient-centeredness. This study is the first of its kind to obtain insight in the often difficult to articulate "doings" of nurse middle managers with regard to patient-centred care through combining time-use analysis with ethnographic work. © 2017 John Wiley & Sons Ltd.
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.
Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.
Full Text Available Staffing needs affect the nursing department’s budget, staff productivity, the quality of care provided to patients and even the retention of nurses. It is unclear how the role players (the nursing agency manager, the nurse manager and the agency nurse perceive the staffing of agency nurses in intensive care units (ICUs. The purpose of this study was to explore and describe the factors that guide nurse managers regarding the staffing of agency nurses in ICUs at private hospitals in Pretoria. A quantitative exploratory and descriptive design was used. A survey by means of a structured questionnaire was carried out. Probability sampling was implemented to obtain a study sample (n = 124. One similar self-administered 5-point scale instrument was completed by the participants. Data was analysed by means of descriptive and inferential statistics. The principles of validity and reliability were adhered to and ethical considerations were also taken into account. The results indicated limitations in the determining of posts, recruitment and advertising, as well as the selection and appointment of agency nurses in ICUs at private hospitals in Pretoria. Recommendations on staffing are made to nurse managers in ICUs.
Castle, Nicholas G.; Decker, Frederic H.
Purpose: The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Design and Methods: Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style…
Campbell, Marie Louise; Rankin, Janet Mary
..., and demonstrates how this work is now organized according to an 'accounting logic,' in which a cost orientation is embedded into care-related activities. Rankin and Campbell illustrate how nurses adapt to - and perpetuate - this system and how they learn to recognize their adaptations as professionally correct and as an adequate basis for professio...
Ahanchian, Mohammad Reza; Emami Zeydi, Amir; Armat, Mohammad Reza
Conflict among nurses has been recognized as an extremely important issue within health care settings throughout the world. Identifying the conflict management style would be a key strategy for conflict management. The aim of this study was to evaluate the prevalence of conflict management styles and its related factors among Iranian critical care nursing staff. In a descriptive cross-sectional study, a total of 149 critical care nurses who worked in the critical care units of 4 teaching hospitals in Sari (Iran) were evaluated. A 2-part self-reported questionnaire including personal information and Rahim Organizational Conflict Inventory II was used for data collection. Although Iranian critical care nurses used all 5 conflict management styles to manage conflict with their peers, the collaborating style was the most prevalent conflict management style used by them, followed by compromising, accommodating, avoiding, and competing. Male gender was a predictor for both compromising and competing styles, whereas position and shift time were significant predictors for compromising and competing styles, respectively. Based on the results of this study, nurse managers need to take these factors into account in designing programs to help nurses constructively manage unavoidable conflicts in health care setting.
Caspers, Barbara A; Pickard, Beth
With the health care environment shifting to a value-based payment system, Catholic Health Initiatives nursing leadership spearheaded an initiative with 14 hospitals to establish best nursing care at a lower cost. The implementation of technology-enabled business processes at point of care led to a new model for best value nursing care: Value-Based Resource Management. The new model integrates clinical patient data from the electronic medical record and embeds the new information in care team workflows for actionable real-time decision support and predictive forecasting. The participating hospitals reported increased patient satisfaction and cost savings in the reduction of overtime and improvement in length of stay management. New data generated by the initiative on nursing hours and cost by patient and by population (Medicare severity diagnosis-related groups), and patient health status outcomes across the acute care continuum expanded business intelligence for a value-based population health system.
dos Santos, Sérgio Ribeiro
This study aimed at developing an information system in nursing with the implementation of nursing care and management of the service. The SisEnf--Information System in Nursing--is a free software module that comprises the care of nursing: history, clinical examination and care plan; the management module consists of: service shifts, personnel management, hospital indicators and other elements. The system was implemented at the Medical Clinic of the Lauro Wanderley University Hospital, at Universidade Federal da Paraiba. In view of the need to bring user and developer closer, in addition to the constant change of functional requirements during the interactive process, the method of unified process was used. The SisEnf was developed on a WEB platform and using free software. Hence, the work developed aimed at assisting in the working process of nursing, which will now have the opportunity to incorporate information technology in their work routine.
Full Text Available Introduction: Model of nursing care based on knowledge management can reduce the incidence of nosocomial infections through the performance of nurses in the prevention of infection. Nursing care based on knowledge management is established from identi fi cation knowledge which is required, prevention performance of nosocomial infections post caesarean section. Nosocomial infections component consists of wound culture result. Method: This study was an observational study with a quasy experimental design. The population were all of nursing staff who working in obstetrics installation and a number of patients who is treated in hospitals A and B post sectio caesarea. Sample is comparised a total population all the nursing staff who worked in obstetrics installation according to criteria of the sample, and most of patients were taken care by nursing staff post caesarean section which is taken by random sampling 15 patients. Data was collected through observation sheets and examination of the wound culture. Data analysis which is used the t test. Result: The result was showed that there was signi fi cant difference in the incidence of nosocomial infection in patients with post sesctio caesarea in hospital before and after nursing care training based on knowledge management (tvalue = 2.316 and p = 0.028 < α = 0.05 level, and the incidence of nosocomial infection was lower after training than before training. Discussion: It can be concluded that training knowledge management based on nursing care effectives to reduce Incidence of Nosocomial Infections in Patients after Sectio Caesarea.
Verkaik, Renate; van Antwerpen-Hoogenraad, Paulien; de Veer, Anke; Francke, Anneke; Huis In Het Veld, Judith
Background Self-management in patients and family caregivers confronted with dementia is not self-evident. Self-management skills may be limited because of the progressive cognitive decline of the patient and because family caregivers are often also very aged. Self-management support by nursing staff is therefore of paramount importance. Objectives To gain insight into how nursing staff perceive their self-management support tasks, and how they put them into practice. Research questions are: 'What are the opinions and experiences of Dutch nursing staff working in home care or residential elderly care regarding self-management support for people with dementia and their family caregivers?' and 'Do nursing staff feel sufficiently trained and skilled for self-management support?'. Methods A mixed methods approach was used, combining cross-sectional quantitative survey data from 206 Dutch nursing professionals with qualitative interviews among 12 nursing staff working in home care or residential elderly care in The Netherlands. Results Nursing staff working in home care experienced self-management support of people with dementia as a part of their job and as an attractive task. They consider 'helping people with dementia to maintain control over their lives by involving them in decisions in daily care' the essence of self-management support. Nursing staff saw family caregivers as their main partners in providing self-management support to the patient. They were less aware that family caregivers themselves might also need self-management support. Nursing staff often felt insufficiently trained to give adequate self-management support. RN's and CNA's did not differ in their opinions, experiences and training needs. Conclusions Nursing staff in home care do consider self-management support an important and attractive task in dementia care. Their skills for providing self-management support to patients with dementia and family caregivers need improvement. Recommendations
Daly, Barbara; Arroll, Bruce; Kenealy, Timothy; Sheridan, Nicolette; Scragg, Robert
The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management. To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses. Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day. Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (pmanagement on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes.
Häggström, Marie; Bergsman, Ann-Christin; Månsson, Ulrika; Holmström, Malin Rising
Being a nurse in an intensive care unit entails caring for seriously ill patients. Vasoactive drugs are one of the tools that are used to restore adequate circulation. Critical care nurses often manage and administer these potent drugs after medical advice from physicians. To describe the experiences of critical care nurses learning to manage vasoactive drugs, and to highlight the competence required to manage vasoactive drugs. Twelve critical care nurses from three hospitals in Sweden were interviewed. Qualitative content analysis was applied. The theme "becoming proficient requires accuracy, practice and precaution" illustrated how critical care nurses learn to manage vasoactive drugs. Learning included developing cognitive, psychomotor, and effective skills. Sources for knowledge refers to specialist education combined with practical exercises, collegial support, and accessible routine documents. The competence required to manage vasoactive drugs encompassed well-developed safety thinking that included being careful, in control, and communicating failures. Specific skills were required such as titrating doses, being able to analyse and evaluate the technological assessments, adapting to the situation, and staying calm. Learning to manage vasoactive drugs requires a supportive introduction for novices, collegial support, lifelong learning, and a culture of safety. Copyright © 2016 Elsevier Ltd. All rights reserved.
Hayes, Jessica Elizabeth; Hart, Bethne; Phillips, Jane
Depression is an important condition to consider if we are to optimise the care outcomes for patients with palliative care needs. Depression has a high incidence in palliative patients, with up to 15% diagnosed with major depression and 37% expressing some form of depressive symptoms ( O'Connor et al, 2010 ). The challenge is to ensure that palliative care patients with depression are identified in a timely manner and that their depression is effectively managed. To examine how Australian specialist inpatient palliative care nurses perceive, assess and respond to depression in a patient case study. This descriptive pilot study is a replication of a United States study by Little et al (2005) , exploring contemporary Australian specialist palliative care nurses' screening, assessment and management of depression in people with a progressive life-limiting illness. A survey titled 'Specialist palliative care nurses managing patients with complex care needs' questioned the nursing assessment, knowledge and clinical care priorities related to a case vignette of a patient demonstrating signs of depression. A total of 33 nurses completed this survey. Less than half (39.4%) of the participants identified depression as a major issue arising from the case vignette. Depression screening tools were not widely known. Functionality assessments measuring activities of daily living were the most recognised and widely used tools by participants. This small sample pilot study demonstrated that specialist palliative care nurses are still not confident in their screening and responding to a patient with depression. The available evidenced based depression screening tools were unfamiliar to these nurses and not widely used which can result in depression remaining undetected and undermanaged. The connections between physical health and mental health need stronger recognition and response within nursing care of palliative patients.
Slemon, Allie; Jenkins, Emily; Bungay, Vicky
The discourse of safety has informed the care of individuals with mental illness through institutionalization and into modern psychiatric nursing practices. Confinement arose from safety: out of both societal stigma and fear for public safety, as well as benevolently paternalistic aims to protect individuals from self-harm. In this paper, we argue that within current psychiatric inpatient environments, safety is maintained as the predominant value, and risk management is the cornerstone of nursing care. Practices that accord with this value are legitimized and perpetuated through the safety discourse, despite evidence refuting their efficacy, and patient perspectives demonstrating harm. To illustrate this growing concern in mental health nursing care, we provide four exemplars of risk management strategies utilized in psychiatric inpatient settings: close observations, seclusion, door locking and defensive nursing practice. The use of these strategies demonstrates the necessity to shift perspectives on safety and risk in nursing care. We suggest that to re-centre meaningful support and treatment of clients, nurses should provide individualized, flexible care that incorporates safety measures while also fundamentally re-evaluating the risk management culture that gives rise to and legitimizes harmful practices. © 2017 The Authors Nursing Inquiry published by John Wiley & Sons Ltd.
Turkelson, Carman; Aebersold, Michelle; Redman, Richard; Tschannen, Dana
Effective interprofessional communication is critical to patient safety. This pre-/postimplementation project used a multifaceted educational strategy with high-fidelity simulation to introduce evidence-based communication tools, adapted from Nursing Crew Resource Management, to intensive care unit nurses. Results indicated that participants were satisfied with the education, and their perceptions of interprofessional communication and knowledge improved. Teams (n = 16) that used the communication tools during simulation were more likely to identify the problem, initiate key interventions, and have positive outcomes.
Light Irin, C; Bincy, R
Stress in nurses affects their health and increases absenteeism, attrition rate, injury claims, infection rates and errors in treating patients. This in turn significantly increases the cost of employment in healthcare units. Proper management of stress ensures greater efficiency at work place and improved wellbeing of the employee. Therefore, a pre-experimental study was conducted among 30 Critical Care Unit nurses working inMedical College Hospital, Thiruvananthapuram, (Kerala) to assess the effect of stress management interventions such as Job Stress Awareness, Assertiveness Training, Time Management, andProgressive Muscle Relaxation on job stress. The results showed that caring for patients, general job requirements and workload were the major sources of stress for the nurses. The level of severe stress was reduced from 60 percent to 20 percent during post-test. The Stress Management Interventions were statistically effective in reducing the stress of nurses at p<0.001 level.
Håkanson, Cecilia; Cronfalk, Berit Seiger; Henriksen, Eva; Norberg, Astrid; Ternestedt, Britt-Marie; Sandberg, Jonas
The aim of this study was to investigate first-line nursing home managers' views on their leadership and related to that, palliative care. Previous research reveals insufficient palliation, and a number of barriers towards implementation of palliative care in nursing homes. Among those barriers are issues related to leadership quality. First-line managers play a pivotal role, as they influence working conditions and quality of care. Nine first-line managers, from different nursing homes in Sweden participated in the study. Semi-structured interviews were conducted and analysed using qualitative descriptive content analysis. In the results, two categories were identified: embracing the role of leader and being a victim of circumstances, illuminating how the first-line managers handle expectations and challenges linked to the leadership role and responsibility for palliative care. The results reveal views corresponding to committed leaders, acting upon demands and expectations, but also to leaders appearing to have resigned from the leadership role, and who express powerlessness with little possibility to influence care. The first line managers reported their own limited knowledge about palliative care to limit their possibilities of taking full leadership responsibility for implementing palliative care principles in their nursing homes. The study stresses that for the provision of high quality palliative care in nursing homes, first-line managers need to be knowledgeable about palliative care, and they need supportive organizations with clear expectations and goals about palliative care. Future action and learning oriented research projects for the implementation of palliative care principles, in which first line managers actively participate, are suggested.
Bos-Touwen, Irene; Dijkkamp, Evelien; Kars, Marijke; Trappenburg, Jaap; De Wit, Niek; Schuurmans, Marieke
Although self-management interventions are, to some extent, individualized in clinical practice, the decision-making process is not fully understood. Exploring nurses' clinical reasoning about how and to what extent they currently tailor self-management support can provide new insights, enhancing process and outcome of chronic care. The aim of this study was to explore how nurses assess chronic patients concerning the potential of self-management and clinical reasoning with regard to tailoring care to the individual patient. A qualitative study was conducted using grounded theory. Semistructured interviews were held with 15 nurses working within chronic care. All interviews were carried out from February to July 2013. All nurses provided individualized care; however, a nurse's view of self-management influenced how tailoring was performed. Substantial differences were seen in patient assessments and how care was individualized. Patients' motivation, capacities, mindset, needs, and preferences were obtained through communication, experience, intuition, and trusting relationships. A typology with four patient types emerged: the unmotivated patient, the patient with limited capacities, the oblivious patient, and the ideal patient. Nurses elaborated on using different approaches for patients in each of these groups. A nurse's perception of self-management substantially impacted how care was individualized. Patient assessment was the key driver of tailoring, which was performed in various ways, and influenced how and the extent to which care was individualized. To enable responding to the unique wishes and needs of individual patients, both scientific and educational efforts need to be directed toward systematic assessments of patient capacity to self-manage their disease.
Luo, H B; Wang, X T; Tang, B; Zhu, Z N; Guo, H L; Li, Z Z; Sun, J H; Liu, D W
Objective: To investigate doctors' and nurses' perceptions and implementation of delirium management in intensive care unit. Methods: A total of 197 doctors and nurses in 2 general ICUs and 3 special ICUs at Peking Union Medical College Hospital finished a self-designed questionnaire of delirium management. Results: There were 47 males and 150 females, 43 doctors and 154 nurses who participated in the survey.One hundred and twenty five participators were from general ICU and the others from special ICU. The ICU staff had a significant difference on the perceptions and implementation of delirium management( P delirium assessment" ( P delirium management,especially in special ICUs. Delirium management should be included as a routine care in ICU to improve patients' outcome.
Brugués Brugués, Alba; Cubells Asensio, Irene; Flores Mateo, Gemma
To describe and analyse the implementaction of nurse demand managment (NDM) among health care providers in Catalonia from 2005 to 2014. Cross sectional survey. Participants All service providers in Catalonia (n=37). Main measurements Interviews with nurse manager of each health care provides about ht barriers and facilitators concerning NDM. Facilitators and barriers were classified into 3 types: (i)health professional (competence, attitudes, motivation for change and individual characteristics); (ii)social context (patients and companions), and (iii)system related factors (organization and structure, economic incentives). Of the 37 providers, 26 (70.3%) have implemented the Demand Management Nurse (NDM). The main barriers identified are the nurse prescriptin regulation, lack of knowledge and skills of nurses, and the lack of protocols at the start of implantation. Among the facilitators are the specific training of professionals, a higher ratio of nurses to doctors, consensus circuits with all professionals and linking the implementation of NDM to economic incentives. NDM is consolidated in Catalonia. However, the NDM should be included in the curricula of nursing degree and continuing education programs in primary care teams. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Edwards, Marie P; McMillan, Diana E; Fallis, Wendy M
Fatigue associated with shiftwork can threaten the safety and health of nurses and the patients in their care. Napping during night shift breaks has been shown to be an effective strategy to decrease fatigue and enhance performance in a variety of work environments, but appears to have mixed support within health care. The purpose of this study was to explore critical care unit managers'perceptions of and experiences with their nursing staff's napping practices on night shift, including their perceptions of the benefits and barriers to napping/not napping in terms of patient safety and nurses'personal health and safety. A survey design was used. Forty-seven Canadian critical care unit managers who were members of the Canadian Association of Critical Care Nurses responded to the web-based survey. Data analysis involved calculation of frequencies and percentages for demographic data, use of the Friedman rank test for comparison of managers' perceptions, and content analysis for responses to open-ended questions. The findings of this study offer valuable insights into the complexities and conflicts perceived by managers with respect to napping on night shift breaks by nursing staff Staff and patient health and safety issues, work and break expectations and experiences, and strengths and deficits related to organizational napping resources and policy are considerations that will be instrumental in the development of effective napping strategies and guidelines.
Full Text Available This research aims to study the historical background and current situation of care management in nursing homes for the elderly in Western Thailand and develop care management according to Buddhist principles. This qualitative research analyzes three nursing homes using interview, observation, focus group discussion and workshop as data collection tools. The researchers used a snowball sampling method to identify 109 respondents, made up of 35 key informants, 34 casual informants and 40 general informants. The researchers verified data with a triangulation method and analyzed information descriptively. Results found that the most eminent problems in care management of elderly nursing homes are the image of experts, environment and activity management. Nursing homes do not respond to spiritual requests because of a lack of social and spiritual development. It is necessary to find a new way to emphasize responsibility and respond to spiritual requests by Buddhist means. In this paper, the researchers propose a set of guidelines for the care management of nursing homes in Western Thailand.
The three main parts of this article include (1) the process of transition from a clinical nurse to a nurse entrepreneur, (2) senior care business management and social responsibility and (3) the development of senior care business in the future as well as the chances for nursing development. The article analyzes the development of gerontology nursing careers in the United States and Taiwan and the role professional nurses can play in ageing societies. A prospective plan for collaboration between gerontology nurses and long-term care health professionals in the United States and Taiwan concludes the article.
The phenomenon of an ageing population is being experienced globally, as countries struggle to change and improve residential models of care and provide services to the elderly. The role of the registered nurse (RN) is considered crucial to the clinical governance and management of care given. To date, however, no systematic review has examined the RN's experience in leadership and management. The objective of this review is to critically appraise, synthesise and present best available evidence on the experiences of RNs as clinical leaders and managers in residential aged care facilities. This review considered qualitative research papers that addressed the experiences of RNs as clinical leaders and managers in residential aged care facilities. Participants of interest were RNs, nurse leaders, nurses holding registration and or regulation under a board of nursing, nurses working in residential aged care and long-term care facilities. The diversity and use of language to describe nurses' roles and models of care for the elderly care environment were considered in the review. The search strategy sought to find both published studies and papers, limited to the English language and published between January 1997 and February 2011. An initial limited search was done in Medical Literature Analysis and Retrieval System Online (MEDLINE) and Cumulative Index to Nursing and Allied Health Literature databases to identify the key words contained in the title or abstract and index terms used to describe the relevant terms in the article. A second extensive search was undertaken and extended to other relevant databases using all identified keywords and index terms. The third step involved searching reference lists and bibliographies of chosen articles for additional studies. Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using an appropriate critical appraisal instrument from the System for the Unified Management
Full Text Available Introduction: Nosocomial infection is one indicator of the quality of health services in the community, which also determines the image of health care institutions becauseit was a major cause of morbidityand death rate (mortality in hospital. Nursing care based on knowledge management is established from identification knowledge which is required, prevention performance of nosocomial infections post section caesarea. Nosocomial infections component consists of wound culture result. Method: This study was an observational study with a quasi experimental design. The population was all of nursing staff who working in obstetrics installation in hospitals A and B as much as 46 people. Sample was the total population. Data was collected through questionnaire, observation sheets and examination of the wound culture. Data was analyzed using t test B 1.274 dan p=0.028 Result: The result showed that 1 there was difference in knowledge management implementation before and after training; 2 there was difference in nurse’s performance in preventing nosocomial infection before and after training; 3 there is significant relationship between nurse’s performance in preventing nosocomial infection and infection incidence; 4 there is no significant difference of nursing care impementation on nosocomial incidence. Discussion: In conclusion, the development of nursing care based on knowledge management as a synthesis or induction of findings directed at 1 nurses’ knowledge does not affect the performance of the prevention of nosocomial infections; 2 knowledge management has a positive effect on the performance of the prevention of nosocomial infections; 3 implementation of infection prevention is integrated capabilities between knowledge, skills and attitudes of nurses in implementing performance in care. Keywords: model prevention, nosocomial infections, nursing care, knowledge management, sectio Caesarea
Workplace incivility is a well-documented issue in nursing in the health care setting. It has the potential to cause emotional and physical distress in victims and potentially affects the quality of care provided. The purpose of this study was to critique and summarize the most recent, available evidence related to interventions in assisting nursing staff working in health care settings in managing incivility. This systematic review of literature yielded 10 studies meeting the criteria. The studies were mostly identified as lower quality research. Despite the lower quality of research, the collection of evidence suggests the use of a combination of educational training about workplace incivility, training about effective responses to uncivil workplace behaviors, and active learning activities to practice newly learned communication skills, in assisting nurses in improving their ability to manage incivility in the workplace.
Castle, Nicholas G; Decker, Frederic H
The purpose of this study was to examine the association of Nursing Home Administrator (NHA) leadership style and Director of Nursing (DON) leadership style with quality of care. Leaders were categorized into 4 groups: consensus managers, consultative autocrats, shareholder managers, or autocrats. This leadership style assessment came from primary data collected from approximately 4,000 NHAs and DONs that was linked to quality information (i.e., Nursing Home Compare Quality Measures and 5-Star rating scores) and nursing home information (i.e., Online Survey, Certification, And Reporting data). A consensus manager leadership style has a strong association with better quality. Top managers using this style solicit and act upon input from their employees. For NHAs exhibiting this leadership style, the coefficients on 5 of the 7 quality indicators are statistically significant, and all 7 are significant when the DON exhibits this style. When the NHA and DON both have a consensus manager leadership style, 6 of the 7 quality indicator coefficients are significantly associated with better quality. The findings indicate that NHA and DON leadership style is associated with quality of care. Leadership strategies are amenable to change; thus, the findings of this study may be used to develop policies for promoting more effective leadership in nursing homes.
Full Text Available Rebecca H LehtoCollege of Nursing, Michigan State University, East Lansing, MI, USAAbstract: Malignant pleural mesothelioma is a relatively rare but aggressive malignancy that is primarily associated with occupational asbestos exposure. While treatment options for mesothelioma have expanded, the disease carries a poor prognosis, with a median of 8 months to 1 year of survival postdiagnosis. This article synthesizes current disease-management practices, including the diagnostic workup, treatment modalities, emerging therapies, and symptom management, and identifies comprehensive nursing strategies that result in the best care based on updated evidence. Multidisciplinary coordination, palliative care initiation, survivorship, and end-of-life care are discussed. Findings may be applied in clinical environments as a resource to help nurses better understand treatment options and care for patients facing malignant pleural mesothelioma. Recommendations for future research are made to move nursing science forward and to improve patient well-being and health-related quality-of-life outcomes for patients and their family members.Keywords: pleural mesothelioma, cancer, symptom management, evidence-based care
This article aims to enhance nurses' understanding of nursing care plans, reflecting on the past, present and future use of care planning. This involves consideration of the central theories of nursing and discussion of nursing models and the nursing process. An explanation is provided of how theories of nursing may be applied to care planning, in combination with clinical assessment tools, to ensure that care plans are context specific and patient centred.
This thesis describes the daily work of nurse middle managers at the frontline of patient care in general hospitals. Their clinical leadership is of the upmost importance in hospitals. It contributes to continuous quality improvement, patient safety practices, patient centeredness, support of
Latour-Delfgaauw, C.H.M.; van der Windt, D.A.W.M.; de Jonge, P.; Riphagen, II; Vos, R.; Huyse, F.J.; Stalman, W.A.B.
Objective: The aim of this study was to summarize the available literature on the effectiveness of ambulatory nurse-led case management for complex patients in general health care. Method: We searched MEDLINE, EMBASE, the Cochrane Controlled Trials Register, and Cinahl. We included randomized
Torrejón, Antonio; Oltra, Lorena; Hernández-Sampelayo, Paloma; Marín, Laura; García-Sánchez, Valle; Casellas, Francesc; Alfaro, Noelia; Lázaro, Pablo; Vera, María Isabel
nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool "Nursing Care Quality in IBD Assessment" (NCQ-IBD) based on these standards. a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee´s expert opinion. the final NCQ-IBD consists of 90 items, organized in13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality). the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations.
Background In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting. Objectives To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting. Data Sources and Review Methods A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2. Results Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change. Limitations There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses. Conclusions Specialized nurses with
Dever, Kathleen H
Nurse managers (NMs) in long-term care supervise health care services for individuals with high acuity levels and numerous comorbidities. There is minimal research identifying NMs' skills and competencies as unit leaders within the long-term care environment. The current mixed-methods study identified NMs' leadership skills and competencies. Nineteen NMs with ≥5 years' long-term care management experience completed the Nurse Manager Inventory Tool and were individually interviewed. They rated their clinical skills at the competent level and their financial/strategic management skills at the novice level. All other skill categories, including leadership reflective practice, diversity, human resource leadership/management, relationship management, performance improvement, and problem solving, were rated at a competent level. Emergent interview qualitative themes included their visibility on the unit, trial and error learning, a sense of "aloneness" due to the absence of other RNs, NM position being a tough job, need for peer support, role modeling, and importance of supporting the resident through their "final journey." [Journal of Gerontological Nursing, 44(5), 32-38.]. Copyright 2018, SLACK Incorporated.
Sredl, Darlene; Aukamp, Virginia
Pregnancy presents many problems without working through additional problems in coping with an ostomy. Yet many women with an ostomy do get pregnant and do deliver healthy babies. Evidence-based nursing is of the utmost importance, as there is little published information on this topic. Because of the scarcity of pregnant subjects within the ostomy category, most studies, by necessity, select a purposive subject base. Therefore, other information sources regarding nursing management of the pregnant woman with an ostomy take on considerably more importance. This article explores other forms of evidence that can be used in managing the care of pregnant ostomy patients and specifically how nurses can integrate various sources of information in designing an evidence-based nursing care plan. Nonpharmacologic forms of relaxation therapy, easily used by nurses, such as mindfulness-based stress reduction, guided imagery, and hypnosis, are also identified as some ways nurses can relieve anxiety and experiential stress associated with pregnancy in women who have an ostomy.
The purpose of this qualitative study was to uncover patterns across nurse practitioner (NP) experiences that contribute to understanding their perceptions of managed care, how it affects daily practice, and how NPs respond to a changing managed care workplace. In-depth interviews were conducted with 14 NPs representing primary care, specialty, and independent practices. Over an 18-month period, data collection and analysis occurred simultaneously using standard methods of purposive sampling, constant comparison, memoing, and member checks. This study illuminates the tension NPs experience between a business and a professional ethic and the strategies they use to reconcile this difference with core nursing values. Type of setting, workplace dynamics, and length of time in practice contributed to variation in NP perspectives.
Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin
AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...
Hogan, Pamela; Moxham, Lorna; Dwyer, Trudy
It is paramount that there is an adequate nursing workforce supply for now and in the future, to achieve equitable and quality health outcomes and consumer access to healthcare, regardless of geographic location. Nursing forms the largest body of employees in the health care system, spanning all segments of care. A shortage of nurses, particularly in the acute care settings in hospitals, jeopardizes the provision of quality health care to consumers. This article provides a literature review of Australian State and Federal Government reports into nurse retention. All reports discuss staff turnover rates; the average age of nurses; enrolment numbers in nursing courses; workloads; nursing workforce shortfalls and the effect on the work environment; leadership and management styles; organizational culture; change management; the mobility of nursing qualifications both locally and internationally and the critical need to value nurses. Then why has the situation of nurse retention not improved? Possible reasons for the continued nurse shortage and the promise of strategic HRM in addressing nurse retention are discussed.
The aim of this study was to examine the relationship between, and factors influencing, staff nurse perceptions of nurse manager caring (NMC) and the perceived exposure to workplace bullying (WPB) in multiple healthcare settings. Workplace bullying is commonplace, increasing, and detrimental to the health and availability of our nursing workforce. Positive relationships between a nurse manager (NM) and staff increase staff satisfaction and reduce turnover. Still unknown, however, is whether a caring relationship between manager and staff can reduce staff nurse perception of exposure to WPB. On the basis of Watson's theory that caring is reciprocal in nature, a descriptive correlational design was used to assess 156 staff nurses' self-report of NMC and their exposure to negative acts using the Caring Factor Survey-Caring of the Manager and the Negative Acts Questionnaire-Revised instruments. There is a significant inverse relationship between NMC and exposure to WPB in the nursing workplace. Gender, work environment, and a high workload influenced these findings. This study highlights the importance of caring leadership to reduce exposure to negative behaviors. The data lend support to the idea of educating NMs regarding the application of caring behaviors to support staff at the point of care.
Purroy, F; Cruz Esteve, I; Galindo Ortego, M G; Marsal Mora, J R; Oró, M; Plana, A
Transient ischaemic attack (TIA) patients often report that Primary Care physicians (PCPs) and nurses are their main medical contacts after onset of symptoms in our health area. There are few studies on the knowledge and management of TIA among Community and Family Medicine professionals. Our aim was to study the current knowledge and practice in the management of TIA patients among Primary Care physicians and nurses. A cross-sectional survey with seven questions about TIA was conducted among 640 PCPs and nurses from Primary Care centres in our health area. In total, 285 (46.7% PCPs) took participate in the study. Of these, 239 (83.9%) participants knew the duration of a TIA. However only 40 (14%) recognised all clinical symptoms. An urgent neuroimaging was preferred by 67%. Only 42.5% agreed that an urgent cervical duplex would be useful in these patients. Transcranial Doppler was recognised by only 35.4%. A majority (78.2%) of participants agreed that TIA patients must be admitted to hospital. PCPs had the best knowledge of TIA (odds ratio [OR] 2.138; 95% CI 1.124-4.067; P = 0.021) but there were no differences between physicians and nurses on the management of these patients. Nurses from rural Primary Care centers had the worst level of knowledge (OR 0.410; 95% CI 0.189-0.891; P = 0.024). TIA was well recognized as a medical emergency. However, knowledge of clinical symptoms of TIA must be improved. Copyright © 2010 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.
Lucieli Dias Pedreschi Chaves
Full Text Available ABSTRACT Objective: To reflect on nursing supervision as a management tool for care comprehensiveness by nurses, considering its potential and limits in the current scenario. Method: A reflective study based on discourse about nursing supervision, presenting theoretical and practical concepts and approaches. Results: Limits on the exercise of supervision are related to the organization of healthcare services based on the functional and clinical model of care, in addition to possible gaps in the nurse training process and work overload. Regarding the potential, researchers emphasize that supervision is a tool for coordinating care and management actions, which may favor care comprehensiveness, and stimulate positive attitudes toward cooperation and contribution within teams, co-responsibility, and educational development at work. Final considerations: Nursing supervision may help enhance care comprehensiveness by implying continuous reflection on including the dynamics of the healthcare work process and user needs in care networks.
aziz alimul hidayat
Full Text Available Introduction: The quality management system is an order that ensures the achievement of goals and quality objectives which are planned in nursing care. One of the factors that may affect the implementation of quality management systems in the inpatient units is the quality leadership of head nurse. This study aims to determine the effect of the quality leadership of the head nurse to the implementation of quality management systems of nursing cares in hospital. Methods: The research method uses analytical research with cross-sectional approach. The sample of this study consists of eight wards; They are Multazam pavillion, Arofah, Sakinah, Shofa Marwah, Annisa, Mina, Ismail, and ICU which meet with the inclusion and exclusion criteria. The data was taken by using simple random sampling. The data collection by using questionnaires, interviews and observation. Data analysis used a simple statistical linear regression tests with a significance the value of α ≤ 0.05. Results: The results showed that the quality of leadership of the head of wards is mostly good (50% and the implementation of quality management system of nursing care is mostly good (62.5%. Results of analysis of the simple linear regression test on the influence of leadership quality of the head nurse through the implementation of the quality management system of inpatient units (ρ = 0.024. Conclusion: The results of this study expect the nurses to increase the commitment and responsibility in implementing the quality management system of nursing cares in the inpatient units so as to achieve the excellent quality of nursing cares and can boost confidence, satisfaction of patients, families, and communities on nursing care. Keywords: Quality Leadership, Quality Management System Implementation
Acevedo-Nuevo, M; González-Gil, M T; Solís-Muñoz, M; Láiz-Díez, N; Toraño-Olivera, M J; Carrasco-Rodríguez-Rey, L F; García-González, S; Velasco-Sanz, T R; Martínez-Álvarez, A; Martin-Rivera, B E
To identify nursing experience on physical restraint management in Critical Care Units. To analyse similarities and differences in nursing experience on physical restraint management according to the clinical context that they are involved in. A multicentre phenomenological study was carried out including 14 Critical Care Units in Madrid, classified according to physical restraint use: Common/systematic use, lacking/personalised use, and mixed use. Five focus groups (23 participants were selected following purposeful sampling) were convened, concluding in data saturation. Data analysis was focused on thematic content analysis following Colaizzi's method. Six main themes: Physical restraint meaning in Critical Care Units, safety (self-retreat vital devices), contribution factors, feelings, alternatives, and pending issues. Although some themes are common to the 3 Critical Care Unit types, discourse differences are found as regards to indication, feelings, systematic use of pain and sedation measurement tools. In order to achieve real physical restraint reduction in Critical Care Units, it is necessary to have a deep understanding of restraints use in the specific clinical context. As self-retreat vital devices emerge as central concept, some interventions proposed in other settings could not be effective, requiring alternatives for critical care patients. Discourse variations laid out in the different Critical Care Unit types could highlight key items that determine the use and different attitudes towards physical restraint. Copyright © 2015 Elsevier España, S.L.U. y SEEIUC. All rights reserved.
Baldwin, Kathleen M; Black, Denice; Hammond, Sheri
This quality improvement project developed a community nursing case management program to decrease preventable readmissions to the hospital and emergency department by providing telephonic case management and, if needed, onsite assessment and treatment by a clinical nurse specialist (CNS) with prescriptive authority. As more people reach Medicare age, the number of individuals with worsening chronic diseases with dramatically increases unless appropriate disease management programs are developed. Care transitions can result in breakdown in continuity of care, resulting in increased preventable readmissions, particularly for indigent patients. The CNS is uniquely educated to managing care transitions and coordination of community resources to prevent readmissions. After a thorough SWOT (strengths, weaknesses, opportunities, and threats) analysis, we developed and implemented a cost-avoidance model to prevent readmissions in our uninsured and underinsured patients. The project CNS used a wide array of interventions to decrease readmissions. In the last 2 years, there have been a total of 22 less than 30-day readmissions to the emergency department or hospital in 13 patients, a significant decrease from readmissions in these patients prior to the program. Three of them required transfer to a larger hospital for a higher level of care. Using advanced practice nurses in transitional care can prevent readmissions, resulting in cost avoidance. The coordination of community resources during transition from hospital to home is a job best suited to CNSs, because they are educated to work within organizations/systems. The money we saved with this project more than justified the cost of hiring a CNS to lead it. More research is needed into this technology. Guidelines for this intervention need to be developed. Replicating our cost-avoidance transitional care model can help other facilities limit that loss.
Durso, Francis T; Ferguson, Ashley N; Kazi, Sadaf; Cunningham, Charlene; Ryan, Christina
Part of the work of a critical care nurse is to manage the threats that arise that could impede efficient and effective job performance. Nurses manage threats by employing various strategies to keep performance high and workload manageable. We investigated strategic threat management by using the Threat-Strategy Interview. Threats frequently involved technology, staff, or organizational components. The threats were managed by a toolbox of multifaceted strategies, the most frequent of which involved staff-, treatment- (patient + technology), examination- (patient + clinician), and patient-oriented strategies. The profile of strategies for a particular threat often leveraged work facets similar to the work facet that characterized the threat. In such cases, the nurse's strategy was directed at eliminating the threat (not working around it). A description at both a domain invariant level - useful for understanding strategic threat management generally - and a description at an operational, specific level - useful for guiding interventions-- are presented. A structural description of the relationship among threats, strategies, and the cues that trigger them is presented in the form of an evidence accumulation framework of strategic threat management. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.
Peterson, Joann M; Virden, Mary D
This article is a description of the development and implementation of a Comprehensive Diabetic Foot Care Program and assessment tool in an academically affiliated nurse-managed, multidisciplinary, safety-net clinic. The assessment tool parallels parameters identified in the Task Force Foot Care Interest Group of the American Diabetes Association's report published in 2008, "Comprehensive Foot Examination and Risk Assessment." Review of literature, Silver City Health Center's (SCHC) 2009 Annual Report, retrospective chart review. Since the full implementation of SCHC's Comprehensive Diabetic Foot Care Program, there have been no hospitalizations of clinic patients for foot-related complications. The development of the Comprehensive Diabetic Foot Assessment tool and the implementation of the Comprehensive Diabetic Foot Care Program have resulted in positive outcomes for the patients in a nurse-managed safety-net clinic. This article demonstrates that quality healthcare services can successfully be developed and implemented in a safety-net clinic setting. ©2012 The Author(s) Journal compilation ©2012 American Association of Nurse Practitioners.
Shivalli, Siddharudha; Sanklapur, Vasudha
The nurse's role in healthcare waste management is crucial. (1) To appraise nurses quantitatively and qualitatively regarding healthcare waste management; (2) to elicit the determinants of knowledge and attitudes of healthcare waste management. A cross-sectional study was undertaken at a tertiary care hospital of Mangalore, India. Self-administered pretested questionnaire and "nonparticipatory observation" were used for quantitative and qualitative appraisals. Percentage knowledge score was calculated based on their total knowledge score. Nurses' knowledge was categorized as excellent (>70%), good (50-70%), and poor (70% score). Most (86%) expressed the need of refresher training. No study variable displayed significant association (P > 0.05) with knowledge. Apt segregation practices were followed except in casualty. Patients and entourages misinterpreted the colored containers. Nurses' knowledge and healthcare waste management practices were not satisfactory. There is a need of refresher trainings at optimum intervals to ensure sustainability and further improvement. Educating patients and their entourages and display of segregation information board in local language are recommended.
Hayes, Eileen F
To explore the attitudes of nurse practitioners (NPs) toward managed care and to identify the sources of negative attitudes and the factors that may ameliorate them. NPs, members of the Massachusetts Coalition of NPs, participated in in-depth interviews about the impact of managed care on their practice. The sources of NP negativity about managed care for many study participants lay in their not appreciating the importance of the business aspects of practice and the provider's role in controlling healthcare costs, reluctance to work with what they perceived as a rigid "system," and lack of support for them to navigate it. They felt pressured by productivity issues, time constraints, practice restrictions, and documentation demands associated with reimbursement. Those who sustained a more positive attitude were realistic about healthcare economics, were willing and able to negotiate the system, were creative and flexible, and felt empowered by knowledge of the business of practice. Some NPs, however, chose to work in practices where they did not feel as pressured as their counterparts in large, busy primary care practices. IMPLICATIONS FOR NP PRACTICE AND EDUCATION: Understanding experiences that have influenced NP attitudes regarding managed care may assist NP faculty to better prepare NP students for their future roles. NPs must be able to challenge, yet be part of, an evolving system that promotes cost-effective health care for everyone, which was what managed care originally was intended to do.
Caffrey, R A; Caffrey, P A
Can nurses practice caring within a healthcare system that promotes codependency? Caring promotes mutual empowerment of all participants while codependent caring disempowers. Nurses are expected to practice caring with clients, The authors contend, however, that nursing, as historically and currently practiced within bureaucratic/patriarchal organizations, is founded on a value system that fosters codependency. Until nursing is practiced within the context of caring organizations and a caring healthcare system, nurses will continue to be powerless to shape their own practice as carers and burnout will continue to be a problem.
de Argila Fernández-Durán, Nuria; Blasco Maldonado, Celeste; Martín Gómez, Mónica
Phototherapy with narrow band ultraviolet B is a treatment used in some dermatology units, and is the first choice in some dermatological diseases due to being comfortable and cheap. The aim of this paper is to describe the management and nursing care by grouping more specific diagnoses, following NANDA-NIC/NOC taxonomy, such as the methodology from application, technique, material, and personnel to space-related aspects, with the aim of avoiding the clinical variability and the possible associated risks for the patients, and for the nurses who administer the treatment. The continuity of the same nurse in the follow-up sessions stimulates the relationship between medical personnel and patients, key points for loyalty and therapeutic adherence. This paper examines a consensus procedure with the Dermatology Unit Team and accredited by the Hospital Quality Unit. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Ercolano, Elizabeth; Grant, Marcia; McCorkle, Ruth; Tallman, Nancy J; Cobb, Martha D; Wendel, Christopher; Krouse, Robert
Living with an ostomy requires daily site and equipment care, lifestyle changes, emotional management, and social role adjustments. The Chronic Care Ostomy Self-Management Training Program (CCOSMTP) offers an ostomy self-management curriculum, emphasizing problem solving, self-efficacy, cognitive reframing, and goal setting. The qualitative method of content analysis was employed to categorize self-reported goals of ostomates identified during a nurse-led feasibility trial testing the CCOSMTP. Thirty-eight ostomates identified goals at three CCOSMTP sessions. The goals were classified according to the City of Hope Health-Related Qualify of Life Model, a validated multidimensional framework, describing physical, psychological, social, and spiritual ostomy-related effects. Nurse experts coded the goals independently and then collaborated to reach 100% consensus on the goals' classification. A total of 118 goals were identified by 38 participants. Eighty-seven goals were physical, related to the care of the skin, placement of the pouch or bag, and management of leaks; 26 were social goals, which addressed engagement in social or recreational roles and daily activities; and 5 were psychological goals, which were related to confidence and controlling negative thinking. Although the goals of survivors of cancer with an ostomy are variable, physical goals are most common in self-management training.
Zwijsen, S.A.; Smalbrugge, M.; Zuidema, S.U.; Koopmans, R.T.C.M.; Bosmans, J.E.; Tulder, M.W. van; Eefsting, J.A.; Gerritsen, D.L.; Pot, A.M.
BACKGROUND: Behavioural problems are common in nursing home residents with dementia and they often are burdensome for both residents and nursing staff. In this study, the effectiveness and cost-effectiveness of a new care programme for managing behavioural problems will be evaluated. METHODS/DESIGN:
Zwijsen, S.A.; Smalbrugge, M.; Zuidema, S.U.; Koopmans, R.T.C.M.; Bosmans, J.E.; van Tulder, M.W.; Eefsting, J.A.; Gerritsen, D.L.; Pot, A.M.
Background: Behavioural problems are common in nursing home residents with dementia and they often are burdensome for both residents and nursing staff. In this study, the effectiveness and cost-effectiveness of a new care programme for managing behavioural problems will be evaluated. Methods/Design.
Coronado-Vázquez, Valle; García-López, Ana; López-Sauras, Susana; Turón Alcaine, José María
Patient safety and quality of care in a highly complex healthcare system depends not only on the actions of professionals at an individual level, but also on interaction with the environment. Proactive risk management in the system to prevent incidents and activities targeting healthcare teams is crucial in establishing a culture of safety in centres. Nurses commonly lead these safety strategies. Even though safety incidents are relatively infrequent in primary care, since the majority are preventable, actions at this level of care are highly effective. Certification of services according to ISO standard 9001:2008 focuses on risk management in the system and its use in certifying healthcare centres is helping to build a safety culture amongst professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Suhonen, Marjo; Paasivaara, Leena
To analyse the challenges that nurse managers meet in project management. Project management done by nurse managers has a significant role in the success of projects conducted in work units. The data were collected by open interviews (n = 14). The participants were nurse managers, nurses and public health nurses. Data analysis was carried out using qualitative content analysis. The three main challenges nurse managers faced in project management in health-care work units were: (1) apathetic organization and management, (2) paralysed work community and (3) cooperation between individuals being discouraged. Nurse managers' challenges in project management can be viewed from the perspective of the following paradoxes: (1) keeping up projects-ensuring patient care, (2) enthusiastic management-effective management of daily work and (3) supporting the work of a multiprofessional team-leadership of individual employees. It is important for nurse managers to learn to relate these paradoxes to one another in a positive way. Further research is needed, focusing on nurse managers' ability to promote workplace spirituality, nurse managers' emotional intelligence and their enthusiasm in small projects. © 2011 Blackwell Publishing Ltd.
Zori, Susan; Morrison, Barbara
Formal education and support is needed for nurse managers to effectively function in their role in the current health care environment. Many nurse managers assume their positions based on expertise in a clinical role with little expertise in managerial and leadership skills. Operating as a manager and leader requires ongoing development of critical thinking skills and the inclination to use those skills. Critical thinking can have a powerful influence on the decision making and problem solving that nurse managers are faced with on a daily basis. The skills that typify critical thinking include analysis, evaluation, inference, and deductive and inductive reasoning. It is intuitive that nurse managers require both the skills and the dispositions of critical thinking to be successful in this pivotal role at a time of transformation in health care. Incorporating critical thinking into education and support programs for the nurse manager is necessary to position the nurse manager for success.
Munyewende, Pascalia O; Levin, Jonathan; Rispel, Laetitia C
Managerial competencies to enhance individual and organisational performance have gained currency in global efforts to strengthen health systems. Competent managers are essential in the implementation of primary health care (PHC) reforms that aim to achieve universal health coverage. To evaluate the competencies of PHC clinic nursing managers in two South African provinces. A cross-sectional study was conducted in two South African provinces. Using stratified random sampling, 111 PHC clinic nursing managers were selected. All supervisors ( n =104) and subordinate nurses ( n =383) were invited to participate in the survey on the day of data collection. Following informed consent, the nursing managers, their supervisors, and subordinate nurses completed a 40-item, 360-degree competency assessment questionnaire, with six domains: communication, leadership and management, staff management, financial management, planning and priority setting, and problem-solving. Standard deviations, medians, and inter-quartile ranges (IQRs) were computed separately for PHC nursing managers, supervisors, and subordinate nurses for competencies in the six domains. The Tinsley and Weiss index was used to assess agreement between each of the three possible pairs of raters. A 95.4% response rate was obtained, with 105 nursing managers in Gauteng and Free State completing the questionnaires. There was a lack of agreement about nursing managers' competencies among the three groups of raters. Overall, clinic nursing managers rated themselves high on the five domains of communication (8.6), leadership and management (8.67), staff management (8.75), planning and priority setting (8.6), and problem-solving (8.83). The exception was financial management with a median score of 7.94 (IQR 6.33-9.11). Compared to the PHC clinic managers, the supervisors and subordinate nurses gave PHC nursing managers lower ratings on all six competency domains, with the lowest rating for financial management
Strudwick, Gillian; Booth, Richard G; Bjarnadottir, Ragnhildur I; Collins, Sarah; Srivastava, Rani
An increasing number of electronic health record (EHR) systems have been implemented in clinical practice environments where nurses work. Findings from previous studies have found that a number of intended benefits of the technology have not yet been realised to date, partially due to poor system adoption among health professionals such as nurses. Previous studies have suggested that nurse managers can support the effective adoption and use of the technology by nurses. However, no known studies have identified what role nurse managers have in supporting technology adoption, nor the specific strategies that managers can employ to support their staff. Therefore, the purpose of this research is to better understand the role of the nurse manager in point-of-care nurses' use of EHRs, and to identify strategies that may be effective in supporting clinical adoption. This study will use a qualitative descriptive design. Interviews with both nurse managers and point-of-care nursing staff will be conducted in a Canadian mental health and addiction healthcare organisation where an EHR has been implemented. A semistructured interview guide will be used, and interviews will be audio recorded. Transcripts will be analysed using a directed content analysis technique. Strategies to ensure the trustworthiness of the data analysis procedure and findings will be employed. Ethical approval for this study has been obtained. Dissemination strategies may include a paper submission to a peer-reviewed journal, a conference submission and meetings to share findings with the study site leadership team. Findings from this research will be used to inform a future study which aims to assess levels of competencies and perform a psychometric analysis of the Nursing Informatics Competency Assessment for the Nurse Leader instrument in a Canadian context. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is
Pascalia O. Munyewende
Full Text Available Background: Managerial competencies to enhance individual and organisational performance have gained currency in global efforts to strengthen health systems. Competent managers are essential in the implementation of primary health care (PHC reforms that aim to achieve universal health coverage. Objective: To evaluate the competencies of PHC clinic nursing managers in two South African provinces. Design: A cross-sectional study was conducted in two South African provinces. Using stratified random sampling, 111 PHC clinic nursing managers were selected. All supervisors (n=104 and subordinate nurses (n=383 were invited to participate in the survey on the day of data collection. Following informed consent, the nursing managers, their supervisors, and subordinate nurses completed a 40-item, 360-degree competency assessment questionnaire, with six domains: communication, leadership and management, staff management, financial management, planning and priority setting, and problem-solving. Standard deviations, medians, and inter-quartile ranges (IQRs were computed separately for PHC nursing managers, supervisors, and subordinate nurses for competencies in the six domains. The Tinsley and Weiss index was used to assess agreement between each of the three possible pairs of raters. Results: A 95.4% response rate was obtained, with 105 nursing managers in Gauteng and Free State completing the questionnaires. There was a lack of agreement about nursing managers’ competencies among the three groups of raters. Overall, clinic nursing managers rated themselves high on the five domains of communication (8.6, leadership and management (8.67, staff management (8.75, planning and priority setting (8.6, and problem-solving (8.83. The exception was financial management with a median score of 7.94 (IQR 6.33–9.11. Compared to the PHC clinic managers, the supervisors and subordinate nurses gave PHC nursing managers lower ratings on all six competency domains, with
Kaasalainen, Sharon; Wickson-Griffiths, Abigail; Akhtar-Danesh, Noori; Brazil, Kevin; Donald, Faith; Martin-Misener, Ruth; DiCenso, Alba; Hadjistavropoulos, Thomas; Dolovich, Lisa
Considering the high rates of pain as well as its under-management in long-term care (LTC) settings, research is needed to explore innovations in pain management that take into account limited resource realities. It has been suggested that nurse practitioners, working within an inter-professional model, could potentially address the under-management of pain in LTC. This study evaluated the effectiveness of implementing a nurse practitioner-led, inter-professional pain management team in LTC in improving (a) pain-related resident outcomes; (b) clinical practice behaviours (e.g., documentation of pain assessments, use of non-pharmacological and pharmacological interventions); and, (c) quality of pain medication prescribing practices. A mixed method design was used to evaluate a nurse practitioner-led pain management team, including both a quantitative and qualitative component. Using a controlled before-after study, six LTC homes were allocated to one of three groups: 1) a nurse practitioner-led pain team (full intervention); 2) nurse practitioner but no pain management team (partial intervention); or, 3) no nurse practitioner, no pain management team (control group). In total, 345 LTC residents were recruited to participate in the study; 139 residents for the full intervention group, 108 for the partial intervention group, and 98 residents for the control group. Data was collected in Canada from 2010 to 2012. Implementing a nurse practitioner-led pain team in LTC significantly reduced residents' pain and improved functional status compared to usual care without access to a nurse practitioner. Positive changes in clinical practice behaviours (e.g., assessing pain, developing care plans related to pain management, documenting effectiveness of pain interventions) occurred over the intervention period for both the nurse practitioner-led pain team and nurse practitioner-only groups; these changes did not occur to the same extent, if at all, in the control group
Luís Carlos Lopes-Júnior
Full Text Available This study aimed to report the experience of last year undergraduate nursing students from Brazilian college pioneer in the use of active teaching-learning methods, in emergency care to a patient in primary care. This assistance which was methodologically problematized triggered by health team, comprised of nurse, physician, nursing assistants and community health worker, a reflection on the organization of the work process. To this end, we used permanent education as a tool guided by the Altadir Method Popular Planning, which contributed to the development of management competence of nurse. A team of health identified problems during assistance, analyzed its causes and consequences, and proposed interventions for the management and organization of the work process to qualify this practice. This report can be useful for the design and implementation of a management exercise that aims to problematize the reality, with a view to linking theory and practice.
Stephen, Catherine; McInnes, Susan; Halcomb, Elizabeth
To explore the feasibility and acceptability of nurse-led chronic disease management and lifestyle risk factor reduction interventions in primary care (general practice/family practice). Growing international evidence suggests that interventions delivered by primary care nurses can assist in modifying lifestyle risk factors and managing chronic disease. To date, there has been limited exploration of the feasibility and acceptability of such interventions. Integrative review guided by the work of Whittemore and Knafl (). Database search of CINAHL, Medline and Web of Science was conducted to identify relevant literature published between 2000-2015. Papers were assessed for methodological quality and data abstracted before thematic analysis was undertaken. Eleven papers met the inclusion criteria. Analysis uncovered four themes: (1) facilitators of interventions; (2) barriers to interventions; (3) consumer satisfaction; and (4) primary care nurse role. Literature supports the feasibility and acceptability of nurse-led interventions in primary care for lifestyle risk factor modification. The ongoing sustainability of these interventions rests largely on organizational factors such as funding, educational pathways and professional support of the primary care nursing role. Further robust research around primary care nurse interventions is required to strengthen the evidence base. © 2017 John Wiley & Sons Ltd.
van der Plas, Annicka G M; Onwuteaka-Philipsen, Bregje D; Vissers, Kris C; Deliens, Luc; Jansen, Wim J J; Francke, Anneke L
To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. Cross-sectional questionnaire study. Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses. © 2015 John Wiley & Sons Ltd.
Brandon A. Haghverdian, BSc
Full Text Available Background: After home health care, the skilled nursing facility (SNF is the most commonly used postacute care modality, among Medicare beneficiaries, after total joint arthroplasty. Prior studies demonstrated that a loss in postsurgical ambulatory gains is incurred in the interval between hospital discharge and arrival at the SNF. The aim of this present study is to determine the consequences of that loss in function, as well as compare SNF-related outcomes in patients with Medicare vs Managed Care (MC insurance. Methods: We conducted a retrospective analysis of 80 patients (54 Medicare and 26 MC who attended an SNF after hospitalization for total joint arthroplasty. Outcomes from physical therapy records were abstracted from each patient's SNF file. Results: There was an approximately 40% drop-off in gait achievements between hospital discharge and SNF admission. This decline in ambulation was significantly greater in Medicare patients (Medicare: 94.6 ± 123.2 ft, MC: 40.0 ± 48.9 ft, P = .034. Larger reductions in gait achievements between hospital discharge and SNF admission were significantly correlated with longer SNF lengths of stay and poorer gait achievements by SNF discharge. Patients with MC insurance made significant improvements in gait training at the SNF beyond that which was acquired at the hospital, whereas Medicare patients did not (PMedicare = .28, PMC = .003. Conclusions: Large losses in motor function between hospital discharge and SNF admission were associated with poor functional outcomes and longer stays at the SNF. These effects were more pronounced in Medicare patients than those with MC insurance. Keywords: Total joint arthroplasty, Skilled nursing facility, Medicare, Managed Care, Physical therapy
Landeiro, Maria José Lumini; Freire, Rosa Maria Albuquerque; Martins, Maria Manuela; Martins, Teresa Vieira; Peres, Heloísa Helena Ciqueto
Objective To identify the technological profile of nurses in Portuguese hospitals. Method A quantitative exploratory study conducted in two hospitals in the northern region and one in the central region of Portugal. The sample was randomly selected and included 960 nurses. Results Of the participants, 420 (46.1%) used computers, 196 (23.4%) reported having knowledge about using computers for teaching, 174 (21.1%) used computers to teach, 112 (15.1%) recognized that using computers can be a technological means to supplement classroom training, 477 (61.6%) would like to receive training on using computers, and 382 (40.9%) reported self-learning of information technology. In relation to distance education, 706 (74.9%) reported they were familiar with it and 752 (76.4%) indicated an interest in participating in training using this modality. Conclusion Organizations should be mindful of the technological profile shown by this group of nurses and look for ways to introduce educational technologies in the management of care.
Susan J. Armstrong
Full Text Available Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36. Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results: The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion: The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision
Gilstrap, Cristina M; White, Zachary M
This study examines the dialectical tensions experienced by home hospice nurses in interactions with patients, families, and health care providers. In-depth, semistructured interviews were conducted with 24 home hospice nurses from a mid-size for-profit hospice organization serving approximately 230 patients on an annual basis. Interviews revealed hospice nurses experience both interpersonal and organizational dialectics during hospice interactions: authoritative-nonauthoritative, revelation-concealment, independence-collaboration, and quality of care-business of care. Dialectics often resulted as a by-product of (a) responding to expectations and care choices of patients and families particular to the emotionally charged home context, (b) obtaining authorization from health care providers who are not members of the interdisciplinary team, and (c) pressures associated with providing quality patient care while fulfilling organizational role requirements. The praxis strategies used to negotiate tensions included segmentation, balance, recalibration, and spiraling inversion. Specifically, nurses employed strategies such as ascertaining family/patient acceptance, using persuasive tactics when communicating with external health care providers, relying on effective time management, and working off the clock to provide more in-person care. Although functional for patients and hospice organizations, nurses who continually rely on these strategies may experience job stress when their interpersonal commitments repeatedly conflict with organizational role demands.
Firmin, Michael W; Bailey, Megan
The purpose of this study was to explore the motivations and stresses associated with full-time working mothers who practice as nurse managers. Full-time work outside the home for mothers has been recognized as a circumstance which may present certain benefits and risks to family life. Nursing management is recognized as a high-stress occupation, which may be filled by mothers who work full time. Little is known about the specific needs and stresses of full-time nurse managers who are caring for children at home. In-depth interviews were conducted with 13 mothers who worked as nurse managers. Participants expressed challenges in several areas including balancing/separating work and home, self-imposed advancement inhibitions, and constant giving. Challenges were offset by assets, which included complimentary roles, health insurance, added income, and professional and personal fulfilment. Participants 'wanted it all', including the conveniences of part-time employment and the benefits of full-time employment. Full-time nurse managers with children at home experience unique tensions which characterize their work and home environments. Employers may assist nurses by adopting flexible scheduling, educational and child-care support and assistance in negotiating work and home roles.
Takai, Yukari; Yamamoto-Mitani, Noriko; Fukahori, Hiroki; Kobayashi, Sayuri; Chiba, Yumi
This study aimed to examine nursing ward managers' perceptions of pain prevalence among older residents and the strategies of pain management at the Health Service Facilities for the Elderly Requiring Care (HSFERC) in Japan and to investigate the factors related to the prevalence. Nursing ward managers in 3,644 HSFERC were asked to participate in this study. Questionnaires were sent to them regarding pain prevalence among the older residents in their wards, their provisions for pain care, and other pain management strategies. The perceived pain prevalence factors were examined statistically. The final sample comprised 439 participants (12.0%). A total of 5,219 residents (22.3%) were recognized as suffering from pain on the investigation day. Only 8 wards (1.8%) used pain management guidelines or care manuals, and 14 (3.2%) used a standardized pain scale. The ward managers' age (p = .008) and nursing experience (p = .006) showed a significant negative association with pain prevalence estimation. Moreover, there was a significant association between the groups' pain prevalence estimation and the nursing managers' beliefs that older adults were less sensitive to pain (p = .01), that pain was common among older people (p = .007), and that the time to treat residents' pain was insufficient (p = .001). The ward managers' perceptions regarding pain prevalence varied; the perceived pain rates were possibly lower than the actual percentages. Insufficient pain management strategies at the HSFERC were also suggested. An appropriate pain management strategy for Japanese aged care and its dissemination are urgently required. Copyright © 2013 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
To deliver the chief nursing officer for England's vision for compassionate care and embed the 6Cs effectively, the NHS must attract, develop and retain talented nurses with a diverse range of skills. This is particularly important given the predicted shortage of nurses and evidence that NHS providers need to increase skill mix ratios to deliver safe patient care. "Talent management" is increasingly discussed within the health service; we recently asked nurses and student nurses to identify their priorities for talent development. They highlighted the importance of strong ward leadership, effective personal appraisal, clearer career pathways, increased staff engagement and involvement in decision making, as well as a need for greater emphasis on the recognition and reward of nursing achievements. We concluded that these factors are crucial to attracting, retaining and developing talent in nursing. Nurse leaders can learn approaches to developing talent from business and wider healthcare settings.
Kydonaki, Kalliopi; Huby, Guro; Tocher, Jennifer; Aitken, Leanne M
respiratory assessment by critical care nurses will ensure optimum patient management in weaning mechanical ventilation. © 2016 John Wiley & Sons Ltd.
Plas, A.G.M. van der; Onwuteaka-Philipsen, B.D.; Vissers, K.C.; Deliens, L.; Jansen, W.J.J.; Francke, A.L.
Aims: To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case
A Magnet-related program has been recently adopted in the Netherlands. Support for staff nurses from nurse middle managers (NMMs) is a key component of such a program. A Bourdieusian ethnographic organizational case study in four hospitals in the Netherlands and the United States (Magnet,
Schneider, Kathleen H
The rate of concussions in adolescents has risen over the last decade, resulting in cognitive and emotional problems. Neurologists recommend cognitive and physical rest during the recovery period, followed by a transitional return-to-classroom protocol. The purpose of the study was to develop and test an instrument that explores the beliefs and roles of school nurses in concussion care management. The instrument was a cross-sectional descriptive survey based on the theory of planned behavior, using Qualtrics®. The psychometric properties of the instrument were assessed through exploratory factor analysis with orthogonal rotation. The reliability of the instrument was assessed for internal consistency reliability using Cronbach's α. Kaiser-Meyer-Olkin for sample adequacy was .8; Cronbach's α strong (.851).
Full Text Available Aim: The aim of this literature review was to search for qualitative studies focusing on the concept of caring in nursing, to analyse them and to synthesize knowledge that concerns the definition of the concept of caring in nursing from the point of view of nurses and patients. Design: Review. Methods: Qualitative studies were searched for systematically in the electronic databases Academic Search Complete (EBSCO, CINAHL, Medline, Science Direct, and the Wiley Library Online, according to set criteria and defined key words for the period 1970-2015. Seven selected articles were analysed after selection of documents with the aid of a sorting chart. Results: Nurses understand caring in nursing as a relationship with patients which is characterised on the nurses' part by an individual and empathetic approach, attentiveness, experience and sensitivity. Through caring, active communication takes place, providing information which reduces anxiety and leads to the breaking down of barriers. This relationship helps protect patients' autonomy, dignity and comfort. It requires experience on the part of nurses, and it is influenced by the environment. The nurses' personal qualities (what professional knowledge, attitudes and skills they have and their availability, reliability, and emotional and physical support are important to patients. Conclusion: The concept of caring is a content specific interpersonal process which is characterized by the professional knowledge, skills, personal maturity, and interpersonal sensitivity of nurses, which result in the protection, emotional support, and the meeting of bio-psycho-social needs of patients. The results of the overview study could contribute to an explanation and understanding of the nature of caring as a fundamental feature of the discipline of nursing.
Full Text Available Background. The nurse’s role in healthcare waste management is crucial. Objectives. (1 To appraise nurses quantitatively and qualitatively regarding healthcare waste management; (2 to elicit the determinants of knowledge and attitudes of healthcare waste management. Method. A cross-sectional study was undertaken at a tertiary care hospital of Mangalore, India. Self-administered pretested questionnaire and “nonparticipatory observation” were used for quantitative and qualitative appraisals. Percentage knowledge score was calculated based on their total knowledge score. Nurses’ knowledge was categorized as excellent (>70%, good (50–70%, and poor (70% score. Most (86% expressed the need of refresher training. No study variable displayed significant association (P>0.05 with knowledge. Apt segregation practices were followed except in casualty. Patients and entourages misinterpreted the colored containers. Conclusion. Nurses’ knowledge and healthcare waste management practices were not satisfactory. There is a need of refresher trainings at optimum intervals to ensure sustainability and further improvement. Educating patients and their entourages and display of segregation information board in local language are recommended.
In response to the increasing demand for better chronic disease management and improved health care efficiency in Ontario, nursing roles have expanded in the primary health care setting. To determine the effectiveness of specialized nurses who have a clinical role in patient care in optimizing chronic disease management among adults in the primary health care setting. A literature search was performed using OVID MEDLINE, OVID MEDLINE In-Process and Other Non-Indexed Citations, OVID EMBASE, EBSCO Cumulative Index to Nursing & Allied Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database. Results were limited to randomized controlled trials and systematic reviews and were divided into 2 models: Model 1 (nurse alone versus physician alone) and Model 2 (nurse and physician versus physician alone). Effectiveness was determined by comparable outcomes between groups in Model 1, or improved outcomes or efficiency in Model 2. Six studies were included. In Model 1, there were no significant differences in health resource use, disease-specific measures, quality of life, or patient satisfaction. In Model 2, there was a reduction in hospitalizations and improved management of blood pressure and lipids among patients with coronary artery disease. Among patients with diabetes, there was a reduction in hemoglobin A1c but no difference in other disease-specific measures. There was a trend toward improved process measures, including medication prescribing and clinical assessments. Results related to quality of life were inconsistent, but patient satisfaction with the nurse-physician team was improved. Overall, there were more and longer visits to the nurse, and physician workload did not change. There was heterogeneity across patient populations, and in the titles, roles, and scope of practice of the specialized nurses. Specialized nurses with an autonomous role in patient care had comparable outcomes to physicians alone (Model
Wiederholt, Peggy A.; Connor, Nadine P.; Hartig, Gregory K.; Harari, Paul M.
Patients with advanced head and neck cancer face not only a life-threatening malignancy, but also a remarkably complex treatment regimen that can affect their cosmetic appearance and ability to speak, breathe, and swallow. These patients benefit from the coordinated interaction of a multidisciplinary team of specialists and a comprehensive plan of care to address their physical and psychosocial concerns, manage treatment-related toxicities, and prevent or limit long-term morbidities affecting health-related quality of life. Although little has been published on patient-provider communication with a multidisciplinary team, evidence has suggested that gaps often occur in communication between patients and providers, as well as between specialists. These communication gaps can hinder the multidisciplinary group from working toward common patient-centered goals in a coordinated 'interdisciplinary' manner. We discuss the role of a head-and-neck oncology nurse coordinator at a single institution in bridging gaps across the continuum of care, promoting an interdisciplinary team approach, and enhancing the overall quality of patient-centered head-and-neck cancer care
This thesis discusses the role of a specialized nurse practitioner in the follow up of children with asthma in comparison with traditional care by a general practitioner or a paediatrician. In addition, we evaluated the suitability of an existing questionnaire to assess quality of care and we
Beck, Esther-Ruth; McIlfatrick, Sonja; Hasson, Felicity; Leavey, Gerry
To examine nursing home managers' knowledge, attitudes, beliefs and current practice regarding advance care planning for people with dementia in long-term care settings informed by the theory of planned behaviour. Internationally, advance care planning is advocated for people with dementia. However, evidence suggests that discussions with people with dementia are rare, particularly in long-term care settings. Whilst nursing home managers can be considered central to implementation in this setting, there is a dearth of research that has examined their perspective. This study reports on their role with regard to advance care planning and the perceived factors which influence this. A cross-sectional postal survey was carried out as part of a larger scale sequential explanatory mixed-methods study between January-March 2015. Nursing home managers in a region in the UK (n = 178). A response rate of 66% (n = 116) was achieved. Nursing home managers demonstrated a lack of knowledge of advance care planning, with negative attitudes underpinned by concerns regarding the capacity and lack of perceived benefits to the person with dementia. Currently, they do not view advance care planning as part of their role, with lack of ownership impacting upon current practice behaviours. Whilst nursing home managers recognise the potential benefits of advance care planning, barriers and challenges create a reluctance to facilitate. Targeted training to address the knowledge deficit is required, with the wider components of advance care planning promoted. There is a need for greater role clarification to ensure nurses in long-term care settings identify with the process in the future. A gap between rhetoric and reality of implementation is evident; therefore, long-term care settings must critically examine system, organisational and individual factors for failure to implement advance care planning for people with dementia. Increased cognisance of the context in which advance care
As newly graduated associate degree nurses (ADN) and baccalaureate degree nurses (BSN) enter into the workforce, they must be equipped to care for a complex patient population; therefore, the purpose of this study was to address the practice expectations and clinical competency of new nurses as perceived by nurse preceptors and nurse managers.…
Fowler, Christopher; Kirschner, Michelle; Van Kuiken, Debra; Baas, Linda
To present a theory of illness representation useful in clinical practice along with two case studies as examples of theory implementation. Literature review of relevant theory and associated literature, case studies from clinical practice. An individual asks several questions when experiencing a physical sensation: "Am I sick, stressed, or is this a sign of aging? If I'm sick, is the symptom connected with a disease label?" After asking these questions, the individual develops a cognitive and emotional illness representation that includes the dimensions of identity, cause, consequences, control, and timeline. This representation is guided by personal, cultural, and environmental contexts and determines coping strategies. By assessing the individual's cognitive and emotional representations of the illness, the nurse practitioner (NP) can use the common sense model of illness representation (CSM) to establish interventions and action plans helpful in decreasing distress in the management of symptoms. NPs frequently care for patients who present with very severe symptoms related to their health problem. This becomes a major challenge in effective disease management. Leventhal's CSM can be used as a framework to identify the cognitive and emotional illness representations individuals develop when acute and chronic symptoms are presented. By assessing the individual's cognitive and emotional representations of the illness, the NP will be able to use the CSM to establish interventions and action plans that will be helpful in decreasing the patient's distress in the management of symptoms.
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.
Falls, Emily; Hensel, Desiree
Nursing leaders have proposed that nurses must have the Quality and Safety Education for Nurses (QSEN) competencies to work in complex health care systems. Using the QSEN framework, this study explored what characteristics perinatal nurse managers desired most in new nurses. This study used a survey design and a convenience sample of perinatal nurse managers working in Indiana hospitals (N = 46). Managers were more likely to hire nurses with experience, positive references, and excellent attendance. Of the QSEN competencies, managers looked most for teamwork and collaboration, followed by safety and patient-centered care. In addition to the traditional qualities desired in new nurses, the QSEN competencies are gaining importance among perinatal managers. Copyright 2012, SLACK Incorporated.
Pascalia O. Munyewende
Full Text Available Background: South Africa is on the brink of another wave of major health system reforms that underscore the centrality of primary health care (PHC. Nursing managers will play a critical role in these reforms. Objective: The aim of the study was to explore the work experiences of PHC clinic nursing managers through the use of reflective diaries, a method hitherto under-utilised in health systems research in low- and middle-income countries. Design: During 2012, a sub-set of 22 PHC nursing managers was selected randomly from a larger nurses’ survey in two South African provinces. After informed consent, participants were requested to keep individual diaries for a period of 6 weeks, using a clear set of diary entry guidelines. Reminders consisted of weekly short message service reminders and telephone calls. Diary entries were analysed using thematic content analysis. A diary feedback meeting was held with all the participants to validate the findings. Results: Fifteen diaries were received, representing a 68% response rate. The majority of respondents (14/15 were female, each with between 5 and 15 years of nursing experience. Most participants made their diary entries at home. Diaries proved to be cathartic for individual nursing managers. Although inter-related and not mutually exclusive, the main themes that emerged from the diary analysis were health system deficiencies; human resource challenges; unsupportive management environment; leadership and governance; and the emotional impact of clinic management. Conclusions: Diaries are an innovative method of capturing the work experiences of managers at the PHC level, as they allow for confidentiality and anonymity, often not possible with other qualitative research methods. The expressed concerns of nursing managers must be addressed to ensure the success of South Africa's health sector reforms, particularly at the PHC level.
Lukewich, Julia; Mann, Elizabeth; VanDenKerkhof, Elizabeth; Tranmer, Joan
The aim of this study was to describe chronic pain self-management from the perspective of individuals living with chronic pain in the context of primary care nursing. Self-management is a key chronic pain treatment modality and support for self-managing chronic pain is mainly provided in the context of primary care. Although nurses are optimally suited to facilitate self-management in primary care, there is a need to explore opportunities for optimizing their roles. Two cross-sectional studies. The Chronic Pain Self-Management Survey was conducted in 2011-2012 to explore the epidemiology and self-management of chronic pain in Canadian adults. The questionnaire was distributed to 1504 individuals in Ontario. In 2011, the Primary Care Nursing Roles Survey was distributed to 1911 primary care nurses in Ontario to explore their roles and to determine the extent to which chronic disease management strategies, including support for self-management, were implemented in primary care. Few respondents to the pain survey identified nurses as being the 'most helpful' facilitator of self-management while physicians were most commonly cited. Seventy-six per cent of respondents used medication to manage their chronic pain. Few respondents to the nursing survey worked in practices with specific programmes for individuals with chronic pain. Individuals with chronic pain identified barriers and facilitators to self-managing their pain and nurses identified barriers and facilitators to optimizing their role in primary care. There are several opportunities for primary care practices to facilitate self-management of chronic pain, including the optimization of the primary care nursing role. © 2015 John Wiley & Sons Ltd.
Xu, Jie; Reale, Carrie; Slagle, Jason M; Anders, Shilo; Shotwell, Matthew S; Dresselhaus, Timothy; Weinger, Matthew B
Medication safety presents an ongoing challenge for nurses working in complex, fast-paced, intensive care unit (ICU) environments. Studying ICU nurse's medication management-especially medication-related events (MREs)-provides an approach to analyze and improve medication safety and quality. The goal of this study was to explore the utility of facilitated MRE reporting in identifying system deficiencies and the relationship between MREs and nurses' work in the ICUs. We conducted 124 structured 4-hour observations of nurses in three different ICUs. Each observation included measurement of nurse's moment-to-moment activity and self-reports of workload and negative mood. The observer then obtained MRE reports from the nurse using a structured tool. The MREs were analyzed by three experts. MREs were reported in 35% of observations. The 60 total MREs included four medication errors and seven adverse drug events. Of the 49 remaining MREs, 65% were associated with negative patient impact. Task/process deficiencies were the most common contributory factor for MREs. MRE occurrence was correlated with increased total task volume. MREs also correlated with increased workload, especially during night shifts. Most of these MREs would not be captured by traditional event reporting systems. Facilitated MRE reporting provides a robust information source about potential breakdowns in medication management safety and opportunities for system improvement.
Ninuk Dian Kurniawati
Full Text Available Introduction. Pulmonary tuberculosis remains prominent as one of public health problems in the world. Patients’ non-compliance to treatment is a significant contributor to drug resistance. This study aimed to develop and to test the efficacy of a nursing care model to prevent non-compliance. Method This study consisted of two phases: phase one, model development, used a descriptive analytic, and phase two, model testing, employed a quasi-experimental design. Participants, comprised both patients and nurses at two health care centres in Surabaya, were recruited by consecutive sampling. Data were collected by interview, self-administered-questionnaires, check-list and focused group discussion. Data analyses were performed using both partial least squares and Wilcoxon signed rank test. Results. The model was statistically effective to improve nearly all aspects of patients’ compliance to TB treatment (knowledge, discipline in taking medications regularity of controls, and abilities to monitor the results of treatment with p < 0.05, except for abilities to cope with drug adverse effects (p = 1.000. This is possible because seldom do patients aware of the medication side effects, so their experiences were probably limited. Conclusion. This study concludes that the KM nursing care model was proven effective to improve patients’ adherence to treatment. Future study is suggested to evaluate the impact of the KM nursing care model in bigger population.
Morrison, R S
Theories from nursing and management provide frameworks for enhancing effectiveness of nursing management practice. The concept nursing management diagnosis has been developed by integrating nursing diagnosis and organizational diagnosis as a basis for nurse manager decision-making. Method triangulation was used to identify problems of managing nursing units, to validate those problems for relevancy to practice, to generate nursing management diagnoses, and to validate the diagnoses. Diagnoses were validated according to a definition of nursing management diagnosis provided. Of the 72 nursing management diagnoses identified, 66 were validated at a 70% level of agreement by nurse managers participating in the study.
Borgès Da Silva, Roxane; Brault, Isabelle; Pineault, Raynald; Chouinard, Maud-Christine; Prud'homme, Alexandre; D'Amour, Danielle
Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients' experience of care in primary care as it pertained to the nursing role. The aim was to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients' experience of care is better. Based on a cross-sectional analysis combining organizational and experience of care surveys, we built 2 groups of PHCOs. The first group of PHCOs reported having a nurse who systematically followed patients. The second group had a nurse who performed a variety of activities but did not systematically follow patients. Five indicators of care were constructed based on patient questionnaires. Bivariate and multivariate linear mixed models with random intercepts and with patients nested within were used to analyze the experience of care indicators in both groups. Bivariate analyses revealed a better patient experience of care in PHCOs where a nurse systematically followed patients than in those where a nurse performed other activities. In multivariate analyses that included adjustment variables related to PHCOs and patients, the accessibility indicator was found to be higher. Results indicated that systematic follow-up of patients by nurses improved patients' experience of care in terms of accessibility. Using nurses' scope of practice to its full potential is a promising avenue for enhancing both patients' experience of care and health services efficiency.
To describe palliative care as part of comprehensive oncology nursing care. A review of the palliative care, oncology, and nursing literature over the past 10 years. Palliative care is mandated as part of comprehensive cancer care. A cancer diagnosis often results in distress in the physical, psychosocial, spiritual, and emotional domains of care. Oncology nurses are essential in providing palliative care from diagnosis to death to patients with cancer. They address the myriad aspects of cancer. With palliative care skills and knowledge, oncology nurses can provide quality cancer care. There are many opportunities in which oncology nurses can promote palliative care. Oncology nurses must obtain knowledge and skills in primary palliative care to provide comprehensive cancer care. Copyright © 2015 Elsevier Inc. All rights reserved.
Bobbio, A; Manganelli Rattazzi, A M; Muraro, M
The aim of the study is to supply a contribution to the validity analysis of the Empowering Leadership Questionnaire (ELQ) in the Italian context. The ELQ has been developed in order to measure empowering leadership style in organizational contexts and, in the present work, has been administered to a group of health care workers in order to evaluate the Nurse Manager's leadership style. Three hundred and eleven individuals from an important Local Health Unit of the Veneto Region participated in the study, filling out a self-administered structured questionnaires. Correlations between ELQ, task-oriented, relationship-oriented and transformational leadership stile are addressed. Moreover, the relationships between ELQ, organizational commitment, job burnout, turnover intentions and job satisfaction are analyzed. Exploratory, confirmatory, reliability analyses and path analyses techniques are applied. Results support the main results obtained by the authors of the scale. In addition, with regards to ELQ predictive validity, the selected dependent variables (turnover intentions and job satisfaction) are significantly influenced by some of the ELQ dimensions, via the mediation of affective commitment and job burnout, supporting the value of the ELQ measures in the healthcare context.
Sears, Nancy A
Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.
Grigsby, K A; Megel, M E
Central to nursing practice today is the theme of caring. Yet nursing faculty are themselves experiencing a lack of caring. Faculty frequently voice the complaint that no one in the school of nursing work environment cares about them as they struggle to balance the demands of work with the demands of a personal life. A descriptive phenomenological approach was used to facilitate understanding of the caring experiences of nurses who teach. The question guiding this study was, "How do nurse educators experience caring in their work situations?" Nomination and purposive sampling techniques were used to select seven nurse faculty as participants. Unstructured interviews, lasting approximately one hour, were audiotaped and transcribed. Colaizzi's (1978) methodology was used to analyze the resulting data. Resulting themes included: 1) Caring is Connection and 2) Caring is a Pattern of Establishing and Maintaining Relationships. The use of narrative, journaling, and dialogue are suggested as techniques that will help nurse educators experience caring in schools of nursing.
Tiessen, Ans H.; Vermeulen, Karin M.; Broer, Jan; Smit, Andries J.; van der Meer, Klaas
Background: Cardiovascular disease (CVD) is largely preventable and prevention expenditures are relatively low. The randomised controlled SPRING-trial (SPRING-RCT) shows that cardiovascular risk management by practice nurses in general practice with and without self-monitoring both decreases
Kayser-Jones, Jeanie S.; Kris, Alison E.; Miaskowski, Christine A.; Lyons, William L.; Paul, Steven M.
Purpose: The purpose of this study was to investigate pain management among 42 hospice and 65 non-hospice residents in two proprietary nursing homes. Design and Methods: In this prospective, anthropological, quantitative, and qualitative study, we used participant observation, event analysis, and chart review to obtain data. The Medication…
Weiskopf, Constance S
The aim of this paper is to report the findings of a study of the experience of caring for prisoners through examining the everyday experience of nurses' delivering health care to inmate patients in a correctional setting. Prisons are most often viewed as places for punishment, while the goals of health and healing, and prevention of diseases in correctional facilities are often neglected. Nurses who deliver health care to prisoners are challenged to do so in a caring relationship that will facilitate their health and healing. The literature on the nature of prison nursing indicates that delivering health care to inmates must be carefully balanced against the need for security, and is affected by factors such as custody staff values, staff education, nursing management, and organizational practices. In-depth interviews were carried out with nine Registered Nurses who had been employed in a variety of correctional institutions throughout their careers, and analysed thematically using Colaizzi's phenomenological method. Findings. Nurses' caring was experienced as an attempt to negotiate the boundaries between the cultures of custody and caring. Facing complex challenges and a number of limitations on the nurse-patient relationship, nurses strived to find a way to care for their inmate patients. Environmental risk meant that caution and vigilance were essential and these nurses demonstrated courage and persevered for the sake of their inmate patients. The findings make clear the challenging and frustrating experience of nurses' caring for inmate patients in restrictive settings. As a result, there are implications for nursing practice, education, and research to assure the best possible health outcomes for inmate patients, the integrity of caring nursing practice, and the safety of both nurses and patients.
Background Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces. Methods During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis. Results A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD = 7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD = 24.3) and 143.41 (SD = 25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR = 3.10 (95% CI: 1.11 to 8.62, P = 0.030)), being tired at work (RRR = 0.19 (95% CI: 0.08 to 0.50, P = 0.001)) and experience of verbal abuse (RRR = 0.18 (95% CI: 0.06 to 0.55, P = 0.001). Conclusion Allowing nurses greater choice of clinic
Munyewende, Pascalia Ozida; Rispel, Laetitia Charmaine; Chirwa, Tobias
Nurses constitute the majority of the health workforce in South Africa and they play a major role in providing primary health care (PHC) services. Job satisfaction influences nurse retention and successful implementation of health system reforms. This study was conducted in light of renewed government commitment to reforms at the PHC level, and to contribute to the development of solutions to the challenges faced by the South African nursing workforce. The objective of the study was to determine overall job satisfaction of PHC clinic nursing managers and the predictors of their job satisfaction in two South African provinces. During 2012, a cross-sectional study was conducted in two South African provinces. Stratified random sampling was used to survey a total of 111 nursing managers working in PHC clinics. These managers completed a pre-tested Measure of Job Satisfaction questionnaire with subscales on personal satisfaction, workload, professional support, training, pay, career prospects and standards of care. Mean scores were used to measure overall job satisfaction and various subscales. Predictors of job satisfaction were determined through multiple logistic regression analysis. A total of 108 nursing managers completed the survey representing a 97% response rate. The mean age of respondents was 49 years (SD = 7.9) and the majority of them (92%) were female. Seventy-six percent had a PHC clinical training qualification. Overall mean job satisfaction scores were 142.80 (SD = 24.3) and 143.41 (SD = 25.6) for Gauteng and Free State provinces respectively out of a maximum possible score of 215. Predictors of job satisfaction were: working in a clinic of choice (RRR = 3.10 (95% CI: 1.11 to 8.62, P = 0.030)), being tired at work (RRR = 0.19 (95% CI: 0.08 to 0.50, P = 0.001)) and experience of verbal abuse (RRR = 0.18 (95% CI: 0.06 to 0.55, P = 0.001). Allowing nurses greater choice of clinic to work in, the prevention of violence
Veterans Health Administration Office of Nursing Services exploration of positive patient care synergies fueled by consumer demand: care coordination, advanced clinic access, and patient self-management.
Wertenberger, Sydney; Yerardi, Ruth; Drake, Audrey C; Parlier, Renee
The consumers who utilize the Veterans Health Administration healthcare system are older, and most are learning to live with chronic diseases. Their desires and needs have driven changes within the Veterans Health Administration. Through patient satisfaction initiatives and other feedback sources, consumers have made it clear that they do not want to wait for their care, they want a say in what care is provided to them, and they want to remain as independent as possible. Two interdisciplinary processes/models of healthcare are being implemented on the national level to address these issues: advanced clinic access and care coordination. These programs have a synergistic relationship and are integrated with patient self-management initiatives. Positive outcomes of these programs also meet the needs of our staff. As these new processes and programs are implemented nationwide, skills of both patients and nursing staff who provide their care need to be enhanced to meet the challenges of providing nursing care now and into the 21st century. Veterans Health Administration Office of Nursing Services Strategic Planning Work Group is defining and implementing processes/programs to ensure nurses have the knowledge, information, and skills to meet these patient care demands at all levels within the organization.
Lee, Jai-Yon; Song, Young Ae; Jung, Ji Young; Kim, Hyun Jeong; Kim, Bo Ram; Do, Hyun-Kyung; Lim, Jae-Young
To determine the need for care robots among nurses and to suggest how robotic care should be prioritized in an integrated nursing care services. Korea is expected to be a super-aged society by 2030. To solve care issues with elderly inpatient caused by informal caregivers, the government introduced 'integrated nursing care services'; these are comprehensive care systems staffed by professionally trained nurses. To assist them, a care robot development project has been launched. The study applied a cross-sectional survey. In 2016, we conducted a multi-center survey involving 302 registered nurses in five hospitals including three tertiary and two secondary hospitals in Korea. The questionnaire consisted of general characteristics of nurses and their views on and extents of agreement about issues associated with robotic care. Trial center nurses and those with ≥10 years of experience reported positively on the prospects for robotic care. The top three desired primary roles for care robots were 'measuring/monitoring', 'mobility/activity' and 'safety care'. 'Reduction in workload', especially in terms of 'other nursing services' which were categorized as non-value-added nursing activities, was the most valued feature. The nurses approved of the aid by care robots but were concerned about device malfunction and interruption of rapport with patients. Care robots are expected to be effective in integrated nursing care services, particularly in 'measuring/monitoring'. Such robots should decrease nurses' workload and minimize non-value-added nursing activities efficiently. No matter how excellent care robots are, they must co-operate with and be controlled by nurses. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
Thorpe, Karran; Loo, Robert
The objectives of this research were to explore and describe emerging new roles of First-Line Nurse Managers (F-LNMs i.e. individuals who oversee the daily operations of nursing units, regardless of their titles) in one Canadian province, identify their requisite knowledge, skills, competencies, and determine the training and development needs of these managers. F-LNMs, recognized as key players in health care systems, face major challenges (e.g. continuing organizational change, lack of resources) daily. These challenges affect their ability to achieve quality work experiences for their staff members and quality of nursing care for their patients and for themselves. The research design entails a triangulation of investigators (nursing and management), methods (interviews and a Delphi Study), samples (interviews with 26 F-LNMs and a Delphi Study with 62 panelists), and data (qualitative and quantitative). Institutions were randomly selected and then F-LNMs were randomly selected to participate in personal interviews and the remaining F-LNMs, along with nominated senior administrators, were invited to participate in the Delphi Study. Key findings relate to role changes (e.g. job enlargement and emphasis on efficiency), challenges (e.g. staffing and retention, frustrations), and recommendations for administrators (e.g. provide resources, training and development) and educators (e.g. link education to organizational needs). Ultimately, organizational changes and challenges affect how F-LNMs perceive their future professional (e.g. providing quality of patient care) and personal (e.g. high quality of life) satisfaction levels. This research suggests that the role of F-LNMs continues to evolve, consistent with the changing health care system. F-LNMs face challenges that compromise performance of their functions as they believe their work should be completed. To enhance satisfaction in their roles, F-LNMs express a desire for balance in their professional and personal
Simons, Sherri Lee
The staff nurses' immediate manager directly influences an NICU's ability to attract and retain professional nurses. This makes it especially important that nurse executives and administrators identify opportunities to better meet the needs of their nurse managers and measure the impacts of their decisions. Data about front-line manager turnover need to be measured, reported, and examined. No longer can organizations afford to view managers as another expense; they are an asset on the balance sheet. Strategic planning for the recruitment and retention of nurse managers will be vital both to an organization's healthy bottom line and to the quality of its patient care.
Zhang, Aihua; Tao, Hong; Ellenbecker, Carol Hall; Liu, Xiaohong
To explore the level of nurses' job satisfaction and compare the differences between critical care nurses and general ward nurses in Mainland China. Hospitals continue to experience high nurse turnover. Job satisfaction is a key factor to retain skilled nurses. The differences in job satisfaction among critical care nurses and general ward nurses are unknown. A cross-sectional design was selected for this descriptive correlation study. Cross-sectional study of critical care nurses (n = 446) and general ward nurses (n = 1118) in 9 general hospitals by means of questionnaires that included the Chinese Nurses Job Satisfaction Scale and demographic scale. The data were collected from June 2010-November 2010. Chinese nurses had moderate levels of job satisfaction, were satisfied with co-workers and family/work balance; and dissatisfied with pay and professional promotion. Critical care nurses were younger; less educated and had less job tenure when compared with nurses working on general wards. Critical care nurses were significantly less satisfied than general ward nurses with many aspects of their job. Levels of nurses' job satisfaction can be improved. The lower job satisfaction of critical care nurses compared with general ward nurses should warn the healthcare administrators and managers of potentially increasing the critical care nurses turn over. Innovative and adaptable managerial interventions need to be taken to improve critical care nurse' job satisfaction and retain skilled nurse. © 2012 Blackwell Publishing Ltd.
Yoder, Linda; Walden, Marlene; Verklan, M Terese
This article presents the struggle between social justice and market justice within the current health care system, specifically issues affecting neonatal care. Community benefit is described and discussed as an aspect of social justice demonstrated by hospitals. The federal and state Children's Health Insurance Program also is discussed in relation to social justice and health care costs. Implications for managers and executives overseeing neonatal care are presented in relation to the economic and social issues.
Igarashi, Ayumi; Kurinobu, Takeshi; Ko, Ayako; Okamoto, Yuko; Matsuura, Shino; Feng, Mei; Yamamoto-Mitani, Noriko
To promote home death, it is necessary to clarify the institutional barriers to conducting end-of-life (EOL) care and consider strategies to deal with this process. This study aims to clarify institution-related factors associated with the provision of home-based EOL care cases, and to compare them among three different types of home-care agencies. We administered a cross-sectional survey throughout Japan to investigate the number and characteristics of EOL cases of home-care nursing (HN), home-help (HH) and care management (CM) agencies. Bivariate and multivariate analyses were performed for each type of agency to examine factors related to the provision of EOL care. 378 HN agencies, 274 HH agencies, and 452 CM agencies responded to the distributed questionnaire. HN agencies had on average 2.1 (SD = 4.0; range 0-60) home-based EOL cases in the last 3 months, while HH agencies had 0.9 (SD = 1.3; range 0-7) and CM agencies had 1.5 (SD = 2.2; range 0-18) in the last 6 months. In a multivariable analysis of HN agencies, a large number of staff (OR: 1.52; p EOL care; in HH agencies, accepting EOL clients in the agency (OR: 3.29; p EOL care; in CM agencies, the number of staff (OR: 1.21; p = 0.037), the number of collaborating HH agencies (OR: 1.07; p = 0.032), and whether home-care nurses and home helpers visit clients together (OR: 1.89; p = 0.007) were positively associated with the provision of EOL care. The agency's size and the inter-agency collaborative system seemed most important among HN agencies and CM agencies, while institutional preparedness for EOL was most important for HH agencies. These findings represent important new information for targeting different effective strategies in the promotion of home-based EOL care, depending on the agency type.
Scheffler, R M; Waitzman, N J; Hillman, J M
Managed care is spreading rapidly in the United States and creating incentives for physician practices to find the most efficient combination of health professionals to deliver care to an enrolled population. Given these trends, it is appropriate to reexamine the roles of physician assistants (PAs) and nurse practitioners (NPs) in the health care workforce. This paper briefly reviews the literature on PA and NP productivity, managed care plans' use of PAs and NPs, and the potential impact of PAs and NPs on the size and composition of the future physician workforce. In general, the literature supports the idea that PAs and NPs could have a major impact on the future health care workforce. Studies show significant opportunities for increased physician substitution and even conservative assumptions about physician task delegation imply a large increase in the number of PAs and NPs that can be effectively deployed. However, the current literature has certain limitations that make it difficult to quantify the future impact of PAs and NPs. Among these limitations is the fact that virtually all formal productivity studies were conducted in fee-for-service settings during the 1970s, rather than managed care settings. In addition, the vast majority of PA and NP productivity studies have viewed PAs and NPs as physician substitutes rather than as members of interdisciplinary health care teams, which may become the dominant health care delivery model over the next 10-20 years.
Rooddehghan, Zahra; Yekta, Zohreh Parsa; Nasrabadi, Alireza N
Rationing of various needed services, for example, nursing care, is inevitable due to unlimited needs and limited resources. Rationing of nursing care is considered an ethical issue since it requires judgment about potential conflicts between personal and professional values. The present research sought to explore aspects of rationing nursing care in Iran. This study applied qualitative content analysis, a method to explore people's perceptions of everyday life phenomena and interpret the subjective content of text data. Data collection was performed through in-depth, unstructured, face-to-face interviews with open-ended questions. The study population included Iranian nurses of all nursing positions, from clinical nurses to nurse managers. Purposive sampling was employed to select 15 female and 3 male nurses (11 clinical nurses, 3 supervisors, 1 matron, 1 nurse, and 2 members of the Nursing Council) working in hospitals of three cities in Iran. The study protocol was approved by Tehran University of Medical Sciences (91D1302870). Written informed consent was also obtained from all participants. According to the participants, rationing of nursing care consisted of two categories, that is, causes of rationing and consequences of rationing. The first category comprised three subcategories, namely, patient needs and demands, routinism, and VIP patients. The three subcategories forming the second category were missed nursing care, patient dissatisfaction, and nurses' feeling of guilt. Levels at which healthcare practices are rationed and clarity of the rationing are important structural considerations in the development of an equal, appropriate, and ethical healthcare system. Moreover, the procedure of rationing is critical as it not only influences people's lives but also reflects the values that dominate in the society. Therefore, in order to minimize the negative consequences of rationing of nursing care, further studies on the ethical dimensions of this phenomenon
Pacheco-Pérez, Luis Arturo; Guevara Valtier, Milton Carlos
Colorectal cancer is one of the leading causes of death from cancer worldwide. Main interventions to reduce the impact are aimed to enhance prevention and early detection. Results of several studies show that tests such as the fecal occult blood test and colonoscopy are effective for early diagnosis. There are hereditary syndromes such as Lynch Syndrome that can lead to certain types of cancers, including bowel neoplasms, therefore early detection needs to be included as part of the treatment. In these cases, family genetic testing is recommended if the bowel cancer is diagnosed before 50 years old. A care plan including the NANDA (North American Nursing Diagnosis Association), NOC (Nursing Outcomes Classification) and NIC (Nursing Interventions Classification) was developed for a patient with suspected Lynch Syndrome. Nurses should be qualified to identify potential cases of cancer associated with this syndrome, and thus, reduce the likelihood that family members develop the disease, through genetic counseling and education of environmental risk factors. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
Gosselin, Emilie; Bourgault, Patricia; Lavoie, Stephan; Coleman, Robin-Marie; Méziat-Burdin, Anne
Pain management in the intensive care unit is often inadequate. There is no tool available to assess nursing pain management practices. The aim of this study was to develop and validate a measuring tool to assess nursing pain management in the intensive care unit during standardized clinical simulation. A literature review was performed to identify relevant components demonstrating optimal pain management in adult intensive care units and to integrate them in an observation tool. This tool was submitted to an expert panel and pretested. It was then used to assess pain management practice during 26 discrete standardized clinical simulation sessions with intensive care nurses. The Nursing Observation Tool for Pain Management (NOTPaM) contains 28 statements grouped into 8 categories, which are grouped into 4 dimensions: subjective assessment, objective assessment, interventions, and reassessment. The tool's internal consistency was calculated at a Cronbach's alpha of 0.436 for the whole tool; the alpha varies from 0.328 to 0.518 for each dimension. To evaluate the inter-rater reliability, intra-class correlation coefficient was used, which was calculated at 0.751 (p nurses' pain management in a standardized clinical simulation. The NOTPaM is the first tool created for this purpose. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Ko, Nai-Ying; Hsieh, Chia-Yin; Chen, Yen-Chin; Tsai, Chen-Hsi; Liu, Hsiao-Ying; Liu, Li-Fang
Since 2005, the Taiwan Centers for Disease Control (Taiwan CDC) initiated an HIV case management program in AIDS-designated hospitals to provide integrative services and risk-reduction counseling for HIV-infected individuals. In light of the increasingly complex and highly specialized nature of clinical care, expanding and improving competency-based professional education is important to enhance the quality of HIV/AIDS care. The aim of this study was to develop the essential competency framework for HIV care for HIV case managers in Taiwan. We reviewed essential competencies of HIV care from Canada, the United Kingdom, and several African countries and devised descriptions of the roles of case managers and of the associated core competencies for HIV care in Taiwan. The modified Delphi technique was used to evaluate the draft framework of these roles and core competencies. A total of 15 HIV care experts were invited to join the expert panel to review and rank the draft framework. The final framework consisted of 7 roles and 27 competencies for HIV case managers. In Round 1, only 3 items did not receive consensus approval from the experts. After modification based on opinions of the experts, 7 roles and 27 competencies received 97.06% consensus approval in Round 2 and were organized into the final framework for HIV case managers. These roles and associated core competencies were: HIV Care Expert (9 competencies), Communicator (1 competency), Collaborator (4 competencies), Navigator (2 competencies), Manager (4 competencies), Advocate (2 competencies), and Professional (5 competencies). The authors developed an essential competency framework for HIV care using the consensus of a multidisciplinary expert panel. Curriculum developers and advanced nurses and practitioners may use this framework to support developments and to ensure a high quality of HIV care.
Ryu, Jeong-Im; Kim, Kisook
To investigate differences in work satisfaction and quality of nursing services between nurses from the nursing care integration service and general nursing units in Korea. The nursing care integration service was recently introduced in Korea to improve patient health outcomes through the provision of high quality nursing services and to relieve the caregiving burden of patients' families. In this cross-sectional study, data were collected from a convenience sample of 116 and 156 nurses working in nursing care integration service and general units, respectively. The data were analysed using descriptive statistics, t tests and one-way analysis of variance. Regarding work satisfaction, nursing care integration service nurses scored higher than general unit nurses on professional status, autonomy and task requirements, but the overall scores showed no significant differences. Scores on overall quality of nursing services, responsiveness and assurance were higher for nursing care integration service nurses than for general unit nurses. Nursing care integration service nurses scored higher than general unit nurses on some aspects of work satisfaction and quality of nursing services. Further studies with larger sample sizes will contribute to improving the quality of nursing care integration service units. These findings can help to establish strategies for the implementation and efficient operation of the nursing care integration service system, for the improvement of the quality of nursing services, and for successfully implementing and expanding nursing care integration service services in other countries. © 2018 John Wiley & Sons Ltd.
Nursing literature supports the importance of an engaged nursing workforce as a means to positively influence performance. Nurse manager leadership style plays a critical role in engaging staff nurses. These relationships have been minimally studied in nurse managers and staff nurses. The aim of this study is to evaluate the influence of nurse manager leadership style factors on staff nurse work engagement. Using a descriptive correlational research design, 441 staff nurses working in 3 acute care hospitals were surveyed. Survey instruments included the Utrecht Work Engagement Scale and the Multifactorial Leadership Questionnaire 5X short form. Transactional and transformational leadership styles in nurse managers positively influenced staff nurse work engagement. Passive-avoidant leadership style in nurse managers negatively influenced staff nurse work engagement. Nurse managers who provide support and communication through transformational and transactional leadership styles can have a positive impact on staff nurse work engagement and ultimately improve organizational outcomes.
Al-Hamdan, Zaid; Nussera, Hayat; Masa'deh, Rami
To explore the relationship between conflict management styles used by nurse managers and intent to stay of staff nurses. Nursing shortages require managers to focus on the retention of staff nurses. Understanding the relationship between conflict management styles of nurse managers and intent to stay of staff nurses is one strategy to retain nurses in the workforce. A cross-sectional descriptive quantitative study was carried out in Jordan. The Rahim organization conflict inventory II (ROCI II) was completed by 42 nurse managers and the intent to stay scale was completed by 320 staff nurses from four hospitals in Jordan. The anova analysis was carried out. An integrative style was the first choice for nurse managers and the last choice was a dominating style. The overall level of intent to stay for nurses was moderate. Nurses tend to keep their current job for 2-3 years. There was a negative relationship between the dominating style as a conflict management style and the intent to stay for nurses. The findings of the present study support the claim that leadership practices affect the staff nurses' intent to stay and the quality of care. Nurse managers can improve the intent to stay for staff nurses if they use the appropriate conflict management styles. © 2015 John Wiley & Sons Ltd.
Patients frequently experience moderate to severe pain inthe postoperative period. Although the pain managementis an integral and important part of the nursing care, studiessuggest that, nursing management of postoperativepain remains inadequate.Postoperative care nurses are responsible to assess thepatient’s pain, teach the patient strategies to deal with thepain, apply the analgesic treatment plan, monitor the resultsof treatment, educate the patient and the family onpain management and doc...
Miller, Anne; Buerhaus, Peter I
Recent findings that variations in nursing workload may affect inpatient outcomes now highlight nurse workload management and the need for an updated analysis of the role of the charge nurse (CN). Observational data for eight CNs, each at one of eight ICUs in a not-for-profit Level 1 Trauma Center, coded to capture interprofessional interactions, decision making, team coordination phases, and support tools. A researcher shadowed each participant for 12 hours. Each shift began and ended with a face-to-face handoff that included summaries of each patient's condition; the current bed census; anticipated admissions, discharges, and transfers; and the number of nurses available to work the current and coming two shifts. The researcher, using a notebook, recorded the substantive content of all work conversations initiated by or directed to the CN from physicians, staff nurses, allied health workers, other employees, and patients/families. The tools used to support conversations were collected as blank forms or computer screen prints and annotated to describe how they were used, when, and for what purpose. Statistically significant three-way interactions suggest that CNs' conversations with colleagues depend on the team coordination phase and the decision-making level, and that the support tools that CNs use when talking to colleagues depend on the decision-making level and the team coordination phase. The role of ICU CNs appears to be continuing to evolve, now encompassing unit resource management in addition to supervising care delivery. Effective support tools, together with education that would enhance communication and resource management skills, will be essential to CNs' ability to support unit resilience and adaptability in an increasingly complex environment.
Majumdar, S R; Johnson, J A; Bellerose, D; McAlister, F A; Russell, A S; Hanley, D A; Garg, S; Lier, D A; Maksymowych, W P; Morrish, D W; Rowe, B H
Few outpatients with fractures are treated for osteoporosis in the years following fracture. In a randomized pilot study, we found a nurse case-manager could double rates of osteoporosis testing and treatment compared with a proven efficacious quality improvement strategy directed at patients and physicians (57% vs 28% rates of appropriate care). Few patients with fractures are treated for osteoporosis. An intervention directed at wrist fracture patients (education) and physicians (guidelines, reminders) tripled osteoporosis treatment rates compared to controls (22% vs 7% within 6 months of fracture). More effective strategies are needed. We undertook a pilot study that compared a nurse case-manager to the multifaceted intervention using a randomized trial design. The case-manager counseled patients, arranged bone mineral density (BMD) tests, and prescribed treatments. We included controls from our first trial who remained untreated for osteoporosis 1-year post-fracture. Primary outcome was bisphosphonate treatment and secondary outcomes were BMD testing, appropriate care (BMD test-treatment if bone mass low), and costs. Forty six patients untreated 1-year after wrist fracture were randomized to case-manager (n = 21) or multifaceted intervention (n = 25). Median age was 60 years and 68% were female. Six months post-randomization, 9 (43%) case-managed patients were treated with bisphosphonates compared with 3 (12%) multifaceted intervention patients (relative risk [RR] 3.6, 95% confidence intervals [CI] 1.1-11.5, p = 0.019). Case-managed patients were more likely than multifaceted intervention patients to undergo BMD tests (81% vs 52%, RR 1.6, 95%CI 1.1-2.4, p = 0.042) and receive appropriate care (57% vs 28%, RR 2.0, 95%CI 1.0-4.2, p = 0.048). Case-management cost was $44 (CDN) per patient vs $12 for the multifaceted intervention. A nurse case-manager substantially increased rates of appropriate testing and treatment for osteoporosis in
Marco Antonio Zapata Sampedro; Laura Castro Varela
The standardized nursing care plan can be used as a means through which the nurse will assess and identify the particular needs of the blood donor.To draw up the care plan, we have conducted the evaluation on the basis of the Marjory Gordon’s functional health patterns.The more prevailing diagnosis according to the NANDA taxonomy have been identified, results have been established according to the NOC (Nursing Outcomes Classification) taxonomy, and nursing interventions have been suggested ac...
Lecordier, Didier; Jovic, Ljiljana
As a continuation of its work and of the seminar on nursing sciences education in 2014, the “Association de recherche en soins infirmiers” (Arsi) organized a seminar on the 3rd and-4th of June 2016 in Nantes entitled : “nursing : perspectives and foresights”. More than fifty participants from the francophone area representing various sectors of practice : clinical, teaching, management and students gathered to debate and produce benchmarks to support the development of nursing sciences in France and to draw future directions for clinical practice and training. The successive sessions made it possible to reflect, to confront opinions, to make proposals and to identify the terms of the problematic of care and nursing knowledge today and the methodological elements relating to foresight. At the end of this very creative seminar, new avenues of reflection emerged shifting our usual look at the nurse profession. Orientations for training and practice have been defined with different stakes depending on the level of training and professional commitment. The strong links between professional, scientific and academic discipline have also been clarified, highlighting the importance to hold a high theoretical and scientific requirement, rigorous clinical practice, strong professional commitment and effective leadership.
Successful competition for acquisition of capitated groups and maintenance of existing managed care contracts require demonstrations of cost controls, positive clinical outcomes, and customer satisfaction. In preparation for, and in response to managed care, healthcare providers must assure equality in their supply and demand equation if they are to survive and prosper. Iatrogenic pressure ulcers represent a major healthcare problem illustrative of this point. Successful pressure ulcer prevention and treatment programs in all practice settings demand: 1) administrative support, 2) access to staffing and supplies, 3) multidisciplinary ownership, 4) integration of science-based knowledge of risk factors, risk assessment tools, pathophysiology, and appropriate management into clinical practice, and 5) dissemination of knowledge.
Hobson, Alexandra; Curtis, Alexa
Improving healthcare delivery for U.S. veterans is a national priority. The Veterans Health Administration (VHA) employs a variety of team-based, population health strategies to address critical issues in veterans' health including the effective management of chronic disease. Nurse practitioners (NPs) are integral members of the VHA patient care team with a substantial role to play in the organization and delivery of healthcare services for veterans. This report explores the contributions of NPs in team-based, population health strategies within the VHA. This review of the literature examines peer-reviewed articles published between 2006 and 2017 to explore the contributions of NPs in team-based, population health strategies within the VHA. Search words include veterans, VHA, NPs, population health, panel management, and chronic disease. NPs are vital members of the VHA primary care team; however, there is a dearth of available evidence reflecting the unique contribution of NPs within VHA team-based, population health management strategies. The VHA adoption of full practice authority for NP practice provides NPs with an expanded capacity to lead improvements in veterans' health. Future research is needed to fully understand the unique role of the NP in the delivery of population health management strategies for veterans. ©2017 American Association of Nurse Practitioners.
Perri, Giulia-Anna; Yeung, Herman; Green, Yoel; Bezant, Abby; Lee, Carman; Berall, Anna; Karuza, Jurgis; Khosravani, Houman
Palliative care is often initiated late for patients with end stage liver disease (ESLD) with pain being a common morbidity that is under-treated throughout the disease trajectory. When admitted to a palliative care unit (PCU), nurses play a pivotal role and must be highly informed to ensure effective pain management. The aim of this study is to determine the baseline level of knowledge and attitudes of PCU nurses regarding pain management in patients with ESLD. A descriptive, cross-sectional self-administered survey design was used for this study. The sample comprised 35 PCU nurses working at a continuing chronic care facility in Toronto, Ontario, Canada. Data on the knowledge and attitudes of the nurses regarding pain management in patients with ESLD, was obtained using a modified version of the "Nurses Knowledge and Attitudes Survey Regarding Pain" (NKASRP) tool. Thirty-one PCU nurses were included for the analysis, giving a response rate of 89%. The mean total percentage score for the nurses on the modified version of the NKASRP was 72%. Only 26% of the nurse participants obtained a passing score of 80% or greater. There were no significant differences in mean total scores by age, gender, years of nursing experience or education level. The findings of this study provide important information about the inadequate knowledge and attitude in nurses regarding pain management for patients with ESLD. It is suggested that targeted educational programs and quality improvement initiatives in pain management for patients with ESLD could improve knowledge and attitudes for PCU nurses.
A.A. Tjale; J. Bruce
Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative a...
Chaves, Lucieli Dias Pedreschi; Mininel, Vivian Aline; Silva, Jaqueline Alcântara Marcelino da; Alves, Larissa Roberta; Silva, Maria Ferreira da; Camelo, Silvia Helena Henriques
To reflect on nursing supervision as a management tool for care comprehensiveness by nurses, considering its potential and limits in the current scenario. A reflective study based on discourse about nursing supervision, presenting theoretical and practical concepts and approaches. Limits on the exercise of supervision are related to the organization of healthcare services based on the functional and clinical model of care, in addition to possible gaps in the nurse training process and work overload. Regarding the potential, researchers emphasize that supervision is a tool for coordinating care and management actions, which may favor care comprehensiveness, and stimulate positive attitudes toward cooperation and contribution within teams, co-responsibility, and educational development at work. Nursing supervision may help enhance care comprehensiveness by implying continuous reflection on including the dynamics of the healthcare work process and user needs in care networks. refletir a supervisão de enfermagem como instrumento gerencial do enfermeiro para integralidade do cuidado, considerando suas potencialidades e limitações no cenário atual. estudo reflexivo baseado na formulação discursiva sobre a supervisão de enfermagem, apresentando conceitos e enfoques teóricos e/ou práticos. limitações no exercício da supervisão estão relacionadas à organização dos serviços de saúde embasada no modelo funcional e clínico de atenção, assim como possíveis lacunas no processo de formação do enfermeiro e sobrecarga de trabalho. Quanto às potencialidades, destaca-se a supervisão como instrumento de articulação de ações assistenciais e gerenciais, que pode favorecer integralidade da atenção, estimular atitudes de cooperação e colaboração em equipe, além da corresponsabilização e promoção da educação no trabalho. supervisão de enfermagem pode contribuir para fortalecimento da integralidade do cuidado, pressupondo reflexão cont
Sandifer, Q D
The terms 'managed care' and 'disease management' are gaining common usage in the health service but their meaning is not widely understood. Managed care is a generic term describing any health care system that integrates the financing and delivery of medical care. Its growth in the United States has been driven by pressure to control costs, and there is circumstantial evidence that costs are slowing as a result of better management of resources. However, it is not clear how much of this is due to managed care, the selection of more favourable enrollees to health plans or other factors. Research evidence is limited, and that available is constrained by the rapidly changing nature of managed care. In the United States a bewildering variety of managed care arrangements have emerged, although several common characteristics can be identified: limited choice of physician providers; controlled access to secondary care; selective contracting; financial incentives; quality management; and utilization management. All are present in the National Health Service (NHS), which exemplifies a nationalized managed care system. Disease management is an extension of managed care that takes a global approach to patient care by attempting to co-ordinate resources across the entire health care delivery system throughout the life cycle of the disease. This is poorly developed in the NHS, so that the attention of commercial organizations has been attracted. However, concern has been expressed about the implications of commercial involvement: the fragmentation of general medical services; effect of for-profit status; and use of patient-based data. Recent policy developments could allow disease management to develop within the NHS.
Swan, Beth Ann; Haas, Sheila A; Chow, Marilyn
On March 1-2, 2010, a state-of-the-science invitational conference titled "Ambulatory Care Registered Nurse Performance Measurement" was held to focus on measuring quality at the RN provider level in ambulatory care. The conference was devoted to ambulatory care RN performance measurement and quality of health care. The specific emphasis was on formulating a research agenda and developing a strategy to study the testable components of the RN role related to care coordination and care transitions, improving patient outcomes, decreasing health care costs, and promoting sustainable system change. The objectives were achieved through presentations and discussion among expert inter-professional participants from nursing, public health, managed care, research, practice, and policy. Conference speakers identified priority areas for a unified practice, policy, and research agenda. Crucial elements of the strategic dialogue focused on issues and implications for nursing and inter-professional practice, quality, and pay-for-performance.
With the increasing emphasis on efficiency and effectiveness in health care, how a nurse manages her time is an important consideration. Whilst time management is recognized as an important component of work performance and professional nursing practice, the reality of this process in nursing practice has been subject to scant empirical investigation. To explore how nurses organize and manage their time. A qualitative study was carried out, incorporating narratives (22 nurses), focus groups (24 nurses) and semi-structured interviews (22 nurses). In my role as practitioner researcher I undertook observation and had informal conversations, which provided further data. Study sites were five health care organizations in the United Kingdom during 1995-1999. Time management is complex, with nurses using a range of time management strategies and a repertoire of actions. Two of these strategies, namely routinization and prioritizing, are discussed, including their implications for understanding time management by nurses in clinical practice. Ignoring the influence of 'others', the team and the organization perpetuates a rather individualistic and self-critical perspective of time management. This may lead to a failure to address problems in the organizing of work, and the co-ordinating of care involving other health care workers.
Jennings, Fiona L; Mitchell, Marion
Trauma patient management is complex and challenging for nurses in the Intensive Care Unit. One strategy to promote quality and evidence based care may be through utilising specialty nursing experts both internal and external to the Intensive Care Unit in the form of a nursing round. Inter Specialty Trauma Nursing Rounds have the potential to improve patient care, collaboration and nurses' knowledge. The purpose of this quality improvement project was to improve trauma patient care and evaluate the nurses perception of improvement. The project included structured, weekly rounds that were conducted at the bedside. Nursing experts and others collaborated to assess and make changes to trauma patients' care. The rounds were evaluated to assess the nurse's perception of improvement. There were 132 trauma patients assessed. A total of 452 changes to patient care occurred. On average, three changes per patient resulted. Changes included nursing management, medical management and wound care. Nursing staff reported an overall improvement of trauma patient care, trauma knowledge, and collaboration with colleagues. Inter Specialty Trauma Nursing Rounds utilizes expert nursing knowledge. They are suggested as an innovative way to address the clinical challenges of caring for trauma patients and are perceived to enhance patient care and nursing knowledge. Copyright © 2017 Elsevier Ltd. All rights reserved.
Xu, Yu; Davidhizar, Ruth
Foreign nurses and American nurses who are culturally diverse make up an increasing number of the US nursing workforce. Of foreign nurses, Asians constitute the largest number. Conflict is an inevitable aspect of human relations in health care settings. Nurses and other health team members with diverse cultural background bring to the workplace different conflict behaviors that directly impact the outcomes of conflicts. It is essential for health care team members and managers to be cognizant of different conflict behaviors as well as different conflict management styles so that strategies can be designed to build a culturally diverse health care team that is able to effectively achieve group and organizational objectives.
Courtenay, Molly; Carey, Nicola
To identify, summarise and critically appraise the current evidence regarding the impact and effectiveness of nurse-led care in acute and chronic pain. A diverse range of models of care exist within the services available for the management of acute and chronic pain. Primary studies have been conducted evaluating these models, but, review and synthesis of the findings from these studies has not been undertaken. Literature review. Searches of Pubmed (NLM) Medline, CINAHL, Web of Knowledge (Science Index, Social Science index), British Nursing Index from January 1996-March 2007 were conducted. The searches were supplemented by an extensive hand search of the literature through references identified from retrieved articles and by contact with experts in the field. Twenty-one relevant publications were identified and included findings from both primary and secondary care. The areas, in which nurses, caring for patients in pain are involved, include assessment, monitoring, evaluation of pain, interdisciplinary collaboration and medicines management. Education programmes delivered by specialist nurses can improve the assessment and documentation of acute and chronic pain. Educational interventions and the use of protocols by specialist nurses can improve patients understanding of their condition and improve pain control. Acute pain teams, led by nurses, can reduce pain intensity and are cost effective. Nurses play key roles in the diverse range of models of care that exist in acute and chronic pain. However, there are methodological weaknesses across this body of research evidence and under researched issues that point to a need for further rigorous evaluation. Nurse-led care is an integral element of the pain services offered to patients. This review highlights the effect of this care and the issues that require consideration by those responsible for the development of nurse-led models in acute and chronic pain.
This survey describes caring in the workplace in selected health services and is part of a greater study conducted in KwaZulu-Natal, South Africa. This study describes the views of nurse managers and nurses regarding caring in the workplace. Human competence, recovery and healing are central to caring. To ensure caring and healing of patients in health services it is of the utmost importance for nurse managers to ensure a healthy and caring environment in the management of nurses. When caring is present in the workplace, nurses are more able to render caring nursing practices in the patient care environment. It is clear that to become a caring person, one must be treated in a caring way and that caring may be impaired or reinforced by the environment. The environment of interest to this study was the environment in which nurses practise. A descriptive survey with a convenience sampling explored caring in the workplace of nurses. The questionnaire was divided into two sections. Section A comprised demographic information and in section B the questionnaire consisted of Likert type questions, open-ended questions and yes/no questions. Analysis included descriptive statistics. It was found that caring was not experienced in the hospitals by nurses in the major management tasks such as respect for human dignity, two-way communication, trust between nurses and nurse managers, wellness, cultural sensitivity, support and the recognition and handling of the concerns of nurses. It was clear that although nurse managers and nurses have the knowledge and structures for the implementation of caring in the hospitals, the everyday practical application of caring needs attention. Nurse managers were aware of caring practices but nurses did not always experience caring in their places of work in the hospitals. Nurse managers and nurses should all accept responsibility for finding means to improve communication and, in particular, participative leadership strategies in the hospitals
Tunlind, Adam; Granström, John; Engström, Åsa
Management of technical equipment, such as ventilators, infusion pumps, monitors and dialysis, makes health care in an intensive care setting more complex. Technology can be defined as items, machinery and equipment that are connected to knowledge and management to maximise efficiency. Technology is not only the equipment itself, but also the knowledge of how to use it and the ability to convert it into nursing care. The aim of this study is to describe critical care nurses' experience of performing nursing care in a high technology healthcare environment. Qualitative, personal interviews were conducted during 2012 with eight critical care nurses in the northern part of Sweden. Interview transcripts were analysed using qualitative content analysis. Three themes with six categories emerged. The technology was described as a security that could facilitate nursing care, but also one that could sometimes present obstacles. The importance of using the clinical gaze was highlighted. Nursing care in a high technological environment must be seen as multi-faceted when it comes to how it affects CCNs' experience. The advanced care conducted in an ICU could not function without high-tech equipment, nor could care operate without skilled interpersonal interaction and maintenance of basal nursing. That technology is seen as a major tool and simultaneously as a barrier to patient-centred care. Copyright © 2014 Elsevier Ltd. All rights reserved.
Morrison, R S
Nursing management diagnosis based on nursing and management science, merges "nursing diagnosis" and "organizational diagnosis". Nursing management diagnosis is a judgment about nursing organizational problems. The diagnoses provide a basis for nurse manager interventions to achieve outcomes for which a nurse manager is accountable. A nursing organizational problem is a discrepancy between what should be happening and what is actually happening that prevents the goals of nursing from being accomplished. The purpose of this study was to validate 73 nursing management diagnoses identified previously in 1992: 71 of the 72 diagnoses were considered valid by at least 70% of 136 participants. Diagnoses considered to have high priority for future research and development were identified by summing the mean scores for perceived frequency of occurrence and level of disruption. Further development of nursing management diagnoses and testing of their effectiveness in enhancing decision making is recommended.
Udod, Sonia; Racine, Louise
This study considers empowerment in nurse-manager relations by examining how conflict is handled on both sides and how the critical social perspective has influenced these relations. The authors use inductive analysis of empirical data to explain how (1) nursing work is organized, structured, and circumscribed by centrally determined policies and practices that downplay nurses' professional judgement about patient care; (2) power is held over nurses in their relationship with their manager; and (3) nurses' response to power is to engage in strategies of resistance. The authors illustrate how power influences relations between staff nurses and managers and provide a critical analysis of the strategies of resistance that result in personal, relational, and critical empowerment among staff nurses. Through resistance, staff nurses engage in alternative discourses to counteract the prevailing neoliberal organizational and managerial discourses of efficiency and cost-effectiveness. Copyright© by Ingram School of Nursing, McGill University.
Murphy, Jill; Quillinan, Bernie; Carolan, Mary
Leadership in nursing plays a crucial part in the provision of good patient care. However, the terms 'nursing leadership' and 'nursing management' are often confused. This article discusses the difficulties in defining 'clinical leadership', outlines its development in the Republic of Ireland, and identifies issues that must be addressed if clinical nurse leaders are to be effective.
Srulovici, Einav; Drach-Zahavy, Anat
lower missed nursing care, beyond scarce resources. Implementation of local and national education programs for nurses and managers, accompanied with empirical research, might increase personal and ward accountability, thereby decreasing missed nursing care. This might help to create a safety culture and reduce negative outcomes for patients, nurses, and organizations. Copyright © 2017 Elsevier Ltd. All rights reserved.
To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar. Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context. A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline. A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland. Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery. A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes. © 2015 John Wiley & Sons Ltd.
Jones, Shelley L
The role of the outreach diabetes case manager in New Brunswick, Canada, was first developed in the Moncton Area of Horizon Health Network in response to a physician-identified gap between patients' diagnoses of diabetes and their attendance at the local diabetes education centre. This model of collaborative interprofessional practice increases support for primary care providers and people living with diabetes in that they are being provided the services of certified diabetes educators who can address knowledge gaps with respect to evidence-based guidelines and best practice, promote advancement of diabetes and chronic-disease management therapies and support adherence to treatment plans and self-management practices. This report chronicles a review of the implementation, expansion and evaluation of the outreach diabetes case manager model in the province of New Brunswick, Canada, along with the rationale for development of the role for registered nurses in other jurisdictions. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.
Kotzer, Anne Marie; Koepping, Dianne M; LeDuc, Karen
Nurse job satisfaction is a complex phenomenon and includes elements of the work environment. The purpose of this study was to evaluate nurses' perception of their real (current) and ideal (preferred) work environment in a pediatric tertiary care setting. Using a descriptive survey design, a convenience sample of staff nurses from three inpatient units was surveyed using the Work Environment Scale (WES) by Moos (1994). The WES consists of 10 subscales characterizing three dimensions: Relationship, Personal Growth, and System Maintenance and Change. Overall, nurses affirmed a highly positive and supportive work environment on their units. Non-significant findings between the real and ideal scores for the Involvement and Managerial Control subscales suggest that staff are concerned about and committed to their work, and satisfied with their managers' use of rules and procedures. Statistically significant differences between selected real and ideal subscale scores will help target intervention strategies to enhance the nursing work environment.
Liu, L; Coenen, A; Tao, H; Jansen, K R; Jiang, A L
This study aimed to develop a prenatal nursing care catalogue of International Classification for Nursing Practice. As a programme of the International Council of Nurses, International Classification for Nursing Practice aims to support standardized electronic nursing documentation and facilitate collection of comparable nursing data across settings. This initiative enables the study of relationships among nursing diagnoses, nursing interventions and nursing outcomes for best practice, healthcare management decisions, and policy development. The catalogues are usually focused on target populations. Pregnant women are the nursing population addressed in this project. According to the guidelines for catalogue development, three research steps have been adopted: (a) identifying relevant nursing diagnoses, interventions and outcomes; (b) developing a conceptual framework for the catalogue; (c) expert's validation. This project established a prenatal nursing care catalogue with 228 terms in total, including 69 nursing diagnosis, 92 nursing interventions and 67 nursing outcomes, among them, 57 nursing terms were newly developed. All terms in the catalogue were organized by a framework with two main categories, i.e. Expected Changes of Pregnancy and Pregnancy at Risk. Each category had four domains, representing the physical, psychological, behavioral and environmental perspectives of nursing practice. This catalogue can ease the documentation workload among prenatal care nurses, and facilitate storage and retrieval of standardized data for many purposes, such as quality improvement, administration decision-support and researches. The documentations of prenatal care provided data that can be more fluently communicated, compared and evaluated across various healthcare providers and clinic settings. © 2016 International Council of Nurses.
Full Text Available Starting points: In Slovenia, the higher education institution for nursing started exploring employability opportunities in nursing care in connection with the achievement of competencies from students’ and employers’ point of view. This article highlights the importance of monitoring nursing graduates’ employability. Its aim is to examine the employability of nursing care graduates based on the self-evaluation of competences obtained during the last study year and to establish a link between the self-evaluation of competences and students’ academic performance.
Clark, Lauren; Fink, Regina; Pennington, Karen; Jones, Katherine
Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.
Tomey, Ann Marriner
The aim of this literature search was to identify recent research related to nursing leadership and management effects on work environment using the 14 forces of magnetism. This article gives some historical perspective from the original 1983 American Academy of Nursing study through to the 2002 McClure and Hinshaw update to 2009 publications. Research publications were given a priority for references. The 14 forces of magnetism as identified by Unden and Monarch were: '1. Quality of leadership..., 2. Organizational structure..., 3. Management style..., 4. Personnel policies and programs..., 5. Professional models of care..., 6. Quality of care..., 7 Quality improvement..., 8. Consultation and resources..., 9. Autonomy..., 10. Community and the hospital..., 11. Nurse as teacher..., 12. Image of nursing..., 13. Interdisciplinary relationships... and 14. Professional development....'. Correlations have been found among positive workplace management initiatives, style of transformational leadership and participative management; patient-to-nurse ratios; education levels of nurses; quality of patient care, patient satisfaction, employee health and well-being programmes; nurse satisfaction and retention of nurses; healthy workplace environments and healthy patients and personnel. This article identifies some of the research that provides evidence for evidence-based nursing management and leadership practice.
Lourenço, Maria Regina; Shinyashiki, Gilberto Tadeu; Trevizan, Maria Auxiliadora
Nurses have assumed management positions in many health institutions. To properly accomplish the demands of this role, it is important that they be competent in both management and leadership. For appropriate performance, knowledge of management and supervision styles is a priority. Therefore, the goal of this investigation is to identify the nurse manager's knowledge regarding management and leadership. A structured questionnaire containing twenty-seven questions was applied to twelve Brazilian nurse managers of primary care center called "Family Basic Health Units". Data analysis suggested that the nurse manager lower knowledge in management and leadership is related to visionary leadership, management and leadership conceptual differences, leader's behavior, and situational leadership. And, nurse manager greater knowledge is related to power; team work, and coherence between values and attitudes.
Supporting Regional Aged Care Nursing Staff to Manage Residents' Behavioural and Psychological Symptoms of Dementia, in Real Time, Using the Nurses' Behavioural Assistant (NBA): A Pilot Site 'End-User Attitudes' Trial.
Klein, Britt; Clinnick, Lisa; Chesler, Jessica; Stranieri, Andrew; Bignold, Adam; Dazeley, Richard; McLaren, Suzanne; Lauder, Sue; Balasubramanian, Venki
This regional pilot site 'end-user attitudes' study explored nurses' experiences and impressions of using the Nurses' Behavioural Assistant (NBA) (a knowledge-based, interactive ehealth system) to assist them to better respond to behavioural and psychological symptoms of dementia (BPSD) and will be reported here. Focus groups were conducted, followed by a four-week pilot site 'end-user attitudes' trial of the NBA at a regional aged care residential facility (ACRF). Brief interviews were conducted with consenting nursing staff. Focus group feedback (N = 10) required only minor cosmetic changes to the NBA prototype. Post pilot site end-user interview data (N = 10) indicated that the regional ACRF nurses were positive and enthusiastic about the NBA, however several issues were also identified. Overall the results supported the utility of the NBA to promote a person centred care approach to managing BPSD. Slight modifications may be required to maximise its uptake across all ACRF nursing staff.
Fluoresceinic angiography of the ocular fundus is a diagnostic technique to study retinal and choroidal circulation. This technique consists of parenteral administration of 500 mg of sodium fluorescein 10% and photographing the fluorescence in the eye vessels. Although this substance is fairly safe, it may also produce mild, moderate or severe local and/or general adverse reactions. The nursing process is routinely used in hospital units but not always in outpatient clinics, even through the use of invasive procedures with intravenous medication administration is common. Therefore, nurses, as those reponsible for intravenous administration, should use the nursing process to guarantee the quality of care required by the patient. To do this, we describe an individualized care plan based on evaluation by Marjorie Gordon's functional health patterns, NANDA's nursing diagnoses Taxonomy II, Nursing Outcomes Classification (NOC), Nursing Interventions Classifications (NIC) and potential complications of the procedure.
Chan, Tom; de Lusignan, Simon; Cooper, Alun; Elliott, Mary
Osteoporosis and associated fragility fractures are a major health problem; they are more common in women over 50 years old. Fracture liaison nurses have been widely used in secondary care to promote the recognition of fragility fractures and to promote the use of bone-sparing medication to reduce the risk of recurrent facture. Audit the impact of a primary care based fracture liaison nurse on the detection of fragility fractures in people with osteoporosis and their treatment with a bone-sparing medication. This audit took place in 12 GP practices using 'before and after' cross-sectional extractions of anonymised routine data. We report, for females 50-74 years and ≥ 75 years old, socio-economic deprivation index, the prevalence of osteoporosis, recording of fragility fractures, dual-energy X-ray absorptiometry (DXA), smoking, and body-mass index (BMI) and use of appropriate bone-sparing medication. We used Altman's test of independent proportions to compare before and after data. Recording of the diagnosis of osteoporosis increased from 1.5% to 1.7% (p = 0.059); the rate of DXA scans fell (1.8% to 1.4%; p = 0.002); recording of fractures and fragility fractures more than doubled (0.8% to 2.0%; p<0.001 and 0.5% to 1.5%; p<0.001, respectively) with approximate doubling of the recording of smoking, and BMI (p<0.001 level). Fragility fracture recording rose from 8.8% to 15% in females aged 50 to 74, and from 0.8% to 2.3% in people aged ≥ 75 years old (p<0.001). There appeared to be inequity in the service, people who were least deprived were more likely to receive DXA scans and the more deprived to be prescribed bone sparing agents. A fracture liaison nurse in primary care has been associated with a period of improved management. Liaison nurses based in different parts of the health system should be tested in a prospective trial.
Full Text Available Osteoporosis and associated fragility fractures are a major health problem; they are more common in women over 50 years old. Fracture liaison nurses have been widely used in secondary care to promote the recognition of fragility fractures and to promote the use of bone-sparing medication to reduce the risk of recurrent facture.Audit the impact of a primary care based fracture liaison nurse on the detection of fragility fractures in people with osteoporosis and their treatment with a bone-sparing medication.This audit took place in 12 GP practices using 'before and after' cross-sectional extractions of anonymised routine data. We report, for females 50-74 years and ≥ 75 years old, socio-economic deprivation index, the prevalence of osteoporosis, recording of fragility fractures, dual-energy X-ray absorptiometry (DXA, smoking, and body-mass index (BMI and use of appropriate bone-sparing medication. We used Altman's test of independent proportions to compare before and after data.Recording of the diagnosis of osteoporosis increased from 1.5% to 1.7% (p = 0.059; the rate of DXA scans fell (1.8% to 1.4%; p = 0.002; recording of fractures and fragility fractures more than doubled (0.8% to 2.0%; p<0.001 and 0.5% to 1.5%; p<0.001, respectively with approximate doubling of the recording of smoking, and BMI (p<0.001 level. Fragility fracture recording rose from 8.8% to 15% in females aged 50 to 74, and from 0.8% to 2.3% in people aged ≥ 75 years old (p<0.001. There appeared to be inequity in the service, people who were least deprived were more likely to receive DXA scans and the more deprived to be prescribed bone sparing agents.A fracture liaison nurse in primary care has been associated with a period of improved management. Liaison nurses based in different parts of the health system should be tested in a prospective trial.
Simon, Harold; Mykolow, Grégory; Guyodo, Josselin
The management of a suicidal crisis falls within the scope of nursing care. There is a high rate of recurrence in the months following an attempted suicide. The nurse monitoring strategy, based on the principle of the 'recontacting' of patients, has been tested by the team of a post-emergency psychiatric unit of a university hospital. Copyright © 2017. Published by Elsevier Masson SAS.
Duan, Xia; Shi, Yan
Background: The quality evaluation of nursing care is a key link in medical quality management. It is important and worth studying for the nursing supervisors to know the disadvantages during the process of quality evaluation of nursing care and then to improve the whole nursing quality. This study was to provide director insight on the current status of quality evaluation of nursing care from Nursing Quality Control Centers (NQCCs). Material and Methods: This qualitative study used a sample ...
Avramescu, Elena Taina; Marius, Mitrache; Camen, Adrian
Over the last two decades nurses have to face the need to be high qualified professionals with always updated competencies and practical skills. Learning on the Internet by the "e learning" method, fundamentally changed the way by which nurses can get information and be involved in educational activities designed to ensure their…
Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H
To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.
Blegen, Nina Elisabeth; Severinsson, Elisabeth
Mental health nurses are agents of change, and their leadership, management role and characteristics exist at many levels in health care. Previous research presents a picture of mental health nurses as subordinate and passive recipients of the leader's influence and regard leadership and management as distinct from the nurses' practical work. The aim was to provide a synthesis of the studies conducted and to discuss the relationship between nursing leadership and nursing management in the context of mental health nursing. A literature search was conducted using EBSCO-host, Academic Search Premier, Science Direct, CINAHL and PubMed for the period January 1995-July 2010. Leadership and management in the context of mental health nursing are human activities that imply entering into mutual relationships. Mental health nurses' leadership, management and transformational leadership are positively related in terms of effectiveness and nurses' skills. It is important to consider mental health nurses' management as a form of leadership similar to or as a natural consequence of transformational leadership (TL) and that ethical concerns must be constantly prioritized throughout every level of the organization. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.
Evans, Jeanne; Bell, Jennifer L; Sweeney, Annemarie E; Morgan, Jennifer I; Kelly, Helen M
The purpose of the study was to gain an understanding of the nursing phenomenon, confidence, from the experience of nurses in the nursing subculture of critical care. Leininger's theory of cultural care diversity and universality guided this qualitative descriptive study. Questions derived from the sunrise model were used to elicit nurses' perspectives about cultural and social structures that exist within the critical care nursing subculture and the influence that these factors have on confidence. Twenty-eight critical care nurses from a large Canadian healthcare organization participated in semistructured interviews about confidence. Five themes arose from the descriptions provided by the participants. The three themes, tenuously navigating initiation rituals, deliberately developing holistic supportive relationships, and assimilating clinical decision-making rules were identified as social and cultural factors related to confidence. The remaining two themes, preserving a sense of security despite barriers and accommodating to diverse challenges, were identified as environmental factors related to confidence. Practice and research implications within the culture of critical care nursing are discussed in relation to each of the themes.
Wil van Erp
The purpose of this study is to explore why and how Management Accounting and Control Systems (MACS) enact and are enacted upon in the Dutch branch of nursing homes, homes for the elderly and home care. In search for answers, this study chooses an actor-network theory (ANT) perspective combined with
Tourangeau, Ann; Patterson, Erin; Rowe, Alissa; Saari, Margaret; Thomson, Heather; MacDonald, Geraldine; Cranley, Lisa; Squires, Mae
To identify factors affecting Canadian home care nurse intention to remain employed (ITR). In developed nations, healthcare continues to shift into community settings. Although considerable research exists on examining nurse ITR in hospitals, similar research related to nurses employed in home care is limited. In the face of a global nursing shortage, it is important to understand the factors influencing nurse ITR across healthcare sectors. A qualitative exploratory descriptive design was used. Focus groups were conducted with home care nurses. Data were analysed using qualitative content analysis. Six categories of influencing factors were identified by home care nurses as affecting ITR: job characteristics; work structures; relationships/communication; work environment; nurse responses to work; and employment conditions. Findings suggest the following factors influence home care nurse ITR: having autonomy; flexible scheduling; reasonable and varied workloads; supportive work relationships; and receiving adequate pay and benefits. Home care nurses did not identify job satisfaction as a single concept influencing ITR. Home care nursing management should support nurse autonomy, allow flexible scheduling, promote reasonable workloads and create opportunities for team building that strengthen supportive relationships among home care nurses and other health team members. © 2013 John Wiley & Sons Ltd.
Gray, Linda R; Shirey, Maria R
To describe what nurse manager engagement means to nurse managers and staff nurses by incorporating an organizational dashboard to document engagement outcomes. Retaining engaged nurse managers is crucial for individual performance and organizational outcomes. However, nurse manager engagement is currently underreported in the literature. Existing data from the 2010 Employee Opinion Survey at the Baylor University Medical Center in Dallas, Texas, were used to measure staff engagement among 28 nurse managers and 1497 staff nurses. The data showed a 21% gap between manager and staff nurse engagement levels, with managers showing higher engagement levels than staff. No clear depiction of nurse manager engagement emerged. Consequently, an expanded definition of nurse manager engagement was developed alongside a beginning dashboard of engagement outcomes. The findings have implications for overcoming barriers that affect staff nurse engagement, improving outcomes, and creating definitions of nurse manager engagement.
Liu, Ying; Aungsuroch, Yupin
To propose a hypothesized theoretical model and apply it to examine the structural relationships among work environment, patient-to-nurse ratio, job satisfaction, burnout, intention to leave and quality nursing care. Improving quality nursing care is a first consideration in nursing management globally. A better understanding of factors influencing quality nursing care can help hospital administrators implement effective programmes to improve quality of services. Although certain bivariate correlations have been found between selected factors and quality nursing care in different study models, no studies have examined the relationships among work environment, patient-to-nurse ratio, job satisfaction, burnout, intention to leave and quality nursing care in a more comprehensive theoretical model. A cross-sectional survey. The questionnaires were collected from 510 Chinese nurses in four Chinese tertiary hospitals in January 2015. The validity and internal consistency reliability of research instruments were evaluated. Structural equation modelling was used to test a theoretical model. The findings revealed that the data supported the theoretical model. Work environment had a large total effect size on quality nursing care. Burnout largely and directly influenced quality nursing care, which was followed by work environment and patient-to-nurse ratio. Job satisfaction indirectly affected quality nursing care through burnout. This study shows how work environment past burnout and job satisfaction influences quality nursing care. Apart from nurses' work conditions of work environment and patient-to-nurse ratio, hospital administrators should pay more attention to nurse outcomes of job satisfaction and burnout when designing intervention programmes to improve quality nursing care. © 2017 John Wiley & Sons Ltd.
Naghneh, Mohammad Hossein Khalilzadeh; Tafreshi, Mansoureh Zagheri; Naderi, Manijeh; Shakeri, Nehzat; Bolourchifard, Fariba; Goyaghaj, Naser Sedghi
Nursing care encompasses physical, emotional, mental and social needs, in order to improve a patient's health and wellbeing. Caring is the central core and the essence of nursing. The important issue of care is access to proper care and increasing patients' satisfaction. Job performance of nurses is affected by many factors including organizational commitment. This study aimed to determine the relationship between organizational commitment and nurses caring behavior. In this cross-sectional study, 322 nurses from selected Hospitals of Shahid Beheshti University of Medical Sciences in Tehran were randomly selected and enrolled in the study in 2015. The self-reported data by nurses were collected through demographic characteristics questionnaire, Meyer & Allen organizational commitment model and Caring Behavior Inventory (CBI). Data were analyzed with SPSS statistical software version 20, using t-test and ANOVA. The majority of nurses (63%) were female. The mean score and standard deviation of organizational commitment and caring behavior of nurses were 74.12±9.61 and 203.1±22.46, respectively. The results showed a significantly positive correlation between organizational commitment and caring behavior (p=0.001). In this study the caring behavior of nurses with higher organizational commitment were significantly better than the others. Managers and nurse leaders should pay more attention to improve organizational commitment of nurses, in order to improve nurses' performance.
Taylor, Elizabeth Johnston; Gober-Park, Carla; Schoonover-Shoffner, Kathy; Mamier, Iris; Somaiya, Chintan K; Bahjri, Khaled
This study measured the frequency of nurse-provided spiritual care and how it is associated with various facets of nurse religiosity. Data were collected using an online survey accessed from the home page of the Journal of Christian Nursing. The survey included the Nurse Spiritual Care Therapeutics Scale, six scales quantifying facets of religiosity, and demographic and work-related items. Respondents ( N = 358) indicated high religiosity yet reported neutral responses to items about sharing personal beliefs and tentativeness of belief. Findings suggested spiritual care was infrequent. Multivariate analysis showed prayer frequency, employer support of spiritual care, and non-White ethnicity were significantly associated with spiritual care frequency (adjusted R 2 = .10). Results not only provide an indication of spiritual care frequency but empirical encouragement for nurse managers to provide a supportive environment for spiritual care. Findings expose the reality that nurse religiosity is directly related, albeit weakly, to spiritual care frequency.
Widger, Kimberley; Pye, Christine; Cranley, Lisa; Wilson-Keates, Barbara; Squires, Mae; Tourangeau, Ann
Generational differences in values, expectations and perceptions of work have been proposed as one basis for problems and solutions in recruitment and retention of nurses. This study used a descriptive design. A sample of 8207 registered nurses and registered practical nurses working in Ontario, Canada, acute care hospitals who responded to the Ontario Nurse Survey in 2003 were included in this study. Respondents were categorized as Baby Boomers, Generation X or Generation Y based on their birth year. Differences in responses among these three generations to questions about their own characteristics, employment circumstances, work environment and responses to the work environment were explored. There were statistically significant differences among the generations. Baby Boomers primarily worked full-time day shifts. Gen Y tended to be employed in teaching hospitals; Boomers worked more commonly in community hospitals. Baby Boomers were generally more satisfied with their jobs than Gen X or Gen Y nurses. Gen Y had the largest proportion of nurses with high levels of burnout in the areas of emotional exhaustion and depersonalization. Baby Boomers had the largest proportion of nurses with low levels of burnout. Nurse managers may be able to capitalize on differences in generational values and needs in designing appropriate interventions to enhance recruitment and retention of nurses.
Simmons, Sandra F; Schnelle, John F; Saraf, Avantika A; Simon Coelho, Chris; Jacobsen, J Mary Lou; Kripalani, Sunil; Bell, Susan; Mixon, Amanda; Vasilevskis, Eduard E
Approximately 20% of hospitalized Medicare beneficiaries are discharged from the hospital to skilled nursing facilities (SNFs); and up to 23% of SNF patients return to the hospital within 30 days of hospital discharge, with pain as one of the most common symptoms precipitating hospital readmission. We sought to examine the prevalence of moderate to severe pain at hospital discharge to SNF, the incidence of new moderate to severe pain (relative to prehospitalization), and satisfaction with pain management among older acute care patients discharged to SNF. Structured patient interviews were conducted with 188 Medicare beneficiaries discharged to 23 area SNFs from an academic medical center. Pain level (0-10) and satisfaction with pain management were assessed upon hospital admission, discharge, and within 1 week after transition to SNF. There was a high prevalence of moderate to severe pain at each time point including prehospital (51%), hospital discharge (38%), and following SNF admission (53%). Twenty-eight percent of participants reported new moderate to severe pain at hospital discharge, whereas 44% reported new moderate to severe pain following SNF admission. Most participants reported being "satisfied" with their pain treatment, even in the context of moderate to severe pain. Moderate to severe pain is a common problem among hospitalized older adults discharged to SNF and continues during their SNF stay. Pain assessment and management should involve a specific, planned process between hospital and SNF clinicians at the point of care transition, even if patients express "satisfaction" with current pain management. © The Author 2015. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: email@example.com.
Newton, Jennifer M; Kelly, Cherene M; Kremser, Anne K; Jolly, Brian; Billett, Stephen
To identify what motivates individuals to engage in a nursing career. Recruitment and retention of nurses is a worldwide concern that is associated with several compounding factors, primarily the high attrition of its new graduates and an ageing workforce. Given these factors, it is necessary to understand why individuals choose to nurse, what keeps them engaged in nursing, and in what ways healthcare systems can support career development and retention. This paper presents initial interview data from a longitudinal multi method study with 29 undergraduate student nurses, 25 registered nurses (RNs), six Nurse Unit Managers (NUMs) and four Directors of Nursing (DoNs) from four hospitals across a healthcare organization in Australia. Thematic analysis yielded four key themes that were common to all participants: (1) a desire to help, (2) caring, (3) sense of achievement and (4) self-validation. These themes represented individuals' motivation to enter nursing and sustain them in their careers as either nurses or managers. Managers need to be cognisant of nurses underlying values and motivators in addressing recruitment and retention issues. Strategies need to be considered at both unit and organizational levels to ensure that the 'desire to care' does not become lost.
Full Text Available This survey describes caring in the workplace in selected health services and is part of a greater study conducted in KwaZulu-Natal, South Africa. This study describes the views of nurse managers and nurses regarding caring in the workplace. Human competence, recovery and healing are central to caring. To ensure caring and healing of patients in health services it is of the utmost importance for nurse managers to ensure a healthy and caring environment in the management of nurses. When caring is present in the workplace, nurses are more able to render caring nursing practices in the patient care environment. It is clear that to become a caring person, one must be treated in a caring way and that caring may be impaired or reinforced by the environment. The environment of interest to this study was the environment in which nurses practise. A descriptive survey with a convenience sampling explored caring in the workplace of nurses. The questionnaire was divided into two sections. Section A comprised demographic information and in section B the questionnaire consisted of Likert type questions, open-ended questions and yes/no questions. Analysis included descriptive statistics.
Dumas, Linda G; Ramadurai, Murali
This article is about pain management and some of the best practices to address the problem of pain in nursing home patients who have a serious illness and multiple comorbid conditions. Management of the emotional distress that accompanies chronic or acute pain is of foremost concern. In this article, the topics discussed include general pain management in a nursing home for a long-term care resident who has chronic pain, the relief of symptoms and suffering in a patient who is on palliative care and hospice, and the pain management of a postoperative patient with acute pain for a short transitional period (post-acute illness or surgery).
Nielsen, Ben; Martinsen, Bente
to improve quality of life after being diagnosed with HIV, a sharp distinction between HIV and AIDS and a religious and spiritually coping. Identifying the emotional challenges women living with HIV face in their daily lives may help nurses obtain a clearer understanding and greater knowledge of how...... to provide HIV-positive women with effective care that empower and support these women in managing their chronic disease. However to ensure that nurses have the proper tools for effective care for women living with HIV European studies are essentials in relation to what emotional challenges these women...
Echevarria, Ilia M; Patterson, Barbara J; Krouse, Anne
The aim of this study was to examine the relationships among education, leadership experience, emotional intelligence and transformational leadership of nurse managers. Nursing leadership research provides limited evidence of predictors of transformational leadership style in nurse managers. A predictive correlational design was used with a sample of nurse managers (n = 148) working in varied health care settings. Data were collected using the Genos Emotional Intelligence Inventory, the Multi-factor Leadership Questionnaire and a demographic questionnaire. Simple linear and multiple regression analyses were used to examine relationships. A statistically significant relationship was found between emotional intelligence and transformational leadership (r = 0.59, P transformational leadership. Nurse managers should be well informed of the predictors of transformational leadership in order to pursue continuing education and development opportunities related to those predictors. The results of this study emphasise the need for emotional intelligence continuing education, leadership development and leader assessment programmes. © 2016 John Wiley & Sons Ltd.
Zietz, Hallie A
Modern therapy for childhood acute leukemia has provided a dramatically improved prognosis over that of just 30 years ago. In the early 1960's survival rates for acute lymphocytic leukemia (ALL) and acute myelogenous leukemia (AML) were 4% and 3%, respectively. By the 1980's survival rates had risen to 72% for all and 25% to 40% for AML. Today, a diagnosis of all carries an 80% survival rate and as high as a 90% survival rate for some low-risk subtypes. Such high cure rates depend on intense and complex, multimodal therapeutic protocols. Therefore, nursing care of the child with acute leukemia must meet the demands of complicated medical therapies and balance those with the needs of a sick child and their concerned family. An understanding of disease process and principles of medical management guide appropriate and effective nursing interventions. Leukemia is a malignant disorder of the blood and blood- forming organs (bone marrow, lymph nodes and spleen). Most believe that acute leukemia results from a malignant transformation of a single early haematopoietic stem cell that is capable of indefinite self-renewal. These immature cells of blasts do not respond to normal physiologic stimuli for differentiation and gradually become the predominant cell in the bone marrow
... 42 Public Health 2 2010-10-01 2010-10-01 false Nursing care. 409.21 Section 409.21 Public Health... HOSPITAL INSURANCE BENEFITS Posthospital SNF Care § 409.21 Nursing care. (a) Basic rule. Medicare pays for nursing care as posthospital SNF care when provided by or under the supervision of a registered...
Cziraki, Karen; McKey, Colleen; Peachey, Gladys; Baxter, Pamela; Flaherty, Brenda
To determine the factors that attract and retain Registered Nurses in the first-line nurse manager role. The first-line nurse manger role is pivotal in health-care organisations. National demographics suggest that Canada will face a first-line nurse manager shortage because of retirement in the next decade. Determination of factors that attract and retain Registered Nurses will assist organisations and policy makers to employ strategies to address this shortage. The study used an exploratory, descriptive qualitative approach, consisting of semi-structured individual interviews with 11 Registered Nurses in first-line nurse manager roles. The findings revealed a discrepancy between the factors that attract and retain Registered Nurses in the first-line nurse manager role, underscored the importance of the mentor role and confirmed the challenges encountered by first-line nurse managers practicing in the current health-care environment. The first-line nurse manager role has been under studied. Further research is warranted to understand which strategies are most effective in supporting first-line nurse managers. Strategies to support nurses in the first-line nurse manager role are discussed for the individual, programme, organisation and health-care system/policy levels. © 2013 John Wiley & Sons Ltd.
Johnson, L J
The growth of corporate orientation for health care structures, with a focus on bottom-line management, has radically altered the role of nurse executives. With the organization's emphasis on performance, productivity, and results, successful nurse executives are now integrating the management of the delivery of nursing care with the management of complex corporate structures and relationships. The editor of Executive Development discusses the rapidly changing expectations and demands of the contemporary nurse executive's work. The nurse executive's role can be viewed from many perspectives: its scope, its value, its structure, its content. Content--"What does the nurse executive do that makes a real difference?"--is the focus here.
Damsgård, Elin; Solgård, Hege; Johannessen, Karin; Wennevold, Katrine; Kvarstein, Gunnvald; Pettersen, Gunn; Garcia, Beate
Pain is common among elderly patients in nursing homes. However, pain assessment and treatment are inadequate. Interprofessional treatment is recommended, and consequently interprofessional education in pain management is necessary. This pilot project aimed to describe how two interprofessional groups of students approached pain management in two nursing home patients. We formed two teams comprising one student from the nursing, physical therapy, pharmacy, and medical educations. Each team spent one day examining a patient with chronic pain at a nursing home and they developed pain management plans. We collected data through video recordings during teamwork before and after examining the patients and field notes during the patient examination. We analysed the video-recordings applying the seven-step model including 1) viewing the video data, 2) describing the video data, 3) identifying critical events, 4) transcribing, 5) coding, 6) constructing storyline and 7) composing a narrative. Field notes supplied the transcripts. Both teams succeeded in making a pain management plan for their patient. The common examination of the patient was crucial for the students' approaches to pain management and changed their pre-assumptions about the patients' pain. By sharing knowledge and reflecting together, the students reached a common consensus on suggestions for management of the patients' problems. Interprofessional collaboration fostered enthusiasm and a more holistic pain management approach. However,students' lack of knowledge limited their understanding of pain. Knowledge of pain management in nursing home patients and the practice of interprofessional cooperation should be included in pain curricula for health care professionals. Copyright © 2018 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
Bakar, Abu; Nursalam; Adriani, Merryana; Kusnanto; Qomariah, Siti Nur; Hidayati, Laily; Pratiwi, Ika Nur; Ni'mah, Lailatun
Caring is a behavior of giving holistic assistance to individuals. In fact, this important behavior still has not routinely performed in current nursing practice. Personality and sipirituality are important factors in forming one's caring behavior. Spirituality is a passion or impulse to perform noble action. The objective of this study was to…
Backes, Dirce Stein; Backes, Marli Stein; Erdmann, Alacoque Lorenzini
This study is the result of the project: networks care and social entrepreneurship: the autonomy and social commitment of nurses. The purpose of this qualitative study is to comprehend the meaning of nursing care as a social enterprising practice. The Grounded Theory was used as a methodological reference and the interview, conducted with 35 participants as technique of data collection. Data codification led to the central theme: Viewing Nursing Care as a Social Enterprising Practice. This theme is complemented by the category, characterized the cause condition: the social integration through the creation a political identity that expresses your involvement. The results showed that is necessary to learn and have a deep dialogic knowledge. In order to consolidate popular participation as a citizenship ideal, a critical professional attitude, base don the combination of care with liberty, participation end autonomy.
Vhuromu, E N; Davhana-Maselesele, M
Treatment of the under five years is a national priority as an attempt in curbing deaths and deformities affecting children. Primary health care was implemented in the clinics in order to help in the treatment of illnesses affecting the community, including children. As a result of childhood illnesses; the World Health Organization (WHO) and United Nation Children's Fund (UNICEF) came up with Integrated Management of Childhood illnesses (IMCI) strategy to enhance treatment of such illnesses in developing countries. Primary health care nurses (PHCNS) in Limpopo Province were also trained to implement the strategy. This study is intended to explore and describe the experiences of PHCNS in implementing the IMCI strategy at selected clinics in Vhembe District in the Limpopo Province. A qualitative, explorative, descriptive and contextual design was used. In-depth interviews were conducted with PHCNS who are IMCI trained and have implemented the strategy for a period of not less than two years. Data analysis was done through using Tesch 's method of open coding for qualitative analysis. Findings revealed that PHCNS had difficulty in rendering IMCI services due to lack of resources and poor working conditions. Recommendations address the difficulties experienced by PHCNS when implementing the IMCI strategy.
Moser, Albine; van der Bruggen, Harry; Widdershoven, Guy; Spreeuwenberg, Cor
Diabetes mellitus is a major public health problem. Little is known about how people with type 2 diabetes experience self-management in a nurse-led, shared-care programme. The purpose of this article is to report an empirically grounded conceptualization of self-management in the context of autonomy of people with type 2 diabetes. This study has a qualitative descriptive, and exploratory design with an inductive approach. Data were collected by means of in-depth interviews. The sample consisted of older adults with type 2 diabetes in a nurse-led, shared-care setting. The data analysis was completed by applying the constant comparative analysis as recommended in grounded theory. People with type 2 diabetes use three kinds of self-management processes: daily, off-course, and preventive. The steps for daily self-management are adhering, adapting, and acting routinely. The steps for off-course self-management are becoming aware, reasoning, deciding, acting, and evaluating. The steps for preventive self-management are experiencing, learning, being cautious, and putting into practice. These processes are interwoven and recurring. Self-management consists of a complex and dynamic set of processes and it is deeply embedded in one's unique life situation. Support from diabetes specialist nurses and family caregivers is a necessity of self-managing diabetes.
Kiljunen, Outi; Välimäki, Tarja; Kankkunen, Päivi; Partanen, Pirjo
People living in care and nursing homes are vulnerable individuals with complex needs; therefore, a wide array of nursing competence is needed to ensure their well-being. When developing the quality of care in these units, it is essential to know what type of competence is required for older people nursing. The aim of this integrative review was to identify the competence needed for older people nursing in licensed practical nurses' and registered nurses' work in care and nursing homes. Integrative literature review. We performed an integrative review using Whittemore and Knafl's method. The CINAHL, MEDLINE, PsycINFO, SocINDEX and Scopus databases were searched for studies published from 2006 to April 2016. We assessed the quality of the studies using Joanna Briggs Institute critical appraisal tools and analysed the data by applying qualitative content analysis. Ten articles were included in the review. Most of the studies focused on registered nurses' work. We identified five competence areas that are needed for older people nursing in registered nurses' work in care and nursing homes: attitudinal and ethical, interactional, evidence-based care, pedagogical, and leadership and development competence. Empirical evidence of competence requirements related to licensed practical nurses' work in these facilities was scarce. The competence required for registered nurses and licensed practical nurses should be clearly identified to support competence management in the care and nursing home context. Well-educated nursing staff are needed in care and nursing homes to provide high-quality care because comprehensive and advanced nurse competence is required to meet the needs of older people. © 2016 John Wiley & Sons Ltd.
Full Text Available Abstract Background In the presence of type 2 diabetes (T2DM or coronary heart disease (CHD, depression is under diagnosed and under treated despite being associated with worse clinical outcomes. Our earlier pilot study demonstrated that it was feasible, acceptable and affordable for practice nurses to extend their role to include screening for and monitoring of depression alongside biological and lifestyle risk factors. The current study will compare the clinical outcomes of our model of practice nurse-led collaborative care with usual care for patients with depression and T2DM or CHD. Methods This is a cluster-randomised intervention trial. Eighteen general practices from regional and metropolitan areas agreed to join this study, and were allocated randomly to an intervention or control group. We aim to recruit 50 patients with co-morbid depression and diabetes or heart disease from each of these practices. In the intervention group, practice nurses (PNs will be trained for their enhanced roles in this nurse-led collaborative care study. Patients will be invited to attend a practice nurse consultation every 3 months prior to seeing their usual general practitioner. The PN will assess psychological, physiological and lifestyle parameters then work with the patient to set management goals. The outcome of this assessment will form the basis of a GP Management Plan document. In the control group, the patients will continue to receive their usual care for the first six months of the study before the PNs undergo the training and switch to the intervention protocol. The primary clinical outcome will be a reduction in the depression score. The study will also measure the impact on physiological measures, quality of life and on patient attitude to health care delivered by practice nurses. Conclusion The strength of this programme is that it provides a sustainable model of chronic disease management with monitoring and self-management assistance for
McKeever, Amy E; Spaeth-Brayton, Sylvia; Sheerin, Sarah
Drug addiction during pregnancy is a complex health and social issue that requires an interdisciplinary health care team providing nonjudgmental, comprehensive care. Critical challenges include onset of and attendance at prenatal care, potential obstetric complications, transition to extrauterine life and potential neonatal abstinence syndrome for the neonate, newborn feeding issues, postpartum depression and risk of relapse for women. © 2014 AWHONN.
Petrosova, Liana; Pokhilenko, Irina
The aim of the study was to research levels of job satisfaction, factors affecting job satisfaction/dissatisfaction, and ways to improve job satisfaction among nursing managers. The purposes of the study were to extend knowledge in the field of healthcare management, to raise awareness about factors that affect job satisfaction in nursing management career, and to provide suggestions regarding how to increase job satisfaction among nursing managers. The method of this study is literature r...
Van Bogaert, Peter; Peremans, Lieve; de Wit, Marlinde; Van Heusden, Danny; Franck, Erik; Timmermans, Olaf; Havens, Donna S
To study nurse managers' perceptions and experiences of staff nurse structural empowerment and its impact on the nurse manager leadership role and style. Nurse managers' leadership roles may be viewed as challenging given the complex needs of patients and staff nurses' involvement in both clinical and organizational decision-making processes in interdisciplinary care settings. Qualitative phenomenological study. Individual semi-structured interviews were conducted with 8 medical or surgical nurse managers in a 600-bed Belgian university hospital between December 2013 and June 2014. This hospital was undergoing conversion from a classical hierarchical, departmental structure to a flat, interdisciplinary model. Nurse managers were found to be familiar with the structural empowerment of clinical nurses in the hospital and to hold positive attitudes toward it. They confirmed the positive impact of empowerment on their staff nurses, as evidenced by increased responsibility, autonomy, critical reflection and enhanced communication skills that in turn improved the quality and safety of patient care. Structural empowerment was being supported by several change initiatives at both the unit and hospital levels. Nurse managers' experiences with these initiatives were mixed, however, because of the changing demands with regard to their manager role and leadership style. In addition, pressure was being experienced by both staff nurses and nurse managers as a result of direct patient care priorities, tightly scheduled projects and miscommunication. Nurse managers reported that structural empowerment was having a favorable impact on staff nurses' professional attitudes and the safety and quality of care in their units. However, they also reported that the empowerment process had led to changes in the managers' roles as well as daily practice dilemmas related to the leadership styles needed. Clear organizational goals and dedicated support for both clinical nurses and nursing unit
Wong, Frances Kam Yuet
To critically review the challenges facing nurse leaders in China during healthcare reform. China is now undergoing a major reform aimed at enhancing the accessibility and quality of its healthcare at a level that is affordable to the people. Nurses have a key role to play in this reform. Key documents produced by the government of China were critically reviewed using the strengths, weaknesses, opportunities and threats (SWOT) framework. A number of factors, including the insufficient number of nurses and the medical orientation of the health system, have hindered the development of nursing. However, healthcare reform has created new opportunities for nurses and nursing. This paper reviews the strengths, weaknesses, opportunities and threats faced by nurse managers in China. It identifies barriers but also possibilities for nurse leaders to advance nursing and make nurses visible in this era of transforming healthcare. Many of the issues identified in this review, such as the enhancement of quality and accessibility of care, are important to nurse leaders around the world. However, this article reveals the particular challenges faced by nurse leaders in China, with its unique social and historical background.
Nurses are practising in a work environment which is sometimes difficult and which can affect their capacity to supervise students. They may sometimes find themselves taking out their frustration on these students. By being better trained in the specificities of adult learning, frontline professionals and tutors could find it easier to adopt a compassionate care attitude towards nursing students, an essential condition for the development of their skills. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
AIMS AND OBJECTIVES: The aim of this phenomenological study was to explore the emotions experienced by children\\'s nurses when caring for children with burns, in addition to ascertaining how the nurses dealt with these emotions. BACKGROUND: The nature of nursing practice is such that it inevitably generates some form of emotional response in nurses. The literature reveals that the manner nurses deal with their emotional experiences can impact on their nursing care. DESIGN: The study used Husserlian phenomenology to explore the emotional experiences of eight purposively selected children\\'s nurses who have worked on the burns unit of an Irish paediatric hospital. METHODS: Data were collected using in-depth, unstructured interviews and analysed using Colaizzi\\'s seven stage framework. RESULTS: The phenomenon of participants\\' emotional experiences is captured in four themes: (1) caring for children with burns, (2) supporting parents, (3) sustaining nurses\\' emotional well-being, and (4) learning to be a burns nurse. Nursing children with burns generated a myriad of emotions for participants. Burns dressing-changes, managing burn-related pain, supporting parents and the impact of busy workloads on the emotional care of children and their parents emerged as the most emotionally challenging aspects of participants\\' role. Participants recognised the need to manage their emotional responses and spoke of the benefits of a supportive nursing team. CONCLUSIONS: The findings offer insights into both the rewarding and challenging aspects of nursing children with burns. Nurses in this environment must be supported to recognise and manage their emotional responses to their work. RELEVANCE TO CLINICAL PRACTICE: Helping nurses to manage the emotional consequences of their work will help to sustain their emotional well-being, enhance the care received by children and also enable nurses to support parents in their role as partners in care.
Fujita, Junko; Fukui, Sakiko; Ikezaki, Sumie; Otoguro, Chizuru; Tsujimura, Mayuko
To define the team types consisting of doctors, home-visiting nurses and care managers for end-of-life care by measuring the collaboration relationship, and to identify the factors related to the team types. A questionnaire survey of 43 teams including doctors, home-visiting nurses and care managers was carried out. The team types were classified based on mutual evaluations of the collaborative relationships among the professionals. To clarify the factors between team types with the patient characteristics, team characteristics and collaboration competency, univariate analysis was carried out with the Fisher's exact test or one-way analysis and multiple comparison analysis. Three team types were classified: the team where the collaborative relationships among all healthcare professionals were good; the team where the collaborative relationships between the doctors and care managers were poor; and the team where the collaborative relationships among all of the professionals were poor. There was a statistically significant association between the team types and the following variables: patient's dementia level, communication tool, professionals' experience of working with other team members, home-visiting nurses' experience of caring for dying patients, care managers' background qualifications, doctor's face-to-face cooperation with other members and home-visiting nurses' collaborative practice. It is suggested that a collaborative relationship would be fostered by more experience of working together, using communication tools and enhancing each professional's collaboration competency. Geriatr Gerontol Int 2017; 17: 1943-1950. © 2017 Japan Geriatrics Society.
Beatriz Francisco Farah
Full Text Available Objective: to understand the perceptions of nurses on nursing supervision in the work process. Methods: this is a qualitative research, with a semi-structured interview, performed with 16 nurses. Data analysis was performed through content analysis. Results: two meanings topics emerged from the speeches of the participants: Nurses´ activities in Primary Health Care Units and Nurses´ perceptions about nursing supervision. In the first category, the actions listed were filling out forms and reports under the supervision of the nursing service. In the second category, supervision was perceived as a function of management and follow-up of the activities planned by the team, in opposition to the classical supervision concept, which is inspecting. Conclusion: nursing supervision has been configured for primary care nurses as an administrative function that involves planning, organization, coordination, evaluation, follow-up and support for the health team.
Meiland, F. J. M.; Danse, J. A. C.; Wendte, J. F.; Gunning-Schepers, L. J.; Klazinga, N. S.
Criteria are used to prioritise patients on waiting lists for health care services. This is also true for waiting lists for admission to psychogeriatric nursing homes. A patient's position on these latter waiting lists is determined by (changes in) urgency and waiting time. The present article
Garwick, Ann W; Svavarsdóttir, Erla Kolbrun; Seppelt, Ann M; Looman, Wendy S; Anderson, Lori S; Örlygsdóttir, Brynja
To identify and compare how school nurses in Reykjavik, Iceland and St. Paul, Minnesota coordinated care for youth with asthma (ages 10-18) and to develop an asthma school nurse care coordination model. Little is known about how school nurses coordinate care for youth with asthma in different countries. A qualitative descriptive study design using focus group data. Six focus groups with 32 school nurses were conducted in Reykjavik (n = 17) and St. Paul (n = 15) using the same protocol between September 2008 and January 2009. Descriptive content analytic and constant comparison strategies were used to categorize and compare how school nurses coordinated care, which resulted in the development of an International School Nurse Asthma Care Coordination Model. Participants in both countries spontaneously described a similar asthma care coordination process that involved information gathering, assessing risk for asthma episodes, prioritizing healthcare needs and anticipating and planning for student needs at the individual and school levels. This process informed how they individualized symptom management, case management and/or asthma education. School nurses played a pivotal part in collaborating with families, school and healthcare professionals to ensure quality care for youth with asthma. Results indicate a high level of complexity in school nurses' approaches to asthma care coordination that were responsive to the diverse and changing needs of students in school settings. The conceptual model derived provides a framework for investigators to use in examining the asthma care coordination process of school nurses in other geographic locations. © 2014 John Wiley & Sons Ltd.
Verkaik, R.; Antwerpen-Hogenraad, P. van; Veer, A. de; Francke, A.; Huis in het Veld, J.
Background: Self-management in patients and family caregivers confronted with dementia is not self-evident. Self-management skills may be limited because of the progressive cognitive decline of the patient and because family caregivers are often also very aged. Self-management
Anzai, Eriko; Douglas, Clint; Bonner, Ann
The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan. © 2013 Wiley Publishing Asia Pty Ltd.
Brodell, Elizabeth Becky
Nurses entering the workforce are faced with many challenges, but today the multiple demands of patient care are complicated by a nurse's need to keep abreast of fast-changing technology. This research is universally relevant to nursing practice in educational settings and practice areas because nursing education needs to develop strategies to…
This article considers the key role played by the district nurse in managing the district nursing team in order to provide high quality health care. It considers how the district nurse can use key managerial roles (interpersonal, informational and decision-making) in order to ensure unity within the team. The importance of shared goals and trust to achieve unity is explored and a strategy for managing conflict is discussed. Finally, the article suggests a set of ground rules which could be used to facilitate effective team working.
Creating opportunities for interdisciplinary collaboration and patient-centred care: how nurses, doctors, pharmacists and patients use communication strategies when managing medications in an acute hospital setting.
Liu, Wei; Gerdtz, Marie; Manias, Elizabeth
This paper examines the communication strategies that nurses, doctors, pharmacists and patients use when managing medications. Patient-centred medication management is best accomplished through interdisciplinary practice. Effective communication about managing medications between clinicians and patients has a direct influence on patient outcomes. There is a lack of research that adopts a multidisciplinary approach and involves critical in-depth analysis of medication interactions among nurses, doctors, pharmacists and patients. A critical ethnographic approach with video reflexivity was adopted to capture communication strategies during medication activities in two general medical wards of an acute care hospital in Melbourne, Australia. A mixed ethnographic approach combining participant observations, field interviews, video recordings and video reflexive focus groups and interviews was employed. Seventy-six nurses, 31 doctors, 1 pharmacist and 27 patients gave written consent to participate in the study. Data analysis was informed by Fairclough's critical discourse analytic framework. Clinicians' use of communication strategies was demonstrated in their interpersonal, authoritative and instructive talk with patients. Doctors adopted the language discourse of normalisation to standardise patients' illness experiences. Nurses and pharmacists employed the language discourses of preparedness and scrutiny to ensure that patient safety was maintained. Patients took up the discourse of politeness to raise medication concerns and question treatment decisions made by doctors, in their attempts to challenge decision-making about their health care treatment. In addition, the video method revealed clinicians' extensive use of body language in communication processes for medication management. The use of communication strategies by nurses, doctors, pharmacists and patients created opportunities for improved interdisciplinary collaboration and patient-centred medication
Full Text Available Introduction: Nurses who frequently often contact to patients and most of their time serve patients in 24 hours, have an important role in caring for the patient. Patient satisfaction as quality indicator is the key success for competitiveness of service in hospital. The aim of this research was to develop nursing service quality model based on the nursing performance, nurse and patient satisfaction. Method: The research method used cross sectional study, at 14 wards of Gresik Hospital. Research factors were namely: oganization characteristic (organization culture and leadership, work factors (feedback and variety of nurses work, nurse characteristics (motivation, attitude, commitment and mental model, nursing practice, interpersonal communication, nurse and patient satisfaction. Statistical analysis of study data was analyzed by Partial Least Square (PLS. Results: The results of nursing performance revealed that nurse characteristic were not affected by organization culture and leadership style, nurse characteristics were affected by work factors, nurse characteristics affected nursing quality service (nursing practice, nursing professional, nurse and patient satisfaction, nurse satisfaction did not affect nursing professionals. Discussion: Based on the overall results of the development of nursing care model that was originally only emphasizes the process of nursing care only, should be consider the input factor of organizational characteristics, job characteristics, and characteristics of individual nurses and consider the process factors of nursing care standards and professional performance of nurses and to consider the outcome factors nurse and patient satisfaction. So in general the development model of quality of existing nursing care refers to a comprehensive system of quality.
Sagherian, Knar; Clinton, Michael E; Abu-Saad Huijer, Huda; Geiger-Brown, Jeanne
Hospital nurses are expected to maintain optimal work performance; yet, fatigue can threaten safe practice and result in unfavorable patient outcomes. This descriptive cross-sectional study explored the association between fatigue, work schedules, and perceived work performance among nurses. The study sample included 77 bedside nurses who were mostly female, single, and between 20 and 29 years of age. The majority worked 8-hour shifts and overtime. Nurses who worked during off days reported significantly higher chronic fatigue compared with those nurses who took time off. Nurses who reported feeling refreshed after sleep had significantly less chronic and acute fatigue and more intershift recovery. Nurses with acute and chronic fatigue perceived poorer physical performance. Also, nurses who reported chronic fatigue perceived they were less alert and less able to concentrate when providing patient care. Less effective communication was also associated with acute and chronic fatigue. In conclusion, fatigue has safety implications for nurses' practice that should be monitored by nursing management.
Crawford, D I
Women managers in business and health care have experienced discrimination related to advancement in management. Nurse executives must understand the strategies to overcome the barriers, the "glass ceiling," as well as implications for future practice. Women executives need an organized blueprint and the tools to dismantle the glass ceiling and overcome the political and discriminatory barriers to success.
Li, Xiao-Qin; Sun, Chao-Feng; Guo, Mei
To investigate the benefits of nursing care service in the assisted reproduction clinic to self-cycle-management and self-efficiency of the outpatients with infertility. We randomly divided 600 females preliminarily diagnosed with infertility into a control and an experimental group, 288 in the former and 285 in the latter group excluding those whose husbands had azoospermia. For the women patients of the experimental group, we conducted nursing care intervention concerning related knowledge, skills, diet, excise, medication, and psychology, by one-to-one consultation, individualized or group communication, establishing files, telephone follow-up, and wechat guidance. After 3 months of intervention, we compared the compliance of medical visits, effectiveness of cycle management, sense of self-efficiency, satisfaction, and anxiety score between the two groups of patients. In comparison with the controls, the patients of the experimental group showed significantly better knowledge about assisted reproduction and higher effectiveness of self-cycle-management, self-efficiency, and satisfaction (P <0.05), but a markedly lower degree of anxiety (P <0.05). Nursing care service in the assisted reproduction clinic can improve the compliance of medical visits, effectiveness of self-cycle-management, self-efficiency, and satisfaction and reduce the anxiety of the patients.
Vincent, Corita; Hall, Peter; Ebsary, Sally; Hannay, Scott; Hayes-Cardinal, Lynn; Husein, Nadira
Diabetes care in the long-term care (LTC) setting is complicated by increased prevalence of comorbidities, age-related changes in medication tolerance, frailty and limited resources. Registered nurses (RNs), registered practical nurses (RPNs) and personal support workers (PSWs) are responsible for front-line diabetes care; however, there is limited formal diabetes education in this setting. The current study aimed to assess the knowledge confidence and desire for additional diabetes education among nurses and PSWs in the LTC setting. We studied 89 RNs, RPNs and PSWs (Mage=43.6, 94.3% female) in 2 LTC facilities in the Kitchener-Waterloo area who participated in an online survey assessing knowledge and confidence in 6 key areas of diabetes care (nutrition, insulin, oral medications, hypoglycemia, hyperglycemia and sick-day management). Interest in further diabetes education was also explored. Self-rated knowledge and confidence were generally moderate to high, ranging from 46% to 79% being moderately to very knowledgeable and from 61% to 74% being moderately to very confident. Knowledge and confidence was highest for nutrition and management of hypo- and hyperglycemia and lower for sick-day management, oral medications and insulin. There were significant differences between clinicians such that PSWs reported less knowledge and confidence than RNs and RPNs on most parameters. Among the whole sample, 85% wanted education about diabetes, and this rate did not vary by occupation. The most commonly reported areas for additional education concerning diabetes were for management of hypo- and hyperglycemia (30% to 31%) and insulin (31%). Overall, the findings indicate moderate levels of self-rated knowledge across diabetes care areas; however, most clinicians feel there is room for more diabetes-care education, particularly regarding insulin and management of hypo- and hyperglycemia. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights
Scalzi, C C; Wilson, D L; Ebert, R
This article presents the results of a national survey of job activities of corporate level occupational health nurse managers. The survey was designed to identify the relative amount of time spent and importance attributed to specific areas of their current job. In general this sample tended to have more management experience and educational preparation than previously cited studies: over 50% had completed a graduate degree. The scores for importance and time spent were highly correlated. That is, occupational health corporate nurse managers seemed to allocate their time to job responsibilities they considered most important. Management activities related to policy, practice standards, quality assurance, staff development, and systems for client care delivery appear to represent the core responsibilities of occupational health nursing management. Curriculum recommendations for management positions in occupational health include: health policy, program planning, and evaluation; business strategy; applications of management information systems; quality assurance; and marketing.
Sprakes, Kate; Tyrer, Julie
Wound and pressure ulcer prevention are key quality indicators of nursing care. This article describes a collaborative project between a community skin care service and a nursing home. The aim of the project was to establish whether the implementation of a wound and pressure ulcer management competency framework within a nursing home would improve patient outcomes and reduce the severity and number of wounds and pressure ulcers. Following the project's implementation, there was a reduction in the number of wounds and pressure ulcers, hospital admissions and district nursing visits. Nursing home staff also reported an increase in their knowledge and skills.
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Full Text Available Introduction: Penitentiary Nursing has experienced during the last decades a deep transformation similar to that experienced by the rest of the Nursing. However, there is a great distance from the protective legislation. Objective: To analyze the main legal documents which regulate the functions of Penitentiary Nursing and to compare it with the health care reality of nurses in Spanish prisons. Methodology: Narrative bibliographic review based on various sources such as Medline, Cuiden, Scielo, Dialnet, etc. Results: Is selected 43 documents, due to its relevance with the theme object of study. Is rejected 4 articles for lack of the same. Analyzed documents regarding legal framework and functions of nursing in prisons in its different sections (health care, teaching, research and management. Conclusion: The functions currently carried out in prisons are the ones provided for by health care legislation outside the prison context, along with the internal administrative regulations established by prisons. The possibility should be reconsidered of integrating Prison Healthcare into the Public Healthcare System so as to guarantee equality of healthcare for persons deprived of liberty and to provide the same rights and obligations to health professionals working in this sector.
Penitentiary Nursing has experienced during the last decades a deep transformation similar to that experienced by the rest of the Nursing. However, there is a great distance from the protective legislation. To analyze the main legal documents which regulate the functions of Penitentiary Nursing and to compare it with the health care reality of nurses in Spanish prisons. Narrative bibliographic review based on various sources such as Medline, Cuiden, Scielo, Dialnet, etc. Is selected 43 documents, due to its relevance with the theme object of study. Is rejected 4 articles for lack of the same. Analyzed documents regarding legal framework and functions of nursing in prisons in its different sections (health care, teaching, research and management). The functions currently carried out in prisons are the ones provided for by health care legislation outside the prison context, along with the internal administrative regulations established by prisons. The possibility should be reconsidered of integrating Prison Healthcare into the Public Healthcare System so as to guarantee equality of healthcare for persons deprived of liberty and to provide the same rights and obligations to health professionals working in this sector.
Raymond, Anita; Lee, Susan F; Bloomer, Melissa J
To investigate nurses' roles and responsibilities in providing bereavement care during the care of dying patients within acute care hospitals. Bereavement within acute care hospitals is often sudden, unexpected and managed by nurses who may have limited access to experts. Nurses' roles and experience in the provision of bereavement care can have a significant influence on the subsequent bereavement process for families. Identifying the roles and responsibilities, nurses have in bereavement care will enhance bereavement supports within acute care environments. Mixed-methods systematic review. The review was conducted using the databases Cumulative Index Nursing and Allied Health Literature Plus, Embase, Ovid MEDLINE, PsychINFO, CareSearch and Google Scholar. Included studies published between 2006-2015, identified nurse participants, and the studies were conducted in acute care hospitals. Seven studies met the inclusion criteria, and the research results were extracted and subjected to thematic synthesis. Nurses' role in bereavement care included patient-centred care, family-centred care, advocacy and professional development. Concerns about bereavement roles included competing clinical workload demands, limitations of physical environments in acute care hospitals and the need for further education in bereavement care. Further research is needed to enable more detailed clarification of the roles nurse undertake in bereavement care in acute care hospitals. There is also a need to evaluate the effectiveness of these nursing roles and how these provisions impact on the bereavement process of patients and families. The care provided by acute care nurses to patients and families during end-of-life care is crucial to bereavement. The bereavement roles nurses undertake are not well understood with limited evidence of how these roles are measured. Further education in bereavement care is needed for acute care nurses. © 2016 John Wiley & Sons Ltd.
Tiessen, Ans H.; Smit, Andries J.; Broer, Jan; Groenier, Klaas H.; van der Meer, Klaas
Background: Treatment goals for cardiovascular risk management are generally not achieved. Specialized practice nurses are increasingly facilitating the work of general practitioners and self-monitoring devices have been developed as counseling aid. The aim of this study was to compare standard
Everingham, Kirsty; Fawcett, Tonks; Walsh, Tim
To discuss the findings from a phenomenological study that provides insights into the intensive care nurses' 'world' following changes in the sedation management of patients in an intensive care unit. Intensive care sedation practices have undergone significant changes. Patients, where possible, are now managed on lighter levels of sedation, often achieved through the performance of sedation holds (SHs). The performance of SHs is normally carried out by the bedside nurse but compliance is reported to be poor. There has been little exploration of the nurses' experiences of these changes and the implications of SHs and subsequent wakefulness on their delivery of care. Following ethical approval, 16 intensive care nurses, experienced and inexperienced, from within a general intensive care unit. A Heideggerian phenomenological approach was used. Data collection consisted of interviews guided by an aide memoir and a framework adapted from Van Manen informed the analysis. The findings reveal new insights into the world of the intensive care nurse in the light of the changes to sedation management. They demonstrate that there have been unforeseen outcomes from well-intentioned initiatives to improve the quality of patients' care. There were implications from the changes introduced for the nurses care delivery. The main themes that emerged were 'working priorities' and 'unintended consequences', in turn revealing embedded tensions between evidence-based targets and holistic care. Intensive care nurses find that the current approach to the changes in sedation management can threaten their professional obligation and personal desire to provide holistic care. The 'targeted' approach by healthcare organisations is perceived to militate against the patient-centred care they want to deliver. Sedation management is complex and needs further consideration particularly the potential constraints 'target-led' care has on nursing practice. © 2013 Blackwell Publishing Ltd.
Gusdal, Annelie K; Josefsson, Karin; Thors Adolfsson, Eva; Martin, Lene
Support from the family positively affects self-management, patient outcomes and the incidence of hospitalizations among patients with heart failure. To involve family members in heart failure care is thus valuable for the patients. Registered nurses frequently meet family members of patients with heart failure and the quality of these encounters is likely to be influenced by the attitudes registered nurses hold toward families. To explore registered nurses' attitudes toward the importance of families' involvement in heart failure nursing care and to identify factors that predict the most supportive attitudes. Cross-sectional, multicentre web-survey study. A sample of 303 registered nurses from 47 hospitals and 30 primary health care centres completed the instrument Families' Importance in Nursing Care - Nurses' Attitudes. Overall, registered nurses were supportive of families' involvement. Nonetheless, attitudes toward inviting families to actively take part in heart failure nursing care and involve families in planning of care were less supportive. Factors predicting the most supportive attitudes were to work in a primary health care centre, a heart failure clinic, a workplace with a general approach toward families, to have a postgraduate specialization, education in cardiac and/or heart failure nursing care, and a competence to work with families. Experienced registered nurses in heart failure nursing care can be encouraged to mentor their younger and less experienced colleagues to strengthen their supportive attitudes toward families. Registered nurses who have designated consultation time with patients and families, as in a nurse-led heart failure clinic, may have the most favourable condition for implementing a more supportive approach to families.
Alharbi, Jalal; Wilson, Rhonda; Woods, Cindy; Usher, Kim
The aim of the study was to explore the prevalence of burnout and job satisfaction among Saudi national critical care nurses. Burnout is caused by a number of factors, including personal, organisational and professional issues. Previous literature reports a strong relationship between burnout and job satisfaction among critical care nurses. Little is known about this phenomenon among Saudi national critical care nurses. A convenience sample of 150 Saudi national critical care nurses from three hospitals in Hail, Saudi Arabia were included in a cross-sectional survey. Saudi national critical care registered nurses reported moderate to high levels of burnout in the areas of emotional exhaustion and depersonalisation. Participants also reported a feeling of ambivalence and dissatisfaction with their jobs but were satisfied with the nature of their work. Saudi national critical care nurses experience moderate to high levels of burnout and low levels of job satisfaction. Burnout is a predictor of job satisfaction for Saudi national critical care nurses. These results provide clear evidence of the need for nurse managers and policy makers to devise strategies to help nurses better cope with a stressful work environment, thereby also improving job satisfaction among Saudi national critical care nurses. © 2016 John Wiley & Sons Ltd.
Miltner, Rebecca S; Jukkala, Angela; Dawson, Martha A; Patrician, Patricia A
Nurse managers have a key role in creating positive work environments where safe, high-quality care is consistently provided. This requires a broad range of skills to be successful within today's complex health care environment; however, managers are frequently selected based on their clinical expertise and are offered little formal preparation for this leadership role. We conducted three focus groups with 20 nurse managers to understand their professional development needs. Transcripts were analyzed using conventional content analysis. Three themes emerged: Managing Versus Leading, Gaining a Voice, and Garnering Support. Managers focused on daily tasks, such as matching staffing to patient needs. However, the data suggested gaps in foundational management skills, such as understanding organizational behavior, use of data to make decisions, and refined problem-solving skills. Professional development activities focusing on higher level leadership competencies could assist managers to be more successful in this challenging, but critical, role. Copyright 2015, SLACK Incorporated.
Minton, Claire; Batten, Lesley
With consideration of an environmental concept, this paper explores evidence related to the negative impacts of the intensive care unit environment on patient outcomes and explores the potential counteracting benefits of 'nature-based' nursing interventions as a way to improve care outcomes. The impact of the environment in which a patient is nursed has long been recognised as one determinant in patient outcomes. Whilst the contemporary intensive care unit environment contains many features that support the provision of the intensive therapies the patient requires, it can also be detrimental, especially for long-stay patients. This narrative review considers theoretical and evidence-based literature that supports the adoption of nature-based nursing interventions in intensive care units. Research and theoretical literature from a diverse range of disciplines including nursing, medicine, psychology, architecture and environmental science were considered in relation to patient outcomes and intensive care nursing practice. There are many nature-based interventions that intensive care unit nurses can implement into their nursing practice to counteract environmental stressors. These interventions can also improve the environment for patients' families and nurses. Intensive care unit nurses must actively consider and manage the environment in which nursing occurs to facilitate the best patient outcomes. © 2015 John Wiley & Sons Ltd.
Boyle, Vicki L; Roychoudhury, Canopy; Beniak, Renee; Cohn, Lisa; Bayer, Albert; Katz, Ira
Depression is a common disorder associated with suffering, morbidity, and mortality in nursing home residents. It is treatable, and improving the quality of treatment can have a major impact. MPRO, Michigan's Quality Improvement Organization, initiated a quality-improvement project in 14 nursing facilities to improve the accuracy of assessments, targeting, and monitoring of care. Electronic Minimum Data Set (MDS) data and medical-record abstraction results were combined to form the analytic dataset. Findings from the baseline phase demonstrated that, according to medical and administrative records, 26% of newly admitted nursing home residents had symptoms of depression that were apparent at admission, and an additional 12% were recognized early in their stay. Eighty-one percent of residents with depression were receiving treatment on admission to the facility, and 79% of those with depression recognized by Day 14 were treated by then. These data demonstrate progress toward improving the initiation of treatment for depression in nursing homes; however, there are still opportunities for improving the quality of care and, especially, the quality of assessments. The authors recommend the addition of the Geriatric Depression Scale to the federally mandated MDS for cognitively intact patients. There could also be mechanisms to ensure that providers and facilities follow recommended practice guidelines. Initiating treatment with antidepressant medications should be followed with monitoring of residents to identify those who still have depressive symptoms and to modify or intensify their treatment.
Erlingmark, Julia; Hedström, Mariann; Lindberg, Magnus
Current trends in renal anaemia management place greater emphasis, and thus increased workload, on the role of the nurse in haemodialysis settings. However, there is little evidence that demonstrates the relationship between nurse staffing and patient outcomes. To describe nurse staffing in haemodialysis settings, its relationship with target levels of renal anaemia management and to describe target level achievement for different ways of organising anaemia management. Cross-sectional audit. Forty (out of 78) haemodialysis centres in Sweden reported quality assurance data. The numbers of bedside registered nurses, licensed nurse assistants and patients undergoing haemodialysis during a predefined morning shift; type of anaemia management and achieved target levels of anaemia management. The mean patient:registered nurse ratio was 2.4 and the mean patient:nurse assistant ratio was 12.8. There were no significant relationships between registered nurse staffing and target level achievement. On average, 45.6% of the patients had haemoglobin within the target levels at centres applying nurse-driven anaemia management, compared with 47.3% at physician-driven centres. These cross-sectional data suggest that renal anaemia outcomes are unrelated to the patient:registered nurse ratio. There is, however, room for improvement in renal anaemia management in the units included in this study, particularly the achievement of target levels of haemoglobin and transferrin saturation. © 2016 European Dialysis and Transplant Nurses Association/European Renal Care Association.
Jones, Liz; Taylor, Tara; Watson, Bernadette; Fenwick, Jennifer; Dordic, Tatjana
Nursing staff are an important source of support for parents of a hospitalized preterm infant. This study aimed to describe parents' and nurses' perceptions of communicating with each other in the context of the special care nursery. A qualitative descriptive design was employed. Thirty two parents with a newborn admitted to one of two special care nurseries in Queensland, Australia participated, and 12 nurses participated in semi-structured interviews. Thematic analysis was used to analyze the interviews. Nurses and parents focused on similar topics, but their perceptions differed. Provision of information and enabling parenting were central to effective communication, supported by an appropriate interpersonal style by nurses. Parents described difficulties accessing or engaging nurses. Managing enforcement of policies was a specific area of difficulty for both parents and nurses. The findings indicated a tension between providing family-centered care that is individualized and based on family needs and roles, and adhering to systemic nursery policies. Copyright © 2015 Elsevier Inc. All rights reserved.
Kuethe, Maarten C.; Vaessen-Verberne, Anja A. P. H.; Elbers, Roy G.; van Aalderen, Wim M. C.
Background Asthma is the most common chronic disease in childhood and prevalence is also high in adulthood, thereby placing a considerable burden on healthcare resources. Therefore, effective asthma management is important to reduce morbidity and to optimise utilisation of healthcare facilities.
Johnson, K A; Valdez, R S; Casper, G R; Kossman, S P; Carayon, P; Or, C K L; Burke, L J; Brennan, P F
The infusion of health care technologies into the home leads to substantial changes in the nature of work for home care nurses and their patients. Nurses and nursing practice must change to capitalize on these innovations. As part of a randomized field experiment evaluating web-based support for home care of patients with chronic heart disease, we engaged nine nurses in a dialogue about their experience integrating this modification of care delivery into their practice. They shared their perceptions of the work they needed to do and their perceptions and expectations for patients and themselves in using technologies to promote and manage self-care. We document three overarching themes that identify preexisting factors that influenced integration or represent the consequences of technology integration into home care: doing tasks differently, making accommodations in the home for devices and computers, and being mindful of existing expectations and skills of both nurses and patients.
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Erdmann, A L; de Andrade, S R; de Mello, A L Ferreira; Klock, P; do Nascimento, K C; Koerich, M Santos; Backes, D Stein
The present study considers the production of knowledge and the interactions in the environment of research and their relationships in the system of caring in nursing and health. To elaborate a theoretical model of the organization of the practices used for caring, based on the experiences made by the research groups of administration and management in nursing, in Brazil. The study is based on grounded theory. Twelve leaders of research groups, working as professors in public universities in the south and the south-east of Brazil, distributed in sample groups, were interviewed. The core phenomenon 'research groups of administration and management in nursing: arrangements and interactions in the system of caring in nursing' was derived from the categories: conceptual bases and contexts of the research groups; experiencing interactions in the research groups; functionality of the research groups; and outputs of the research groups. The research groups are integrated in the system of caring in nursing. The activities of the Brazilian administration and management in nursing research groups are process oriented and in a process of constant renovation, socially relevant, operate in a complex scenario and contribute to the advancement of the organizations of the system of caring in nursing through strengthening the connection among academia, service and community. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.
Ana Paula da Silva Morais
Full Text Available Objective: to analyze the evidence of the literature about pain management during arterial puncture, venous and capillary in the newborn that received non-pharmacological measures before the painful procedure. Methods: this is an integrative review performed in databases. Initially, 120 articles were selected being a sample composed of ten articles. Data were collected in forms. Results: orally glucose was the most used method followed by breast milk and contact measures and the use of glucose associated or not to breast milk and contact measures. Conclusion: the use of non-pharmacological methods has been proven effective to promote the relief of pain in newborns.
Titzer, Jennifer L; Shirey, Maria R
The current nursing leadership pipeline is inadequate and demands strategic succession planning methods. This article provides concept clarification regarding nurse manager succession planning. Attributes common to succession planning include organizational commitment and resource allocation, proactive and visionary leadership approach, and a mentoring and coaching environment. Strategic planning, current and future leadership analysis, high-potential identification, and leadership development are succession planning antecedents. Consequences of succession planning are improved leadership and organizational culture continuity, and increased leadership bench strength. Health care has failed to strategically plan for future leadership. Developing a strong nursing leadership pipeline requires deliberate and strategic succession planning. © 2013 Wiley Periodicals, Inc.
Harrod, Molly; Montoya, Ana; Mody, Lona; McGuirk, Helen; Winter, Suzanne; Chopra, Vineet
To understand the perceived preparedness of frontline nurses (registered nurses (RNs), licensed practical nurses (LPNs)), unit nurse managers, and skilled nursing facility (SNF) administrators in providing care for residents with peripherally inserted central catheters (PICCs) in SNFs. Exploratory, qualitative pilot study. Two community based SNFs. Residents with PICCs, frontline nurses (RNs, LPNs), unit nurse managers, and SNF administrators. Over 36 weeks, 56 residents with PICCs and their nurses were observed and informally interviewed, focusing on PICC care practices and documentation. In addition, baseline PICC data were collected on placement indication (e.g., antimicrobial administration), placement setting (hospital vs SNF), and dwell time. Focus groups were then conducted with frontline nurses and unit nurse managers, and semistructured interviews were conducted with SNF administrators to evaluate perceived preparedness for PICC care. Data were analyzed using a descriptive analysis approach. Variations in documentation were observed during weekly informal interviews and observations. Differences were noted between resident self-reported PICC concerns (quality of life) and those described by frontline nurses. Deficiencies in communication between hospitals and SNFs with respect to device care, date of last dressing change, and PICC removal time were also noted. During focus group sessions, perceived inadequacy of information at the time of care transitions, limited availability of resources to care for PICCs, and gaps in training and education were highlighted as barriers to improving practice and safety. Practices for PICC care in SNFs can be improved. Multimodal strategies that enhance staff education, improve information exchange during care transitions, and increase resource availability in SNFs appear necessary to enhance PICC care and safety. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.
Lammintakanen, Johanna; Saranto, Kaija; Kivinen, Tuula
The purpose of this study is to describe nurse managers' perceptions of the use of electronic information systems in their daily work. Several kinds of software are used for administrative and information management purposes in health care organizations, but the issue has been studied less from nurse managers' perspective. The material for this qualitative study was acquired according to the principles of focus group interview. Altogether eight focus groups were held with 48 nurse managers from both primary and specialized health care organizations. The nurse managers were asked in focus groups to describe the use of information systems in their daily work in addition to some other themes. The material was analyzed by inductive content analysis using ATLAS.ti computer program. The main category "pros and cons of using information systems in nursing management" summarized the nurse managers' perceptions of using electronic information systems. The main category consisted of three sub-categories: (1) nurse managers' perceptions of the use of information technology; (2) usability of management information systems; (3) development of personnel competencies and work processes. The nurse managers made several comments on the implementation of immature electronic information systems which caused inefficiencies in working processes. However, they considered electronic information systems to be essential elements of their daily work. Furthermore, the nurse managers' descriptions of the pros and cons of using information systems reflected partly the shortcomings of strategic management and lack of coordination in health care organizations. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
The increasing number of ethical issues highlighted in everyday nursing care demonstrates the connectedness between nursing ethics and nursing practice. However, what is the role of ethical theories in this context? This question will be examined in this article by analysing the contribution made by the ethics of care, in particular in understandings of gender roles, asymmetries of power, professional knowledge and experience. The adoption and criticism of an emergent nursing ethics is discussed and stated from different viewpoints. The actuality of the caring approach is affirmed by a new reading of the given situation. This article first describes the traditional perception of nurses as marginalised actors in the health sector. By making reference to the current and growing global scarcity of nursing care, it contends that nursing will no longer be marginalised, but instead at the centre of public health attention and reputation. Nevertheless, marginalisation will persist by increasingly affecting the care receivers, especially those groups that are pushed to the fringes by the consequences of the healthcare market, such as persons of extreme old age, suffering from multiple morbidities, or with poor health literacy. Whereas the "classical" understanding of the ethics of care focuses on the nurse-patient relationship and on individual care and understanding of ethics, the new understanding confirms the classical, but adds an understanding of social ethics: caring for the access to care is seen as a main ethical goal of social justice within a nursing ethic.
Wittenberg-Lyles, Elaine; Goldsmith, Joy; Ferrell, Betty
Although quality communication has been identified as a necessary component to cancer care, communication skills training programs have yet to focus on the unique role of nurses. This study explored communication barriers as reported by seven nurse managers to better identify communication skills needed for oncology nurses to practice patient-centered care. Thematic analysis of transcripts was used to identify barriers to patient and family communication and desirable patient-centered nursing communication skills. Overall, the nurse managers reported that nurses experience patient and family communication difficulties as a result of inconsistent messages to patients and family from other healthcare staff. Physician assumptions about nursing left nurses feeling uncomfortable asking for clarification, creating a barrier to team communication processes. Patient-centered communication and care cannot be actualized for nurses unless team roles are clarified and nurses receive training in how to communicate with physicians, patients, and family. Therefore, the authors of this article created the COMFORT communication training protocol, and key concepts and resources for nurse communication training through COMFORT are detailed in this article.
Kleinpell, Ruth; Barden, Connie; Rincon, Teresa; McCarthy, Mary; Zapatochny Rufo, Rebecca J
Information on the impact of tele-intensive care on nursing and priority areas of nursing care is limited. To conduct a national benchmarking survey of nurses working in intensive care telemedicine facilities in the United States. In a 2-phased study, an online survey was used to assess nurses' perceptions of intensive care telemedicine, and a modified 2-round Delphi study was used to identify priority areas of nursing. In phase 1, most of the 1213 respondents agreed to strongly agreed that using tele-intensive care enables them to accomplish tasks more quickly (63%), improves collaboration (65.9%), improves job performance (63.6%) and communication (60.4%), is useful in nursing assessments (60%), and improves care by providing more time for patient care (45.6%). Benefits of tele-intensive care included ability to detect trends in vital signs, detect unstable physiological status, provide medical management, and enhance patient safety. Barriers included technical problems (audio and video), interruptions in care, perceptions of telemedicine as an interference, and attitudes of staff. In phase 2, 60 nurses ranked 15 priority areas of care, including critical thinking skills, intensive care experience, skillful communication, mutual respect, and management of emergency patient care. The findings can be used to further inform the development of competencies for tele-intensive care nursing, match the tele-intensive care nursing practice guidelines of the American Association of Critical-Care Nurses, and highlight concepts related to the association's standards for establishing and sustaining healthy work environments. ©2016 American Association of Critical-Care Nurses.
Nov 3, 2010 ... non-nursing jobs which offer better salaries, more job satisfaction and better working hours (Ehlers. 2003:81) further ..... had advantages. Older nurses brought the human touch, while the younger nurses completed tasks expeditiously. Some of the responses that attest to these standpoints are: 'The older ...
Huisman-de Waal, Getty; Feo, Rebecca; Vermeulen, Hester; Heinen, Maud
The aim of the study is to explore the perspectives of nursing students on their education concerning basic nursing care, learned either during theoretical education or clinical placement, with a specific focus on nutrition and communication. Basic care activities lie at the core of nursing, but are ill-informed by evidence and often poorly delivered. Nursing students' education on basic care might be lacking, and the question remains how they learn to deliver basic care in clinical practice. Descriptive study, using an online questionnaire. Nursing students at the vocational and bachelor level of six nursing schools in the Netherlands were invited to complete an online questionnaire regarding their perception of basic nursing care education in general (both theoretical education and clinical placement), and specifically in relation to nutrition and communication. Nursing students (n=226 bachelor students, n=30 vocational students) completed the questionnaire. Most students reported that they learned more about basic nursing care during clinical placement than during theoretical education. Vocational students also reported learning more about basic nursing care in both theoretical education and clinical practice than bachelor students. In terms of nutrition, low numbers of students from both education levels reported learning about nutrition protocols and guidelines during theoretical education. In terms of communication, vocational students indicated that they learned more about different aspects of communication during clinical practice than theoretical education, and were also more likely to learn about communication (in both theoretical education and clinical practice) than were bachelor students. Basic nursing care seems to be largely invisible in nursing education, especially at the bachelor level and during theoretical education. Improved basic nursing care will enhance nurse sensitive outcomes and patient satisfaction and will contribute to lower healthcare
Scardina, S A
Rising health care costs and competition among hospital facilities have resulted in the need to recognize patient satisfaction as an important indicator of quality care. Nurses provide the primary service to patients; therefore, their role is influential in overall satisfaction. Several instruments have been developed to measure patient satisfaction with nursing care; however, most of them focus only on patient perceptions. One such approach to evaluating patient satisfaction with nursing care involves an instrument, SERVQUAL, derived from a marketing service perspective. Adapting SERVQUAL for use in evaluating nursing care is the focus of this article. SERVQUAL assesses both patient perceptions and expectations of quality service and permits managers and clinicians to view the gaps between the two; thus, the overall areas of improvement in nursing services can be determined.
Schenin-King, Palmyre; Thomas, Fanny; Braha-Zeitoun, Sonia; Bouaziz, Noomane; Januel, Dominique
Therapies based on cognitive remediation integrate psychiatric care. Cognitive remediation helps to ease cognitive disorders and enable patients to improve their day-to-day lives. It is essential to complete nurses' training in this field. This article presents the example of a patient with schizophrenia who followed the Cognitive Remediation Therapy programme, enabling him to access mainstream employment. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Labrague, Leodoro J; McEnroe-Petitte, Denise M; Achaso, Romeo H; Cachero, Geifsonne S; Mohammad, Mary Rose A
This study was to explore the perceptions of Filipino nurses' spirituality and the provision of spiritual nursing care. A descriptive, cross-sectional, and quantitative study was adopted for this study. The study was conducted in the Philippines utilizing a convenience sample of 245 nurses. Nurses' Spirituality and Delivery of Spiritual Care (NSDSC) was used as the main instrument. The items on NSDSC with higher mean scores related to nurses' perception of spirituality were Item 7, "I believe that God loves me and cares for me," and Item 8, "Prayer is an important part of my life," with mean scores of 4.87 (SD = 1.36) and 4.88 (SD = 1.34), respectively. Items on NSDSC with higher mean scores related to the practice of spiritual care were Item 26, "I usually comfort clients spiritually (e.g., reading books, prayers, music, etc.)," and Item 25, "I refer the client to his/her spiritual counselor (e.g., hospital chaplain) if needed," with mean scores of 3.16 (SD = 1.54) and 2.92 (SD = 1.59). Nurse's spirituality correlated significantly with their understanding of spiritual nursing care (r = .3376, p ≤ .05) and delivery of spiritual nursing care (r = .3980, p ≤ .05). Positive significant correlations were found between understanding of spiritual nursing care and delivery of spiritual nursing care (r = .3289, p ≤ .05). For nurses to better provide spiritual nursing care, they must care for themselves through self-awareness, self-reflection, and developing a sense of satisfaction and contentment. © The Author(s) 2015.
Dahlke, Sherry Ann; Phinney, Alison; Hall, Wendy Ann; Rodney, Patricia; Baumbusch, Jennifer
The increased incidence of health challenges with aging means that nurses are increasingly caring for older adults, often in hospital settings. Research about the complexity of nursing practice with this population remains limited. To seek an explanation of nursing practice with hospitalised older adults. Design. A grounded theory study guided by symbolic interactionism was used to explore nursing practice with hospitalised older adults from a nursing perspective. Glaserian grounded theory methods were used to develop a mid-range theory after analysis of 375 hours of participant observation, 35 interviews with 24 participants and review of selected documents. The theory of orchestrating care was developed to explain how nurses are continuously trying to manage their work environments by understanding the status of the patients, their unit, mobilising the assistance of others and stretching available resources to resolve their problem of providing their older patients with what they perceived as 'good care' while sustaining themselves as 'good' nurses. They described their practice environments as hard and under-resourced. Orchestrating care is comprised of two subprocesses: building synergy and minimising strain. These two processes both facilitated and constrained each other and nurses' abilities to orchestrate care. Although system issues presented serious constraints to nursing practice, the ways in which nurses were making meaning of their work environment both aided them in managing their challenges and constrained their agency. Nurses need to be encouraged to share their important perspective about older adult care. Administrators have a role to play in giving nurses voice in workplace committees and in forums. Further research is needed to better understand how multidisciplinary teams influence care of hospitalized older adults. © 2014 John Wiley & Sons Ltd.
Construction of a new model of job engagement, psychological empowerment and perceived work environment among Chinese registered nurses at four large university hospitals: implications for nurse managers seeking to enhance nursing retention and quality of care.
Fan, Yuying; Zheng, Qiulan; Liu, Shiqing; Li, Qiujie
To explore the relationships among perceived work environment, psychological empowerment and job engagement of clinical nurses in Harbin, China. Previous studies have focused on organisational factors or nurses' personal characteristics contributing to job engagement. Limited studies have examined the effects of perceived work environment and psychological empowerment on job engagement among Chinese nurses. A cross-sectional quantitative survey with 923 registered nurses at four large university hospitals in China was carried out. Research instruments included the Chinese versions of the perceived nurse work environment scale, the psychological empowerment scale and the job engagement scale. The relationships of the variables were tested using structural equation modelling. Structural equation modelling revealed a good fit of the model, χ(2) /df = 4.46, GFI = 0.936, CFI = 0.957. Perceived work environment was a significant positive direct predictor of psychological empowerment and job engagement. Psychological empowerment was a significant positive direct contributor to job engagement and had a mediating effect on the relationship between perceived work environment and job engagement. Perceived work environment may result in increased job engagement by facilitating the development of psychological empowerment. For nurse managers wishing to increase nurse engagement and to achieve effective management, both perceived work environment and psychological empowerment are factors that need to be well controlled in the process of nurse administration. © 2016 John Wiley & Sons Ltd.
Navarro, V B; Stout, W A; Tolley, F M
Traditional service configuration with separate nursing units for outpatient and inpatient care is becoming ineffective for new patient care delivery models. With the new configuration of a combined nursing unit, it was necessary to rethink traditional reporting methodologies and calculation of hours of care. This project management plan is an initial attempt to develop a standard costing/productivity model for a combined unit. The methodology developed from this plan measures nursing care hours for each patient population to determine the number of full time equivalents (FTEs) for a combined unit and allocates FTEs based on inpatient (IP), outpatient (OP), and emergency room (ER) volumes.
Goldie, Christine; Brown, Jenny
Obesity is a complex problem and often difficult to tackle in primary care. A year-long pilot of a practice nurse-led scheme that used a holistic approach towards self-care in obesity management was set up to reduce the cardiovascular risk of patients who were obese and improve their quality of life. This person-centred approach may offer an important tool in the management of these patients in the GP surgery.
Peter Mathieu Van Bogaert
Full Text Available Key words: burnout,job satisfaction, nurse retention, nurse practice environment,quality of care, acute health care,structural equation modelling. Aim:To explore the mechanisms through which nurse practice environment dimensions are associated with job outcomes and nurse-assessed quality of care. Mediating variables tested included nurse work characteristics of workload, social capital, decision latitude, as well as work engagement dimensions of vigor, dedication and absorption.Background: Understanding to support and guide the practice community in their daily effort to answer most accurate complex care demands along with a stable nurse workforce are challenging.Design: Cross-sectional survey.Method:Based on previous empirical findings,a structural equation model designed with valid measurement instruments was tested.The study population was registered acute care hospital nurses(N = 1201 in twoindependent hospitals and one hospital group with six hospitals in Belgium.Results: Nurse practice environment dimensions predicted job outcome variables and nurse ratings of quality of care.Analyses were consistent with features of nurses’ work characteristics including perceived workload,decision latitude,and social capital,as well as three dimension of work engagement playing mediating roles between nurse practice environment and outcomes.A revised model adjusted using various fit measures explained 60 % and 47 % of job outcomes and nurse - assessed quality of care,respectively.Conclusion: Study findings show that aspects of nurse work characteristics such as workload,decision latitude and social capital along with nurse work engagement(e.g.vigor, dedication and absorption play a role between how various stakeholders such as executives,nurse managers and physicians will organize care and how nurses perceive job outcomes and quality of care.
Kim, Kyoung-Ja; Yoo, Moon Sook; Seo, Eun Ji
This study aimed to explore the influence of nurse work environment and patient safety culture in hospital on instances of missed nursing care in South Korea. A cross-sectional design was used, in which a structured questionnaire was administered to 186 nurses working at a tertiary university hospital. Data were analyzed using descriptive statistics, t-test or ANOVA, Pearson correlation and multiple regression analysis. Missed nursing care was found to be correlated with clinical career, nursing work environment and patient safety culture. The regression model explained approximately 30.3 % of missed nursing care. Meanwhile, staffing and resource adequacy (β = -.31, p = .001), nurse manager ability, leadership and support of nurses (β = -.26, p = .004), clinical career (β = -.21, p = .004), and perception on patient safety culture within unit (β = -.19, p = .041) were determined to be influencing factors on missed nursing care. This study has significance as it suggested that missed nursing care is affected by work environment factors within unit. This means that missed nursing care is a unit outcome affected by nurse work environment factors and patient safety culture. Therefore, missed nursing care can be managed through the implementation of interventions that promote a positive nursing work environment and patient safety culture. Copyright © 2018. Published by Elsevier B.V.
Kebede, Mihiretu; Endris, Yesuf; Zegeye, Desalegn Tegabu
Even though nursing care documentation is an important part of nursing practice, it is commonly left undone. The objective of this study was to assess nursing care documentation practice and the associated factors among nurses who are working at the University of Gondar Hospital. An institution-based cross-sectional study was conducted among 220 nurses working at the University of Gondar Hospital inpatient wards from March 20 to April 30, 2014. Data were collected using a structured and pre-tested self-administered questionnaire. Data were entered into Epi Info version 7 and analyzed with SPSS version 20. Descriptive statistics, bivariate, and multivariate logistic regression analyses were carried out. Two hundred and six nurses returned the questionnaire. Good nursing care documentation practice among nurses was 37.4%. A low nurse-to-patient ratio AOR = 2.15 (95%CI [1.155, 4.020]), in-service training on standard nursing process AOR = 2.6 (95%CI[1.326, 5.052]), good knowledge AOR = 2.156(95% CI [1.092, 4.254]), and good attitude toward nursing care documentation AOR = 2.22 (95% CI [1.105, 4.471] were significantly associated with nursing care documentation practice. Most of the nursing care provided remains undocumented. Nurse-to-patient ratio, in-service training, knowledge, and attitude of nurses toward nursing care documentation were factors associated with nursing care documentation practice.
Full Text Available Patients frequently experience moderate to severe pain inthe postoperative period. Although the pain managementis an integral and important part of the nursing care, studiessuggest that, nursing management of postoperativepain remains inadequate.Postoperative care nurses are responsible to assess thepatient’s pain, teach the patient strategies to deal with thepain, apply the analgesic treatment plan, monitor the resultsof treatment, educate the patient and the family onpain management and document the pain managementoutcomes. The nurses’ holistic approach to pain managementminimizes the patients’ discomfort caused by pain inthe postoperative period after the surgery. In this article,nurses’ approaches to postoperative pain managementare discussed. J Clin Exp Invest 2011; 2 (4: 474-478
Chuang, Shu-Ting; Liu, Yi-Fang; Fu, Zi-Xuan; Liu, Kuang-Chung; Chien, Sou-Hsin; Lin, Chin-Lon; Lin, Pi-Yu
Traditionally, a patient presses the nurse call button and alerts the central nursing station. This system cannot reach the primary care nurse directly. The aim of this study was to apply a new smartphone system through the cloud system and information technology that linked a smartphone and a mobile nursing station for nursing care service. A smartphone and mobile nursing station were integrated into a smartphone nurse call system through the cloud and information technology for better nursing care. Waiting time for a patient to contact the most responsible nurse was reduced from 3.8 min to 6 s. The average time for pharmacists to locate the nurse for medication problem was reduced from 4.2 min to 1.8 min by the new system. After implementation of the smartphone nurse call system, patients received a more rapid response. This improved patients' satisfaction and reduced the number of complaints about longer waiting time due to the shortage of nurses.
Gunnarsdóttir, Sigrún; Clarke, Sean P; Rafferty, Anne Marie; Nutbeam, Don
To investigate aspects of nurses' work environments linked with job outcomes and assessments of quality of care in an Icelandic hospital. Prior research suggests that poor working environments in hospitals significantly hinder retention of nurses and high quality patient care. On the other hand, hospitals with high retention rates (such as Magnet hospitals) show supportive management, professional autonomy, good inter-professional relations and nurse job satisfaction, reduced nurse burnout and improved quality of patient care. Cross-sectional survey of 695 nurses at Landspitali University Hospital, Reykjavík. Nurses' work environments were measured using the nursing work index-revised (NWI-R) and examined as predictors of job satisfaction, the Maslach burnout inventory (MBI) and nurse-assessed quality of patient care using linear and logistic regression approaches. An Icelandic adaptation of the NWI-R showed a five-factor structure similar to that of Lake (2002). After controlling for nurses' personal characteristics, job satisfaction, emotional exhaustion and nurse rated quality of care were found to be independently associated with perceptions of support from unit-level managers, staffing adequacy, and nurse-doctor relations. The NWI-R measures elements of hospital nurses' work environments that predict job outcomes and nurses' ratings of the quality of patient care in Iceland. Efforts to improve and maintain nurses' relations with nurse managers and doctors, as well as their perceptions of staffing adequacy, will likely improve nurse job satisfaction and employee retention, and may improve the quality of patient care.
Broderick, Margaret C
BACKGROUND: Documentation is an essential part of nursing. It provides evidence that care has been carried out and contains important information to enhance the quality and continuity of care. Person-centred care (PCC) is an approach to care that is underpinned by mutual respect and the development of a therapeutic relationship between the patient and nurse. It is a core principle in standards for residential care settings for older people and is beneficial for both patients and staff (International Practice Development in Nursing and Healthcare, Chichester, Blackwell, 2008 and The Implementation of a Model of Person-Centred Practice in Older Person Settings, Dublin, Health Service Executive, 2010a). However, the literature suggests a lack of person-centredness within nursing documentation (International Journal of Older People Nursing 2, 2007, 263 and The Implementation of a Model of Person-Centred Practice in Older Person Settings, Dublin, Health Service Executive, 2010a). AIMS AND OBJECTIVES: To explore nursing documentation in long-term care, to determine whether it reflected a person-centred approach to care and to describe aspects of PCC as they appeared in nursing records. METHOD: A qualitative descriptive study using the PCN framework (Person-centred Nursing; Theory and Practice, Oxford, Wiley-Blackwell, 2010) as the context through which nursing assessments and care plans were explored. RESULTS: Findings indicated that many nursing records were incomplete, and information regarding psychosocial aspects of care was infrequent. There was evidence that nurses engaged with residents and worked with their beliefs and values. However, nursing documentation was not completed in consultation with the patient, and there was little to suggest that patients were involved in decisions relating to their care. IMPLICATIONS FOR PRACTICE: The structure of nursing documentation can be a major obstacle to the recording of PCC and appropriate care planning. Documentation
Magluta, Cynthia; Gomes, Maria A de Sousa Mendes; Wuillaume, Susana M
Clinical guidelines are tools that systematize scientific evidence and help to achieve proper care. Several difficulties are reported regarding the effective use, such as the shortcomings in the level of knowledge and attitudes by the professionals, the service structure and the preferences appointed by patients. An analysis of these difficulties was the objective of this study in the context of government Neonatal Intensive Care Units (NICU) in Brazil. A semi-structured survey was carried out with 53 managers (medical and nursing) of the 15 NICU in a convenient sample of two groups of government units in Brazil. The managers chose their answers from a list of difficulties to implement the guidelines based on the analytical model of Cabana and graded the difficulties found on a 5-point scale with no reference to quality. Respondents have reported several difficulties with the following priority: lack of professionals to provide care, being perceived as more critical within the nursing and physiotherapy crews, minor participation of professionals in the discussion process and inadequate infrastructure. The lack of acquaintance with the guidelines by the professionals has been reported by few of the surveyed. These findings show some common ground to literature pointing the importance of adequate infrastructure. Managers showed a low valuation of both the level of knowledge and the professionals' adhesion to the guidelines. © 2011 Blackwell Publishing Ltd.
This essay considers Nurse Jackie, one of several recent television shows, including HawthoRNe, and Mercy, that features a nurse as the main character. All 3 shows premiered in 2009 and challenged nursing's longstanding invisibility and misrepresentation on television. Although the plots of each show corrected problematic aspects of nursing's usual media representation, only Nurse Jackie remains on the air. In this paper, I analyze why Nurse Jackie succeeded where the other 2 shows did not, considering the representational politics of care on television and in the national context where health care remains a significant concern. Copyright © 2012 Elsevier Inc. All rights reserved.
Elana, Valérie; Gaborieau, Fabienne; Renault, Valérie
The nurses of the centre for care, support and prevention in addictology (CSAPA) and the addictology liaison and care team (ELSA) at Avicenne hospital in Bobigny play a leading role within the multidisciplinary team. They focus particularly on relational care.
Spagnol, Carla Aparecida
This theoretical work aimed to study Hospital Administration, focusing on Nursing Management. The author points out contemporary administration concepts, and leads us to think over how those new models of management (already in use in some institutions known as pioneers on this area) may have influence on the Nursing Management practice inserted on the context. The author concludes that Nursing is going through a transition moment, breaking paradigms, trying to get over Classical Administration beliefs and searching for flexible, humanized and shared ways to manage Nursing Care.
Williamson, Kathleen M
This exploratory study involved the triangulation of qualitative (interview and observation) and quantitative methods (Psychological Empowerment Instrument). This study examined the individual home care nurses' perception of empowerment and how it influences decisions in the home clinical setting. Fifteen nurses were self-selected to participate. All completed an interview, and were observed and given Likert Instrument to complete. A framework analysis was performed to identify mutually exclusive and exhaustive emergent themes and patterns within the data. Home care nurses described that enpowerment is in the interaction between nurse and patient, and nurse and health care provider. Empowered is defined as being independent, confident, trusting, and comfortable with providing quality care. Home health care nurses believe that having the ability to practice collaboratively and build professional relationships was essential. Nurses in this study perceived empowerment as having meaning, choice, and competence in their job.
Hendricks, Joyce M; Cope, Vicki C
This article presents a discussion of generational differences and their impact on the nursing workforce and how this impact affects the work environment. The global nursing workforce represents four generations of nurses. This generational diversity frames attitudes, beliefs, work habits and expectations associated with the role of the nurse in the provision of care and in the way the nurse manages their day-to-day activities. An electronic search of MEDLINE, PubMed and Cinahl databases was performed using the words generational diversity, nurse managers and workforce. The search was limited to 2000-2012. Generational differences present challenges to contemporary nurse managers working in a healthcare environment which is complex and dynamic, in terms of managing nurses who think and behave in a different way because of disparate core personal and generational values, namely, the three Cs of communication, commitment and compensation. An acceptance of generational diversity in the workplace allows a richer scope for practice as the experiences and knowledge of each generation in the nursing environment creates an environment of acceptance and harmony facilitating retention of nurses. Acknowledgement of generational characteristics provides the nurse manager with strategies which focus on mentoring and motivation; communication, the increased use of technology and the ethics of nursing, to bridge the gap between generations of nurses and to increase nursing workforce cohesion. © 2012 Blackwell Publishing Ltd.
Forbes, Angus; While, Alison
This paper explores the nature of the nursing contribution to chronic disease management (CDM) and identifies a number of key nursing activities within CDM both at the individual patient and care system levels. The activities were identified following a detailed review of the literature (160 reports and studies of nursing practice) relating to three tracer disorders: diabetes, chronic obstructive pulmonary disease and multiple sclerosis. The paper examines these activities collectively to generate models expressing some of the core functions of nursing within CDM. The paper illustrates some of the changing characteristics of nursing roles within CDM. More fundamentally, the paper questions the position of nursing in relation to the technologies that define CDM systems and proposes four levels of contribution: the nurse as technology; the nurse as technologist; the nurse as system engineer; and the nurse as architect. These different levels reflect distinctions in the nature of the nursing gaze and power relations within the health care workforce. The paper also highlights how nurses are failing to develop the evidence for their practice in CDM. The paper concludes that there is a need for some clear principles to guide clinical practice and encourage innovation in CDM. It is argued that the principles should not be rule-bound but define a distinctive nursing gaze that will position the nursing profession within the health care system and in relation to other professions. The gaze should incorporate the needs of the individual patient and the care system that they inhabit.
Elliott, Kate-Ellen J; Rodwell, John; Martin, Angela J
Relationships exist between aged care nurses' perceptions of psychosocial work characteristics, job satisfaction and mental health, suggesting these characteristics may be important for the management of aged care services. An expanded demand-control-support model that included justice perceptions was examined to determine its impact on multiple types of psychological and organisational well-being outcomes (i.e. job satisfaction, psychological distress and depression). Data were collected from a sample of 173 aged care nurses using a self-report survey and analysed using hierarchical multiple regression. A significant proportion (27-28%) of the variance in aged care nurses' satisfaction, depression and psychological distress was explained by the psychosocial factors included in the model. Job control had the most consistent impact with direct effects on job satisfaction, psychological distress and depression. Informational justice was associated with both psychological distress and depression. Targeting job control may provide the biggest response for nurse managers in aged care, as it is likely to influence nurses' job satisfaction, psychological distress and depression. Facility managers should implement organisational policies and procedures that promote higher levels of control over how nurses perform their work in order to improve nurse well-being in aged care settings. © 2017 John Wiley & Sons Ltd.
Shalala, Donna E
Millions more insured Americans. Increasing numbers of older patients. Higher rates of chronic illness. Fewer providers. How can our healthcare system not only manage these challenges but also improve performance and access to care while containing costs? The answer lies with our nurses. In some parts of the United States, nurses provide the full spectrum of primary and preventive care. They have successfully improved access and quality in rural areas. In other parts, nurses' hands are tied by antiquated laws and regulations that limit their ability to expand access to care. Our system cannot increase access when we have providers who are not allowed to perform to the top of their education, training, and capability. It is time to rethink how we deliver primary and preventive care and redefine the roles of doctors and nurses. This article examines the history of the Institute of Medicine's (IOM) Future of Nursing report (chaired by the author) and the resulting Future of Nursing Campaign for Action, which is working to institute the report's recommendations in all 50 states. The IOM report's recommendations are simple: 1. Remove outdated restrictions on nursing practice. 2. Promote nurse leadership on hospital boards and in all healthcare sectors. 3. Strengthen nurse education and training, and increase the number of nurses with advanced degrees. 4. Increase diversity in the nursing workforce to better reflect the patient population. 5. Improve data reporting and compilation to predict workforce needs. New York, Kentucky, and Minnesota are three recent states to remove barriers pre venting advanced practice registered nurses from practicing at the top of their license. Similar efforts in California, Florida, and Indiana failed initially but are expected to make progress in the near future. The article makes clear how and why the Center to Champion Nursing in America (an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation) is working to
Van Dyk, Jennifer; Siedlecki, Sandra L; Fitzpatrick, Joyce J
This study was focused on determining relationships between confidence levels and self-efficacy among nurse managers. Frontline nurse managers have a pivotal role in delivering high-quality patient care while managing the associated costs and resources. The competency and skill of nurse managers affect every aspect of patient care and staff well-being as nurse managers are largely responsible for creating work environments in which clinical nurses are able to provide high-quality, patient-centred, holistic care. A descriptive, correlational survey design was used; 85 nurse managers participated. Years in a formal leadership role and confidence scores were found to be significant predictors of self-efficacy scores. Experience as a nurse manager is an important component of confidence and self-efficacy. There is a need to develop educational programmes for nurse managers to enhance their self-confidence and self-efficacy, and to maintain experienced nurse managers in the role. © 2016 John Wiley & Sons Ltd.
Hildebrandt, Eugenie; Baisch, Mary Jo; Lundeen, Sally P.; Bell-Calvin, Jean; Kelber, Sheryl
Client visits to an academic community nursing center (n=25,495) were coded and analyzed. Results show expansion of nursing practice and services, strong case management, and management of illness care. The usefulness of computerized clinical documentation system and of the Lundeen conceptional model of community nursing care was demonstrated.…
Vesterinen, Soili; Isola, Arja; Paasivaara, Leena
The purpose of the present study was to explore nurse managers' perceptions of their leadership styles and factors influencing it. It is a challenge for nurse managers to retain nurses in hospitals and to ensure a high quality of care in nursing practice. Leadership style is an important part of leadership. Knowledge concerning nurse managers' resonant and non-resonant leadership styles provides nurse managers with tools to reflect on their own leadership style. Open-ended, tape-recorded interviews were conducted with 13 nurse managers from five Finnish hospitals and two long-term care facilities. The data were analysed using qualitative content analysis. Five categories of leadership style were discerned: visionary, coaching, affiliate, democratic, commanding. Factors that influence leadership style were identified: earlier superiors, values, information, cooperation, employees and education. The results of this study show that Finnish nurse managers use both resonant and non-resonant leadership styles. The findings of this study show that nurse managers use a variety of leadership styles. The study demonstrates the importance of knowledge about leadership styles and factors influencing it among nurse managers providing future leadership and management education.
Full Text Available Quiescent leadership cannot last long time. When the environment is constant and unchanged, firms will have little mobility Human is subject to organizational changes and numerous factors. Removing the rust from the mirror of the soul of man enhances his development towards his capabilities. Purpose: This study aimed to examine change management capabilities of nurse managers (Head nurses. This research is a descriptive study, which examines the change management capabilities in 50 different supervisors from the perspective of 187 nurses in hospitals under the supervision of head nurses in Qazvin, and it is conducted by Census method. The tools of this research are Bass and Avolio's Transformational leadership questionnaire that its validity and reliability were confirmed. To analyze the data, the software ѕрѕѕ version 22 statistical tests of Pearson, T, Nava, KS, and Chi-square exact was used. The findings showed that, according to the results of t-test, a statistically significant difference was not seen between the scores on all subscales obtained from the questionnaire of management capabilities in change management from nurses, demographic characteristics of nurses. (All p>0/5. However, scores in terms of individual consideration was (p=0/44 and Mental stimulation was (p=0/035 and only statistically significant difference was observed in the education of nurses. Given that nursing managers (supervisors in the field of change management have a poor and average performance, it seems the higher the level of education is for nurse managers, their ability to apply change management is higher. Also supervisors' performance within individual consideration with an error probability equal to 0/012 is at an optimum level and hence was able to win the trust of staff. To advance the goals of excellence in medical care, training the managers towards change, establishing physical and mental health and confidence in them by their involvement, is
Full Text Available Abstract Background Although stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency. Methods A cross-sectional survey research design was used. A total of 572 public and private nursing homes were identified nationally and a stratified random selection of 60 nursing homes with 3,239 residents was made. In half of the nursing homes (n = 30 efforts were made to interview all residents with stroke Survey instruments were used to collect data from residents with stroke and nursing home managers on demography, patient disability, and treatment. Results Across all nursing homes (n = 60, 18% (n = 570 of the residents had previously had a stroke. In homes (n = 30, where interviews with residents with stroke (n = 257, only 7% (n = 18 residents were capable of answering for themselves and were interviewed. Data on the remaining 93% (n = 239 residents were provided by the nursing home manager. Nurse Managers reported that 73% of residents with stroke had a high level of dependency. One in two residents with stroke was prescribed antidepressants or sedative medication. Only 21% of stroke residents were prescribed anticoagulants, 42% antiplatelets, and 36% cholesterol lowering medications. Stroke rehabilitation guidelines were lacking and 68% reported that there was no formal review process in place. Conclusions This study provides seminal findings on stroke and nursing home services in Ireland. We now know that one in six nursing home residents in a national survey are residents with a stroke, and have a wide range of disabilities. There is currently little or no structured care (beyond generic care for stroke survivors who reside in nursing homes in Ireland.
BACKGROUND: Although stroke is recognised as a major factor in admission to nursing home care, data is lacking on the extent and nature of the disabilities and dependency in nursing homes arising from stroke. A national study conducted in nursing homes can quantify the number of residents with stroke in nursing homes, their disability and levels of dependency. METHODS: A cross-sectional survey research design was used. A total of 572 public and private nursing homes were identified nationally and a stratified random selection of 60 nursing homes with 3,239 residents was made. In half of the nursing homes (n = 30) efforts were made to interview all residents with stroke Survey instruments were used to collect data from residents with stroke and nursing home managers on demography, patient disability, and treatment. RESULTS: Across all nursing homes (n = 60), 18% (n = 570) of the residents had previously had a stroke. In homes (n = 30), where interviews with residents with stroke (n = 257), only 7% (n = 18) residents were capable of answering for themselves and were interviewed. Data on the remaining 93% (n = 239) residents were provided by the nursing home manager. Nurse Managers reported that 73% of residents with stroke had a high level of dependency. One in two residents with stroke was prescribed antidepressants or sedative medication. Only 21% of stroke residents were prescribed anticoagulants, 42% antiplatelets, and 36% cholesterol lowering medications. Stroke rehabilitation guidelines were lacking and 68% reported that there was no formal review process in place. CONCLUSIONS: This study provides seminal findings on stroke and nursing home services in Ireland. We now know that one in six nursing home residents in a national survey are residents with a stroke, and have a wide range of disabilities. There is currently little or no structured care (beyond generic care) for stroke survivors who reside in nursing homes in Ireland.
Jones, Km; Adaji, A; Schattner, Ps
Medicare items were introduced in 2005 to encourage general practitioners (GPs) to involve other healthcare providers in the management of patients with chronic disease. However, there appears to be barriers to converting financial incentives and the use of information technology as a communication tool to better patient outcomes. The aim of this study was to explore these barriers from the perspectives of practice nurses and allied health practitioners. Three focus groups were held, comprising a convenience sample of 10 practice nurses and 17 allied health professionals from south-east Melbourne. FINDINGS were reported under five themes: (1) attitudes and beliefs, (2) communication using care planning documents, (3) electronic communication, (4) care planning and collaboration between healthcare professionals and (5) ongoing challenges. While allied professionals use care planning tools, there is confusion about the extent to which these tools are for the GPs to provide structured care to assist with communication or funding mechanisms for allied health services. Further research is needed on the contributions of these groups to the care planning process and how communication and collaboration between healthcare professionals can be strengthened.
In June 2008 the UK government, supported by the Royal College of Nursing, stated that nursing care would be measured for compassion. This paper considers the implications of this statement by critically examining the relationship of compassion to care from a variety of perspectives. It is argued that the current market-driven approaches to healthcare involve redefining care as a pale imitation, even parody, of the traditional approach of the nurse as "my brother's keeper". Attempts to measure such parody can only measure artificial techniques and give rise to a McDonald's-type nursing care rather than heartfelt care. The arguments of this paper, although applied to nursing, also apply to medicine and healthcare generally.
Calpin-Davies, Philomena J.
Caring is the end purpose of nursing. The management and leadership of education for empowered caring requires teaching and learning that develop creative, flexible, interdependent nurses. Key issues are investing in technology, supporting lifelong learning, and creating a community workplace. (Contains 68 references.) (SK)
Hanley Nadeau, Ellen; Toronto, Coleen E
Childhood asthma is a growing health concern. Asthma is the most common chronic illness of childhood and a leading cause of emergency room visits, hospitalizations, and school absenteeism. School nurses play a valuable role in asthma management. The purpose of this integrative review is to examine barriers to asthma management for school nurses in the school setting. Findings revealed multiple barriers school nurses encounter in managing asthma. Six themes emerged that included lack of resources and support, insufficient time, communication challenges, limited knowledge, and lack of awareness of school nurses' expertise. Students, parents, primary care physicians, school administration, staff, and school nurses themselves all play a role in constructing barriers to asthma management. There is a need for school nurses and school nurse leaders to focus efforts to develop strategies to overcome barriers to ensure evidence-based, best practice management of asthma in the school setting. © The Author(s) 2015.
Nov 21, 2014 ... Health Insurance, which is intended to improve care, requires capacity building for nurses at .... on-site training of nurses by nurse trainers was incorporated ... we focused on hypertension, diabetes, epilepsy, depression,.
Waldorff, Frans Boch; Bülow, L B; Malterud, K
OBJECTIVE: The objective of this study was to explore the context and experiences of collaboration between the GP and the district nurse (DN) in diagnosing dementia, in order to identify possible procedures to improve care. METHODS: Two group interviews were conducted with four DNs and five GPs......, respectively, working in the municipality of Copenhagen. RESULTS: The group interviews revealed that the suboptimized collaboration could be due to different inter-professional diagnostic strategies and a lack of understanding of the importance of early, shared, decision making. This could create conflicts...... between the groups. CONCLUSIONS: This study indicates a possibility for improved collaboration between the two professional groups in diagnosing dementia. Possible approaches for improved care should focus on an inter-professional understanding of the importance of early, shared, decision making...
White, Donna M; Hand, Mikel
The failure of nursing schools to integrate spiritual nursing care education into the curriculum has contributed to a lack in nurses' spiritual care ability. Developing, integrating, and testing a Spiritual Care Nursing Education strategy in an Associates of Science nursing program significantly increased the perceived spiritual care competence of student nurses. Utilizing a faculty team to develop learning activities to address critical spiritual care attributes offers a method to integrate spiritual nursing care content throughout the curriculum in ASN and BSN programs.
Fry, Margaret; MacGregor, Casimir; Ruperto, Kate; Jarrett, Kate; Wheeler, Janet; Fong, Jacqueline; Fetchet, Wendy
The Clinical Initiative Nurse (CIN) is a role that requires experienced emergency nurses to assess, initiate diagnostic tests, treat and manage a range of patient conditions. The CIN role is focused on the waiting room and to 'communicate the wait', initiate diagnostics or treatment and follow-up for waiting room patients. We aim to explore what emergency nurses' do in their extended practice role in observable everyday life in the emergency department (ED). The paper argues that compassionate caring is a core nursing skill that supports CIN interpersonal relations, despite the role's highly clinical nature. Sixteen non-participant observations were undertaken in three EDs in New South Wales, Australia. Nurses were eligible for inclusion if they had two years of emergency experience and had worked in the CIN role for more than one year. All CIN's that were observed were highly experienced with a minimum three year ED experience. The CIN observations revealed how compassionate caring was utilised by CIN's to quickly build a therapeutic relationship with patients and colleagues, and helped to facilitate core communication and interpersonal skills. While the CIN role was viewed as extended practice, the role relied heavily on compassionate care to support interpersonal relationships and to actualise extended practice care. The study supports the contribution made by emergency nurses and demonstrates how compassionate caring is central to nursing praxis. This paper also demonstrates that the CIN role utilises a complex mix between advanced clinical skills and compassion that supports interpersonal and therapeutic relationships. Further research is needed to understand how compassionate care can be optimised within nursing praxis and the duty of care between nurses and patients, nurses and other health care professionals so that future healthcare goals can be realised. Copyright © 2013 College of Emergency Nursing Australasia Ltd. All rights reserved.
Han, Claire Jungyoun
The purpose of the study is to identify the concept of personalized health care in nursing and to address future direction in person-centered nursing care. Personalized health care has attracted increased attention in the twenty-first century. As more and more preclinical studies are focusing on cost-effective and patient-centered care, there also has been an identified need for a personalized health care in nursing. Yet the term lacks clear definition and interests among healthcare professionals. Rodgers' strategy for concept analysis was used in this analysis. A literature review for 1960-2014 was conducted for the following keywords: nursing care, personalized, and health care. The analysis demonstrates that personalized health care in nursing is an intangible asset, including explicit attributes (interprofessional collaboration and individualized care approach) and implicit attributes (managing personal vulnerabilities: molecular-based health information and self-health-seeking behaviors). The result of this analysis provides a guide for further conceptual and empirical research and clinical practice in the personalized healthcare era. This concept analysis represents an effort to describe the attributes of a concept regarded as representing an important feature of nursing care and to promote discourse that will enhance maturation of the concept into one that is established with clearly delineated characteristics. © 2015 Wiley Periodicals, Inc.
Vânea Lúcia dos Santos Silva
Full Text Available Abstract OBJECTIVE To assess the frequency of the leadership practices performed by the manager nurses of hospital institutions and their association with the variables of the socioprofessional profile. METHOD Cross-sectional, descriptive, correlational study conducted in four hospitals in a city of the state of São Paulo. A sociodemographic questionnaire and the instrument Leadership Practices Inventory were used. Data collection and analysis were based on an exemplary Leadership Practices Model. RESULTS Eighty-four manager nurses participated in the study. The mean values of the leadership practices used by the nurses were: enable others to act (50.6; encourage the heart (48.2; model the way (46.7; challenge the process (43.3; and inspire a shared vision (43.1. Data analysis also evidenced a correlation between the practice encourage the heart and the variables time of care and employment relationship. Conclusion The study evidenced the presence of manager nurses exercising moderate leadership, and promoting teamwork, an environment of trust, and a horizontal vision. However, moderate values also reveal managerial aspects to be improved by the leaders by means of organizational strategies and/or tools aimed at best leadership practices.
Garwick, Ann W.; Svavarsdóttir, Erla Kolbrun; Seppelt, Ann M.; Looman, Wendy S.; Anderson, Lori S.; Örlygsdóttir, Brynja
Aim To identify and compare how school nurses in Reykjavik, Iceland and St. Paul, Minnesota coordinated care for youth with asthma (ages 10–18) and to develop an asthma school nurse care coordination model. Background Little is known about how school nurses coordinate care for youth with asthma in different countries. Design A qualitative descriptive study design using focus group data. Methods Six focus groups with 32 school nurses were conducted in Reykjavik (n=17) and St. Paul (n=15) using the same protocol between September 2008 – January 2009. Descriptive content analytic and constant comparison strategies were used to categorize and compare how school nurses coordinated care, which resulted in the development of an International School Nurse Asthma Care Coordination Model. Findings Participants in both countries spontaneously described a similar asthma care coordination process that involved information gathering, assessing risk for asthma episodes, prioritizing health care needs and anticipating and planning for student needs at the individual and school levels. This process informed how they individualized symptom management, case management and/or asthma education. School nurses played a pivotal part in collaborating with families, school and health care professionals to ensure quality care for youth with asthma. Conclusions Results indicate a high level of complexity in school nurses’ approaches to asthma care coordination that were responsive to the diverse and changing needs of students in school settings. The conceptual model derived provides a framework for investigators to use in examining the asthma care coordination process of school nurses in other geographic locations. PMID:25223389
Sellgren, Stina; Ekvall, Göran; Tomson, Göran
The aim was to explore nursing leadership regarding what nurse managers and subordinates see as important and to explore subordinates' opinions of their nurse manager's performance in reality. Background The manager's style can be fundamental for subordinates' acceptance of change and in motivating them to achieve stated visions and goals and high quality of care. Nurse managers (n=77) and 10 of each included nurse manager's subordinates received a questionnaire to assess 'preferred' leadership behaviour in three dimensions: change, production and employee/relation orientations. The same questionnaire was used to assess subordinates' opinions of their manager's leadership behaviour. There are statistically significant differences in opinions of preferred leadership between managers and subordinates, especially related to production and relation orientation. The subordinates' perception of real leadership behaviour has lower mean values than their preferred leadership behaviour in all three dimensions. Subordinates prefer managers with more clearly expressed leadership behaviour than managers themselves prefer and demonstrate.
Living in an increasingly multicultural society, nurses are regularly required to care for employees from a variety of cultural backgrounds. An awareness of cultural differences focuses occupational health nurses on those differences and results in better employee care. This article explores the concept of culturally competent employee care, some of the non-verbal communication cues among cultural groups, models associated with completing a cultural assessment, and how health disparities in the workplace can affect delivery of employee care. Self-evaluation of the occupational health nurse for personal preferences and biases is also discussed. Development of cultural competency is a process, and occupational health nurses must develop these skills. By developing cultural competence, occupational health nurses can conduct complete cultural assessments, facilitate better communication with employees from a variety of cultural backgrounds, and improve employee health and compliance with care regimens. Tips and guidelines for facilitating communication between occupational health nurses and employees are also provided. © 2015 The Author(s).
This article explores mental health nurses' diabetes training needs. A survey of inpatient and community mental health nurses was undertaken using a 16-item self-reporting questionnaire. Two hundred and twenty questionnaires were sent out and 138 returned, providing a response rate of 63%. Analysis shows that mental health nurses are currently involved in a range of diabetes care activities, however, their knowledge and skills may not be up to date. Mental health nurses also report the growing impact of diabetes care on their workload. Areas of identified training needs include taking blood glucose readings, giving dietary advice, liaison with diabetes nurse specialists and weight management. Mental health services and education providers need to consider developing specific training courses for mental health nurses.
Modified electroconvulsive therapy (ECT) is a controlled medical procedure in which a seizure is induced in an anaesthetized patient to produce a therapeutic effect. ECT is the most acutely effective treatment available for affective disorders and is more effective than antidepressant drugs. Although in use for 70 years, ECT continues to attract controversy and there is considerable stigma associated with its use that often overshadows the empirical evidence for its effectiveness. One way to overcome this is for health professionals to be educated about contemporary ECT practice. Patients need to make informed decisions when consenting to ECT and this process can be influenced by preconceived ideas and scientific fact. It is, therefore, essential that nurses possess sufficient information to help patients make rational and informed treatment decisions and be able to care for both the clinical and psychological needs of patients treated with ECT. This review outlines the nursing role in ECT and summarizes the main aspects of contemporary ECT practice relevant to general and psychiatric nursing practice.
Makamure, Miranda; Makamure, Muriel; Mendiola, Williane; Renteria, Daisy; Repp, Melissa; Willden, Azshwee
The impact of disease outbreaks continues to increase globally. As frontline staff, critical care nurses (CCNs) are more likely to be confronted with the need to care for affected patients. With different pathological diseases emerging, CCNs play an integral role in disease outbreaks. The advanced skill set of CCNs is pivotal in the management and care of patients during an outbreak. Lack of planning and preparation before disease outbreaks leads to detrimental patient outcomes. Panic, chaos, and fear for personal safety cause stress and anxiety for unprepared nurses. However, this problem can be resolved. Comprehensive planning, training, and education can better prepare intensive care unit nurses for disease outbreaks. This article reviews some of the current literature on intensive care unit nurse preparedness for disease outbreaks in the United States. This article also offers strategies that may be used to better prepare CCNs for disease outbreaks.
Purpose The aim of this study was to describe Jordanian critical care nurses' experiences of autonomy in their clinical practice. Design/methodology/approach A descriptive correlational design was applied using a self-reported cross-sectional survey. A total of 110 registered nurses who met the eligibility criteria participated in this study. The data were collected by a structured questionnaire. Findings A majority of critical care nurses were autonomous in their decision-making and participation in decisions to take action in their clinical settings. Also, they were independent to develop their own knowledge. The study identified that their autonomy in action and acquired knowledge were influenced by a number of factors such as gender and area of practice. Practical implications Nurse's autonomy could be increased if nurses are made aware of the current level of autonomy and explore new ways to increase empowerment. This could be offered through classroom lectures that concentrate on the concept of autonomy and its implication in practice. Nurses should demonstrate autonomous nursing care at the same time in the clinical practice. This could be done through collaboration between educators and clinical practice to help merge theory to practice. Originality/value Critical care nurses were more autonomous in action and knowledge base. This may negatively affect the quality of patient care and nurses' job satisfaction. Therefore, improving nurses' clinical decision-making autonomy could be done by the support of both hospital administrators and nurses themselves.
Monareng, Lydia V
Although the concept 'spiritual nursing care' has its roots in the history of the nursing profession, many nurses in practice have difficulty integrating the concept into practice. There is an ongoing debate in the empirical literature about its definition, clarity and application in nursing practice. The study aimed to develop an operational definition of the concept and its application in clinical practice. A qualitative study was conducted to explore and describe how professional nurses render spiritual nursing care. A purposive sampling method was used to recruit the sample. Individual and focus group interviews were audio-taped and transcribed verbatim. Trustworthiness was ensured through strategies of truth value, applicability, consistency and neutrality. Data were analysed using the NUD*IST power version 4 software, constant comparison, open, axial and selective coding. Tech's eight steps of analysis were also used, which led to the emergence of themes, categories and sub-categories. Concept analysis was conducted through a comprehensive literature review and as a result 'caring presence' was identified as the core variable from which all the other characteristics of spiritual nursing care arise. An operational definition of spiritual nursing care based on the findings was that humane care is demonstrated by showing caring presence, respect and concern for meeting the needs not only of the body and mind of patients, but also their spiritual needs of hope and meaning in the midst of health crisis, which demand equal attention for optimal care from both religious and nonreligious nurses.
Kodama, Yoshimi; Fukahori, Hiroki; Sato, Kana; Nishida, Tomoko
To determine if nurse managers' leadership style is related to Japanese staff nurses' affective commitment to their hospital. In Western countries, nurse managers' transformational leadership style has been found to increase staff nurses' affective commitment to their hospital. However, there are few studies examining this relationship in the context of acute care hospitals in Japan. Staff nurses completed measures of their nurse managers' perceived leadership style and factors related to their own affective commitment. The association between affective commitment and perception of leadership style was assessed with multiple logistic regression. Of 736 questionnaires distributed, 579 (78.9%) were returned, and data from 396 (53.8%) fully completed questionnaires were analysed. The intellectual stimulation aspect of transformational leadership positively increased staff nurses' affective commitment (odds ratio: 2.23). Nurse managers' transactional and laissez-faire leadership styles were not related to affective commitment among staff nurses. The intellectual stimulation aspect of transformational leadership may increase the retention of staff nurses through enhanced affective commitment. To increase staff nurses' affective commitment to their hospital, we suggest that hospital administrators equip nurse managers with intellectual stimulation skills. © 2016 John Wiley & Sons Ltd.
Eliason, Michele J.
Argues that nursing practice and theory cannot be ethical unless cultural factors are taken into consideration and that ethical/transcultural nursing is central to the philosophy and practice of nursing. (Author)
Poortaghi, Sarieh; Salsali, Mahvash; Ebadi, Abbas; Rahnavard, Zahra; Maleki, Farzaneh
Background Although using the nursing process improves nursing care quality, few studies have evaluated nursing performance in accordance with nursing process steps either nationally or internationally. Objectives This study aimed to audit nursing care based on a nursing process model. Patients and Methods This was a cross-sectional descriptive study in which a nursing audit checkl...
Full Text Available Suicide remains a serious health care problem and a sentinel event tracked by The Joint Commission. Nurses are pivotal in evaluating risk and preventing suicide. Analysis of nurses' barriers to risk management may lead to interventions to improve management of suicidal patients. These data emerged from a random survey of 454 oncology nurses' attitudes, knowledge of suicide, and justifications for euthanasia. Instruments included a vignette of a suicidal patient and a suicide attitude questionnaire. Results. Psychological factors (emotions, unresolved grief, communication, and negative judgments about suicide complicate the nurse's assessment and treatment of suicidal patients. Some nurses (=122 indicated that euthanasia was never justified and 11 were unsure of justifications and evaluated each case on its merits. Justifications for euthanasia included poor symptom control, poor quality of life, incurable illness or permanent disability, terminal illness, and terminal illness with inadequate symptom control or impending death, patient autonomy, and clinical organ death. The nurses indicated some confusion and misconceptions about definitions and examples of euthanasia, assisted suicide, and double effect. Strategies for interdisciplinary clinical intervention are suggested to identify and resolve these psychosocial barriers.
Haney, Linda L; Wright, Laurette
Applying management concepts from marketing and business sources can assist critical care units with establishing a planned change in the way nurses perform manual handling tasks, and thus, help insure that it is sustained.
‘Values are principles and standards that have meaning and worth to an individual, family, group, or community’ (Purnell & Paulanka 1998: 3). Values are central to the care provided by nurses. The provision of nursing care within the context of value clarification, has been explored from various...... perspectives, however, as values vary within cultures, there is a limited range of studies reflecting on Saudi Arabian nurses’ perspectives of nursing care. Through a Heideggerian phenomenological research design, six nurses were enrolled through purposive sampling. Semi-structured, in-depth interviews, which...... were audio tape-recorded, were chosen as the methods of data collection. A seven stage framework approach was applied to analyse and organise the research findings in three conceptual themes: values in context of Islam, the nurse-patient relationship, and identity’s influence on being in the world...
Bakir, Ercan; Samancioglu, Sevgin; Kilic, Serap Parlar
The purpose of this study was to determine the experiences and perceptions of intensive care nurses (ICNs) about spirituality and spiritual care, as well as the effective factors, and increase the sensitivity to the subject. In this study, we examined spiritual experiences, using McSherry et al. (Int J Nurs Stud 39:723-734, 2002) Spirituality and spiritual care rating scale (SSCRS), among 145 ICNs. 44.8% of the nurses stated that they received spiritual care training and 64.1% provided spiritual care to their patients. ICNs had a total score average of 57.62 ± 12.00 in SSCRS. As a consequence, it was determined that intensive care nurses participating in the study had insufficient knowledge about spirituality and spiritual care, but only the nurses with sufficient knowledge provided the spiritual care to their patients.
Studies have shown that job dissatisfaction can intensify emotional exhaustion, and this can influence nurses to perceive their work as tiresome and repetitive, leading to frustration and discouragement. The purpose of this study was to investigate the relationship between job satisfaction and attitude towards nursing care at ...
The thesis deals with integrated dental care in nursing homes. First, the dental treatment needs were ascertained of 432 residents in three Dutch nursing homes that offer integrated dental care. Dentist researchers intra-orally examined the residents and found that 72% required dental treatment.
The refusal of nursing care forms part of the freedom offered to anyone wanting to refuse, consciously and knowingly, any form of nursing care such as washing, the taking of medication or hospitalisation. However, limits are fixed by law as well as by case law. Are we totally free in the expression of our will? Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Can an EASYcare based dementia training programme improve diagnostic assessment and management of dementia by general practitioners and primary care nurses? The design of a randomised controlled trial
Full Text Available Abstract Background Early diagnosis of dementia benefits both patient and caregiver. Nevertheless, dementia in primary care is currently under-diagnosed. Some educational interventions developed to improve dementia diagnosis and management were successful in increasing the number of dementia diagnoses and in changing attitudes and knowledge of health care staff. However, none of these interventions focussed on collaboration between GPs and nurses in dementia care. We developed an EASYcare-based Dementia Training Program (DTP aimed at stimulating collaboration in dementia primary care. We expect this program to increase the number of cognitive assessments and dementia diagnoses and to improve attitudes and knowledge of GPs and nurses. Methods The DTP is a complex educational intervention that consists of two workshops, a coaching program, access to an internet forum, and a Computerized Clinical Decision Support System on dementia diagnostics. One hundred duos of GPs and nurses will be recruited, from which 2/3 will be allocated to the intervention group and 1/3 to the control group. The effects of implementation of the DTP will be studied in a cluster-randomised controlled trial. Primary outcomes will be the number of cognitive assessments and dementia diagnoses in a period of 9 months following workshop participation. Secondary outcomes are measured on GP and nurse level: adherence to national guidelines for dementia, attitude, confidence and knowledge regarding dementia diagnosis and management; on patient level: number of emergency calls, visits and consultations and patient satisfaction; and on caregiver level: informal caregiver burden and satisfaction. Data will be collected from GPs' electronic medical records, self-registration forms and questionnaires. Statistical analysis will be performed using the MANOVA-method. Also, exploratory analyses will be performed, in order to gain insight into barriers and facilitators for implementation and
Eskes, Anne M; Maaskant, Jolanda M; Holloway, Samantha; van Dijk, Nynke; Alves, Paulo; Legemate, Dink A; Ubbink, Dirk T; Vermeulen, Hester
Health care professionals responsible for patients with complex wounds need a particular level of expertise and education to ensure optimum wound care. However, uniform education for those working as wound care nurses is lacking. We aimed to reach consensus among experts from six European countries as to the competencies for specialised wound care nurses that meet international professional expectations and educational systems. Wound care experts including doctors, wound care nurses, lecturers, managers and head nurses were invited to contribute to an e-Delphi study. They completed online questionnaires based on the Canadian Medical Education Directives for Specialists framework. Suggested competencies were rated on a 9-point Likert scale. Consensus was defined as an agreement of at least 75% for each competence. Response rates ranged from 62% (round 1) to 86% (rounds 2 and 3). The experts reached consensus on 77 (80%) competences. Most competencies chosen belonged to the domain 'scholar' (n = 19), whereas few addressed those associated with being a 'health advocate' (n = 7). Competencies related to professional knowledge and expertise, ethical integrity and patient commitment were considered most important. This consensus on core competencies for specialised wound care nurses may help achieve a more uniform definition and education for specialised wound care nurses. © 2013 The Authors. International Wound Journal © 2013 Medicalhelplines.com Inc and John Wiley & Sons Ltd.
Ngunyulu, R N; Peu, M D; Mulaudzi, F M; Mataboge, M L S; Phiri, S S
Collaborative HIV care between the nurses and traditional health practitioners is an important strategy to improve health care of people living with HIV. To explore and describe the views of nurses regarding collaborative HIV care in primary healthcare services in the City of Tshwane, South Africa. A qualitative, descriptive design was used to explore and describe the views of nurses who met the study's inclusion criteria. In-depth individual interviews were conducted to collect data from purposively selected nurses. Content analysis was used to analyse data. Two main categories were developed during the data analysis stage. The views of nurses and health system challenges regarding collaborative HIV care. The study findings revealed that there was inadequate collaborative HIV care between the nurses and the traditional health practitioners. It is evident that there is inadequate policy implementation, monitoring and evaluation regarding collaboration in HIV care. The study findings might influence policymakers to consider the importance of collaborative HIV care, and improve the quality of care by strengthening the referral system and follow-up of people living with HIV and AIDS, as a result the health outcomes as implied in the Sustainable Development Goals 2030 might be improved. Training and involvement of traditional health practitioners in the nursing and health policy should be considered to enhance and build a trustworthy working relationship between the nurses and the traditional health practitioners in HIV care. © 2017 International Council of Nurses.
Rhodes, Marilyn K; Morris, Arlene H; Lazenby, Ramona Browder
An award-winning journalist spoke to a group of students during their first month in a baccalaureate nursing program, challenging the nursing profession to abandon its image of nurses as angels and promote an image of nurses as competent professionals who are both knowledgeable and caring. This presentation elicited an unanticipated level of emotion, primarily anger, on the part of the students. This unexpected reaction prompted faculty to explore the students' motivations for entering the nursing profession and their perceptions of the relative importance of competence and caring in nursing. The authors begin this article by reviewing the literature related to motivations for selecting a profession and the contributions of competence and caring to nursing care. Next they describe their survey method and analysis and report their findings regarding student motivations and perceptions of competence and caring in nursing. Emerging themes for motivation reflected nursing values, especially altruism, and coincided with students' beliefs of self-efficacy and goal attainment. Student responses indicated their understanding of the need for competence and revealed idealistic perceptions of caring. The authors conclude with a discussion of these themes and recommendations for student recruitment, curricular emphasis, and future research in this area.
Inoue, Madoka; Chapman, Rose; Wynaden, Dianne
This paper reports a study of male nurses' experiences of providing intimate care for women clients. The number of men entering the nursing profession has increased worldwide. As a consequence of the move to a more gender-balanced profession, debate has ensued over how intimate care should be performed when this requires male nurses to be physically close to women clients. As there was little previous work on this topic, we wished to provide nurses, clients and other healthcare professionals with a better understanding of male nurses' experiences of working with women clients and within a healthcare system where they often feel excluded. Semi-structured, open-ended interviews were conducted with male nurses working in various clinical settings in Western Australia. Latent content analysis was used to analyse the interviews, which were carried out between June and July 2004. Three themes were identified: the definition of intimate care, the emotional experience associated with providing intimate care and strategies used to assist in the delivery of intimate care for women clients. Providing intimate care for women clients was a challenging experience for male nurses. Participants described how it required them to invade these clients' personal space. Consequently, they often experienced various negative feelings and used several strategies to assist them during care delivery. Nurse educators should assist male nurses to be better prepared to interact with women clients in various settings. Furthermore, workplace environments need to provide additional support and guidance for male nurses to enable them to develop effective coping strategies to manage challenging situations.
Carlson, Elisabeth; Rämgård, Margareta; Bolmsjö, Ingrid; Bengtsson, Mariette
In Sweden, as well as in most industrialised countries, an increasing older population is expected to create a growing demand for health care staff. Previous studies have pointed to lack of proficient medical and nursing staff specialised in geriatric care, which poses serious threats to the care of a vulnerable population. At the same time, there are studies describing elderly care as a low-status career choice, attracting neither nurses nor student nurses. Judging from previous research it was deemed important to explore how nurses in elderly care perceive their work, thus possibly provide vital knowledge that can guide nurse educators and unit managers as a means to promote a career in elderly care. The aim of the present study was to illuminate how nurses, working in nursing homes and home-based care, perceived their professional work. This was a qualitative study using focus groups. 30 registered nurses in seven focus groups were interviewed. The participants worked in nursing homes and home-based care for the elderly in rural areas and in a larger city in southern Sweden. The interviews were analysed in line with the tradition of naturalistic inquiry. Our findings illustrate how nurses working in elderly care perceived their professional work as holistic and respectful nursing. Three categories of professional work emerged during analysis: (1) establishing long-term relationships, (2) nursing beyond technical skills, and (3) balancing independence and a sense of loneliness. The findings are important as they represent positive alternatives to the somewhat prevailing view on elderly care as depressing and undemanding. Nurse educators might use the key aspects as good examples, thus influencing student nurses' attitudes towards elderly care in a positive way. Elderly care agencies might find them helpful when recruiting and retaining nurses to a much needed area. Copyright © 2013 Elsevier Ltd. All rights reserved.
Christensen, Kirsten Haugaard; Turner, de Sales
Spiritual care perspectives of Danish Nurses The purpose of this study was to explore how Danish registered nurses understand the phenomenon of spiritual care and how their understanding impacts on their interventions with their patients. Nurses are responsible for the provision of care which...... approach rooted in the philosophy of Gadamer was chosen as methodology. In-depth interviews were used as data collection tool, and six registered nurses who worked within hospital settings in Denmark were interviewed. The findings revealed that deep knowing of the patients were essential before nurses...... would engage in provision of spiritual care. The participants acknowledged that their understanding of spirituality influenced their provision of spiritual care, which was recognized as a challenge requiring the nurse’s initiative and courage. Spirituality was primarily understood as a patient’s private...
Calpin-Davies, Philomena J
The purpose of this paper is to review the dual concepts of leadership and management in nursing education. It provides a consideration of caring as the end purpose of nursing education and argues that empowered caring makes use of professional academic credentials to form collaborative alliances that influence health care delivery. Inspiring and empowering leadership also transform educational services. In particular the key issues of investing in technology, supporting life long learning and creating a community workplace are addressed. It concludes with the suggestion that the nurse education ought to be led and managed differently.
Retaining professional nurses in South Africa: Nurse managers' perspectives. ... This implies that creating a favourable environment in the workplace situation ... Unsafe working environments and a lack of resources threaten the safety and ...
Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy
Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is
Damart, Sébastien; Kletz, Frédéric
The study aims to explore perceptions of the causes of nurse absenteeism. Nurse absenteeism is rising in many countries. However, there is little evidence as to how strategies adopted in order to cushion the effects of absenteeism on workload influence absenteeism itself. The study used a 'qualitative' method based on cognitive mapping techniques in order to represent perceptions about absenteeism graphically. The study was conducted in two health-care facilities with a sample of 55 interviewees. Absenteeism is due in part to strategies adopted in order to cushion the effects of absenteeism on organisations. Furthermore, the strategies are self-legitimising. The more they are used, the more they are regarded as normal and useful. A plan to reduce absenteeism among nurses must explicitly take into account the strategies used to cushion its impact. To cushion the effects of absenteeism among caregivers, managers must make trade-offs that take into account, for example, the workload or disruption linked to the substitution of personnel. © 2014 John Wiley & Sons Ltd.
McCauley, Linda; Peterman, Katherine
Repealing the Affordable Care Act (ACA) has significant implications for the future of occupational health nursing practice. As changes are proposed and implemented, occupational health nurses must continue to prioritize preventive care, chronic disease management, healthy communities, environmental health, and sustainability. In particular, immigrant workers are a vulnerable population needing attention by occupational health nurses.
Pooyan, Abdullah; And Others
Turnover rates for nurses are among the highest for all professional employees. This study investigated the potential predictors of registered nurses' intention to quit. Survey questionnaires were mailed to a population of 779 registered nurses from two hospitals in North Dakota. Approximately 4 weeks later, usable responses were received from 353…
Healy, Patricia; Fallon, Anne
This article reviews the origins and evolution of neonatology and considers the role of the neonatal nurse within this specialty. Neonatal nurses are a vital part of the neonatal team that provides care for sick babies. The nursing care required by sick babies and their families on a neonatal unit can be variable and complex. The past century has seen significant changes in the role of the neonatal nurse. This has come about through dramatic technological developments on neonatal units, an increased understanding of neonatal physiology and pathology, changes in the education of neonatal nurses, and active and ongoing clinical research within the specialty. The resulting significant advances in neonatal care, including that provided by neonatal nurses, have made a crucial and steadfast contribution to marked improvements in neonatal outcomes.
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.
Trinier, Ruth; Liske, Lori; Nenadovic, Vera
Variability in parameters such as heart rate, respiratory rate and blood pressure defines healthy physiology and the ability of the person to adequately respond to stressors. Critically ill patients have lost this variability and require highly specialized nursing care to support life and monitor changes in condition. The critical care environment is a dynamic system through which information flows. The critical care unit is typically designed as a tree structure with generally one attending physician and multiple nurses and allied health care professionals. Information flow through the system allows for identification of deteriorating patient status and timely interventionfor rescue from further deleterious effects. Nurses provide the majority of direct patient care in the critical care setting in 2:1, 1:1 or 1:2 nurse-to-patient ratios. The bedside nurse-critically ill patient relationship represents the primary, real-time feedback loop of information exchange, monitoring and treatment. Variables that enhance information flow through this loop and support timely nursing intervention can improve patient outcomes, while barriers can lead to errors and adverse events. Examining patient information flow in the critical care environment from a dynamic systems perspective provides insights into how nurses deliver effective patient care and prevent adverse events.
Jakimowicz, Samantha; Perry, Lin; Lewis, Joanne
To explore patient-centred nursing, compassion satisfaction and compassion fatigue from intensive care nurses' perspectives. Compassion satisfaction and compassion fatigue can influence critical care nurses' decisions to either continue or leave the profession, and could impact the compassionate patient-centred nursing care patients receive during their ICU admission. This qualitative research design was informed by Charmaz's Grounded Theory Constructivist methodology. In-depth interviews were conducted with 21 critical care nurses of two ICUs in Australia during 2016. Interview data were analysed using grounded theory processes. Findings reflected positive and negative impacts on critical care nurses' ability to deal compassionately with their patients. Effects on patient-centred nursing and critical care nurses' own well-being were revealed. A core category of "Expectations" emerged, explaining the tension between critical care nurses' biomedical, clinical skills and knowledge versus compassionate, patient-centred nursing care. This tension was clarified and expanded in subcategories of "Life in the Balance," "Passion and Pressure," "Understanding and Advocacy" and "Tenacity and Fragility". Providing patient-centred nursing may enhance critical care nurses' experience of compassion satisfaction, in turn impacting delivery of compassionate patient-centred nursing to generate a virtuous circle. Critical care nurses who feel respected and supported by their management team and colleagues experience feelings of compassion satisfaction, leading to greater engagement and care towards their patient. Systematically addressing critical care nurses' needs to successfully balance biomedical with compassionate nursing care may lead to greater well-being in the critical care nursing workforce and improve patient experience of intensive care. © 2017 John Wiley & Sons Ltd.
Caffrey, Rosalie A
Few nurses have the experience of developing an independent practice. This ethnographic study explores the process and challenges of becoming an entrepreneur as described by nurses developing independent practices in community care gerontologic nursing. The process included developing a legal contract, marketing strategies, and reimbursement amounts and strategies. Major barriers to implementing this role identified by the nurses included ignorance and confusion by others about their role, financial issues related to an uncertain income, time management, and legal concerns especially around delegation. These were experienced and dedicated nurses who were also risk-takers and enjoyed the independence of practicing nursing because they believed it was meant to be practiced. Suggestions for research, education, and practice are included.
Cox, S.; Wark, E.
This and the preceding article (Nursing Mirror, Sept. 1, 1978) form a slightly shortened version of Chap. 5 from Vol. 2 of the book 'Oncology for Nurses and Health Care Professionals', ed. R. Tiffany, (Allen and Unwin, Oct. 1978). Teletherapy was dealt with in part 1. Part 2 is concerned with radiotherapy using radioisotope implants and applicators and unsealed sources, and with surgery and chemotherapy, including side effects of anti-tumour drugs. The physical and psychological effects on the patient of these forms of treatment are discussed, and nursing care and radiological safety precautions for both patients and nursing staff are described. (author)
Cameron, Fiona; Brownie, Sonya
To identify the factors that impact the resilience of registered aged care nurses, that is their capacity to adapt to the physical, mental and emotional demands of working in aged care facilities. This study explored the lived experience of nine registered nurses working in residential aged care facilities on the Sunshine Coast, Queensland, who were asked to reflect on the phenomenon of resilience in the workplace. This study found that clinical expertise, a sense of purpose in a holistic care environment, a positive attitude and work-life balance are important determinants of resilience in aged care nurses. Resilience in nurses in residential aged care facilities is enhanced when they are able to maintain long-term, meaningful relationships with residents. Collegial support that provides opportunities to debrief and validate experiences as well as the use of humour to defuse stress promotes well-being and builds resilience in the workplace.
"We should be able to bear our patients in our teaching in some way": theoretical perspectives on how nurse teachers manage their emotions to negotiate the split between education and caring practice.
Smith, Pam; Allan, T Helen
In a classic paper, Menzies (1960) argued that nurses distanced themselves from patients in order to avoid direct engagement with them and as a means of managing their anxiety. Reflecting on the work 40years later Fabricius argued that in the move from hospital-based nurse education to universities, nurse educators had further entrenched this defence. It is from both these perspectives that we locate this paper to explore the position of nurse teachers today drawing on empirical data from a study set up to investigate who currently leads student nurse learning in the clinical areas and as a follow up to original research on the emotional labour of nursing (Smith, 1992). This paper presents findings from interviews with nurse teachers which are complemented by student nurse responses to a ward learning environment questionnaire, interviews with ward based nurses and documentary analysis. A major theme to emerge from the study was that there has been an uncoupling of education and practice as a consequence of the changes taking place in nurse education over the last two decades. This paper describes the range of emotions expressed as a consequence of this uncoupling such as increasing feelings of uncertainty over the nurse teacher's role in clinical practice and anxiety generated from working in a university system which appeared to devalue caring. The apparent impact of these feelings on nurse teachers was to reinforce the education/practice split and the projection of their anxiety onto students and practitioners. We suggest that nurse teachers and in particular the system in which they work need to recognise both split and projection so that they are able to bear their anxiety and manage it in their teaching.
Nursing is widely considered as an art and a science, wherein caring forms the theoretical framework of nursing. Nursing and caring are grounded in a relational understanding, unity, and connection between the professional nurse and the patient. Task-oriented approaches challenge nurses in keeping care in nursing. This challenge is ongoing as professional nurses strive to maintain the concept, art, and act of caring as the moral center of the nursing profession. Keeping the care in nursing involves the application of art and science through theoretical concepts, scientific research, conscious commitment to the art of caring as an identity of nursing, and purposeful efforts to include caring behaviors during each nurse-patient interaction. This article discusses the profession of nursing as an art and a science, and it explores the challenges associated with keeping the care in nursing.
Salehian, Maryam; Heydari, Abbas; Aghebati, Nahid; Karimi Moonaghi, Hossein; Mazloom, Seyed Reza
The aim of this principle-based concept analysis was to analyze caring in nursing education and to explain the current state of the science based on epistemologic, pragmatic, linguistic, and logical philosophical principles. A principle-based concept analysis method was used to analyze the nursing literature. The dataset included 46 English language studies, published from 2005 to 2014, and they were retrieved through PROQUEST, MEDLINE, CINAHL, ERIC, SCOPUS, and SID scientific databases. The key dimensions of the data were collected using a validated data-extraction sheet. The four principles of assessing pragmatic utility were used to analyze the data. The data were managed by using MAXQDA 10 software. The scientific literature that deals with caring in nursing education relies on implied meaning. Caring in nursing education refers to student-teacher interactions that are formed on the basis of human values and focused on the unique needs of the students (epistemological principle). The result of student-teacher interactions is the development of both the students and the teachers. Numerous applications of the concept of caring in nursing education are available in the literature (pragmatic principle). There is consistency in the meaning of the concept, as a central value of the faculty-student interaction (linguistic principle). Compared with other related concepts, such as "caring pedagogy," "value-based education," and "teaching excellence," caring in nursing education does not have exact and clear conceptual boundaries (logic principle). Caring in nursing education was identified as an approach to teaching and learning, and it is formed based on teacher-student interactions and sustainable human values. A greater understanding of the conceptual basis of caring in nursing education will improve the caring behaviors of teachers, create teaching-learning environments, and help experts in curriculum development.
Boehringer, Bradley; Choate, Michael; Hurwitz, Shelley; Tilney, Peter V R; Judge, Thomas
Accurate endotracheal intubation for patients in extremis or at risk of physiologic decompensation is the gold standard for emergency medicine. Field intubation is a complex process and time to intubation, number of attempts, and hypoxia have all been shown to correlate with increases in morbidity and mortality. Expanding laryngoscope technology which incorporates active video, in addition to direct laryngoscopy, offers providers improved and varied tools to employ in management of the advanced airway. Over a nine-year period a helicopter emergency medical services team, comprised of a flight paramedic and flight nurse, intended to intubate 790 patients. Comparative data analysis was performed and demonstrated that the introduction of the CMAC video laryngoscope improved nearly every measure of success in airway management. Overall intubation success increased from 94.9% to 99.0%, first pass success rates increased from 75.4% to 94.9%, combined first and second pass success rates increased from 89.2% to 97.4%, and mean number of intubation attempts decreased from 1.33 to 1.08.
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.
Sullivan, Debra Henline
Technology is rapidly changing the way nurses deliver patient care. The Health Information Technology for Economic and Clinical Health Act of 2009 encourages health care providers to implement electronic health records for meaningful use of patient information. This development has opened the door to many technologies that use this information to streamline patient care. This article explores current and new technologies that nurses will be working with either now or in the near future. Copyright © 2015 Elsevier Inc. All rights reserved.
Levine, C D; Wilson, S F; Guido, G W
Two hundred members of the American Association of Critical-Care Nurses responded to a mail-out survey done to determine the psychologic profile of critical care nurses in terms of self-esteem, gender identity, and selected personality characteristics. The instruments used were Cattell's 16 PR, the Personal Attributes Questionnaire (PAQ), and the Texas Social Behavior Inventory (TSBI). Their personality factors tended to be aggressive, assertive, competitive, persevering, moralistic, resourceful, and mechanical. The nurses who enjoyed the field most were of the androgynous or masculine type and had high levels of self-esteem. On the basis of these findings, the nurse recruiter or faculty member doing career counseling could assess the personality characteristics, gender identity, and self-esteem levels of interested nurses. The goal would be to identify nurses who would both enjoy the field and remain active in critical care nursing after orientation. The goal could also be to help nurses dissatisfied with critical care nursing to seek means of improving their self-esteem.
Personal stories of illness give depth to otherwise clinical descriptions of diagnoses. This article offers an autobiographical narrative of complications after total knee replacement surgery. Diagnosis and nursing management of acute compartment syndrome, nociceptive and neuropathic origins of pain, pharmacologic and nursing interventions for pain, the use of prayer in illness, and compassionate caring from a Christian perspective are discussed.
Full Text Available Karen Jackson,1 Deborah E White,2 Jeanne Besner,1 Jill M Norris21Health Systems and Workforce Research Unit, Alberta Health Services, Calgary, Alberta, Canada; 2Faculty of Nursing, University of Calgary, Calgary, Alberta, CanadaBackground: Effective and efficient use of nursing human resources is critical. The Nursing Role Effectiveness Model conceptualizes nursing practice in terms of key clinical role accountabilities and has the potential to inform redesign efforts. The aims of this study were to develop, implement, and evaluate a job redesign intended to optimize the enactment of registered nurse (RN clinical role accountabilities.Methods: A job redesign was developed and implemented in a single medical patient care unit, the redesign unit. A mixed-methods design was used to evaluate the job redesign; a second medical patient care unit served as a control unit. Data from administrative databases, observations, interviews, and demographic surveys were collected pre-redesign (November 2005 and post-redesign (October 2007.Results: Several existing unit structures and processes (eg, model of care delivery influenced RNs' ability to optimally enact their role accountabilities. Redesign efforts were hampered by contextual issues, including organizational alignment, leadership, and timing. Overall, optimized enactment of RN role accountabilities and improvements to patient outcomes did not occur, yet this was predictable, given that the redesign was not successful. Although the results were disappointing, much was learned about job redesign.Conclusion: Potential exists to improve the utilization of nursing providers by situating nurses' work in a clinical role accountability framework and attending to a clear organizational vision and well-articulated strategic plan that is championed by leaders at all levels of the organization. Health care leaders require a clear understanding of nurses' role accountabilities, support in managing change, and
Luana Loppi Goulart
Full Text Available Severely injured patients with multiple and conflicting injuries present themselves to nursing professionals at critical care units faced with care management challenges. The goal of the present study is to evaluate nursing workload and verify the correlation between workload and the APACHE II severity index. It is a descriptive study, conducted in the Trauma Intensive Care Unit of a teaching hospital. We used the Nursing Activities Score and APACHE II as instruments. The sample comprised 32 patients, of which most were male, young adults, presenting polytrauma, coming from the Reference Emergency Unit, in surgical treatment, and discharged from the ICU. The average obtained on the Nursing Activities Score instrument was 72% during hospitalization periods. The data displayed moderate correlation between workload and patient severity. In other words, the higher the score, the higher the patient’s mortality risk. doi: 10.5216/ree.v16i2.22922.
Full Text Available In recent years, many study results have been published confirming an improvement in the outcomes of treatment related with management of patients within the fast-track surgery programme. Early postoperative rehabilitation is possible provided there is engagement of a multi-disciplinary team, including well-educated nurses. Today, a diversion can be observed from traditional nursing on behalf of a coordinated, holistic approach, while more attention is paid to the, thus far marginalised, psychosocial aspects of care. The objective of the study is to discuss the basic assumptions of fast track surgery with respect to nursing care, with particular emphasis placed on the educational function. Modern nursing within the short-track surgery programme should focus on the provision of patients with care consisting of preliminary information concerning the perioperative period, social and psychological support, counselling in the area of home convalescence, and procedures in the case of complications.
van Dover, Leslie; Pfeiffer, Jane Bacon
This paper reports the development of a substantive theory to explain the process parish nurses use to provide spiritual care to parishioners in Christian churches in a context where patients and nurses share a common set of values. Despite a surge of interest in spirituality and spiritual care in nursing, consensus is lacking on how care should be conceptualized and provided. Grounded theory method was used to explore and describe the processes 10 American parish nurses experienced and used as they gave spiritual care. Data were collected between 1998 and 2001. Participants were interviewed and audiotapes transcribed verbatim. Constant comparative methods were used to analyse more than 50 separate incidents reported by the nurses. From its initial emergence as the core category, 'Bringing God Near' became a Basic Social Process theory of giving spiritual care for these parish nurses. This Basic Social Process became a theory through writing theoretical memos that described how the 'main concern' of the nurses to give spiritual care was resolved. Phases within the process include: trusting God, forming relationships with the patient/family, opening to God, activating/nurturing faith and recognizing spiritual renewal or growth. The essence is bringing God near to people as they face health challenges. Findings from the study and spiritual care literature are integrated in the discussion. The parish nurses' spiritual challenge is to respond to what God is directing the nurse to be and do to strengthen people spiritually. This spiritual care can help restore the patient's sense of well-being, and encourage growth in faith. Those interested in providing and teaching spiritual care in the church context will find this theory useful as a conceptual guide.
Mastal, Margaret; Levine, June
Ambulatory care settings employ 25% of the three million registered nurses in the United States. The American Academy of Ambulatory Care Nursing (AAACN) is committed to improving the quality of health care in ambulatory settings, enhancing patient outcomes, and realizing greater health care efficiencies. A survey of ambulatory care registered nurses indicates they are well positioned to lead and facilitate health care reform activities with organizational colleagues. They are well schooled in critical thinking, triage, advocating for patients, educating patients and families, collaborating with medical staff and other professionals, and care coordination. The evolving medical home concept and other health care delivery models reinforces the critical need for registered nurses to provide chronic disease management, care coordination, health risk appraisal, care transitions, health promotion, and disease prevention services. Recommendations are offered for organizational leaders, registered nurses, and AAACN to utilize nursing knowledge and skills in the pursuit of leading change and advancing health.
Lowe, Grainne; Plummer, Virginia; Boyd, Leanne
The aim of this qualitative research was to explore perceptions of organisational change related to the integration of nurse practitioners from key nursing stakeholders. The ongoing delivery of effective and efficient patient services is reliant upon the development and sustainability of nurse practitioner roles. Examination of the factors contributing to the underutilization of nurse practitioner roles is crucial to inform future management policies. A change management theory is used to reveal the complexity involved. Qualitative interviews were undertaken using a purposive sampling strategy of key stakeholders. Thematic analysis was undertaken and key themes were correlated to the theoretical framework. The results confirm the benefits of nurse practitioner roles, but suggest organisational structures and embedded professional cultures present barriers to full role optimization. Complicated policy processes are creating barriers to the integration of nurse practitioner roles. The findings increase understanding of the links between strategic planning, human resource management, professional and organisational cultures, governance and politics in change management. Effective leadership drives the change process through the ability to align key components necessary for success. Sustainability of nurse practitioners relies on recognition of their full potential in the health care team. The results of this study highlight the importance of management and leadership in the promotion of advanced nursing skills and experience to better meet patient outcomes. The findings reinforce the potential of nurse practitioners to deliver patient centred, timely and efficient health care. © 2018 John Wiley & Sons Ltd.
... cases, you can also call the Department of Health. Nursing homes are required to post information on how you ... nursing homes in your area, go to Medicare’s Nursing Home Compare website at ... information is not intended to diagnose health problems or to take the place of medical ...
Spears, L A
Based on interviews, this study indicates that writing business communications is a key task for nurse managers, affecting their professional success and power. However, most of the nurse managers interviewed felt they needed more education in business communications. Several ways of bringing this training to nursing students and practicing managers are suggested.
Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78). Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses and quality of care is
Full Text Available Abstract Background Leadership and staffing are recognised as important factors for quality of care. This study examines the effects of ward leaders' task- and relationship-oriented leadership styles, staffing levels, ratio of registered nurses and ratio of unlicensed staff on three independent measures of quality of care. Methods A cross-sectional survey of forty nursing home wards throughout Norway was used to collect the data. Five sources of data were utilised: self-report questionnaires to 444 employees, interviews with and questionnaires to 13 nursing home directors and 40 ward managers, telephone interviews with 378 relatives and 900 hours of field observations. Separate multi-level analyses were conducted for quality of care assessed by relatives, staff and field observations respectively. Results Task-oriented leadership style had a significant positive relationship with two of the three quality of care indexes. In contrast, relationship-oriented leadership style was not significantly related to any of the indexes. The lack of significant effect for relationship-oriented leadership style was due to a strong correlation between the two leadership styles (r = 0.78. Staffing levels and ratio of registered nurses were not significantly related to any of the quality of care indexes. The ratio of unlicensed staff, however, showed a significant negative relationship to quality as assessed by relatives and field observations, but not to quality as assessed by staff. Conclusions Leaders in nursing homes should focus on active leadership and particularly task-oriented behaviour like structure, coordination, clarifying of staff roles and monitoring of operations to increase quality of care. Furthermore, nursing homes should minimize use of unlicensed staff and address factors related to high ratios of unlicensed staff, like low staff stability. The study indicates, however, that the relationship between staffing levels, ratio of registered nurses
Abernethy, M A; Stoelwinder, J U
Professional/bureaucratic conflict theory suggests that the extent to which nurse managers use management control systems will depend on whether their goal orientation is to system rather than output or derived goals. This article examines the use of budgeting as a management control strategy, in relation to the goal orientation of nurse managers, in four large teaching hospitals. The goal orientations and use of budgeting by nurse managers is also compared with those of physician managers and other sub-unit managers. The results indicate that nurse managers appear to be developing their goals of professionalization without a diminution of their organizational focus or their orientation towards providing a high standard of patient care.
Day, Mary Rose
Self-neglect is a worldwide and serious public health issue that can have serious adverse outcomes and is more common in older people. Cases can vary in presentation, but typically present as poor self-care, poor care of the environment and service refusal. Community nurses frequently encounter self-neglect cases and health and social care professionals play a key role in the identification, management and prevention of self-neglect. Self-neglect cases can give rise to ethical, personal and professional challenges. The aim of this article is to create a greater understanding of the concept of self-neglect among community nurses.
Fabrellas, Núria; Vidal, Angel; Amat, Gemma; Lejardi, Yolanda; del Puig Deulofeu, Maria; Buendia, Carmen
This paper is a report of a study to assess the feasibility and efficacy of a programme of nurse management for patients requesting same day consultation for minor illnesses in primary care. The efficacy of such programmes has been demonstrated in randomized studies but there is little information on these programmes in highly populated areas. Patients seeking same day consultation for one of 23 preselected minor illnesses (16 for adults, 7 for paediatric patients) from March 2009 to April 2010 were seen by trained nurses who followed predefined algorithms. If signs of alarm were detected, patients were referred to a general practitioner. A total of 629,568 consultations were performed, 575,189 in adults and 54,379 in paediatric patients. Case resolution was achieved in 61.8% of adult and 75.6% of paediatric patients. In adults, the highest resolution rates (>90%) were obtained for burns, skin injury and emergency contraception, and the lowest for lower urinary symptoms (46.7%), sore throat (45.7%), pink eye (45.5%) and upper respiratory symptoms (41.4%). In paediatric patients, the highest resolution rates (>90%) were obtained for stomach cramps and burns and the lowest for cough (36.2%). A return to consultation during a 7-day period for the same reason as the first consultation was low, 4% for adults and 2.4% for paediatric patients. An extended programme of nurse management for same day consultation of patients with minor illnesses showed an acceptably high rate of resolution and low rate of return to consultation. The application of such programmes in extensive areas is feasible and effective. © 2011 Blackwell Publishing Ltd.
Alavi, Azam; Bahrami, Masoud; Zargham-Boroujeni, Ali; Yousefy, Alireza
The present study was conducted to clarify pediatric nurses' characteristics of caring self-efficacy. This study was conducted using a qualitative content analysis approach. The participants included 27 pediatric nurses and clinical instructors, selected purposively. Data were collected using semi-structured interviews and were analyzed using the content analysis method. Data analysis generated four main themes as attributes of a self-efficient pediatric nurse including: (a) professional communications; (b) management of care; (c) altruism; and (d) proficiency. Nursing managers and instructors can use these results to help develop nurses' empowerment and self-efficacy, especially in pediatric care. © 2015, Wiley Periodicals, Inc.
Sacco, Tara L; Ciurzynski, Susan M; Harvey, Megan Elizabeth; Ingersoll, Gail L
Although critical care nurses gain satisfaction from providing compassionate care to patients and patients' families, the nurses are also at risk for fatigue. The balance between satisfaction and fatigue is considered professional quality of life. To establish the prevalence of compassion satisfaction and compassion fatigue in adult, pediatric, and neonatal critical care nurses and to describe potential contributing demographic, unit, and organizational characteristics. In a cross-sectional design, nurses were surveyed by using a demographic questionnaire and the Professional Quality of Life Scale to measure levels of compassion fatigue and compassion satisfaction. Nurses (n = 221) reported significant differences in compassion satisfaction and compassion fatigue on the basis of sex, age, educational level, unit, acuity, change in nursing management, and major systems change. Understanding the elements of professional quality of life can have a positive effect on work environment. The relationship between professional quality of life and the standards for a healthy work environment requires further investigation. Once this relationship is fully understood, interventions to improve this balance can be developed and tested. ©2015 American Association of Critical-Care Nurses.
Jooste, Karien; Cairns, Lindi
This paper compares the perceptions of nurse managers and nurses about self-leadership of professional nurses while taking ownership of capacity building during unit management. The Nursing Strategy for South Africa states that the competency of nurses is dependent upon factors that lead to capacity building. A quantitative design was followed by conducting a survey. The target population included nurse managers and professional nurses working at an academic public hospital in the Gauteng Province of South Africa. The findings indicate shortcomings in relation to advising professional nurses about self-direction while taking ownership of their daily pressures and stresses associated with unit management. Professional nurses should develop their confidence by focusing on their self-leadership strengths when managing a unit. Recommendations are made to promote self-leadership while taking ownership of nurses during capacity building of unit management. © 2014 John Wiley & Sons Ltd.
Saleh, Usama; O'Connor, Tom; Al-Subhi, Hattan; Alkattan, Rana; Al-Harbi, Saad; Patton, Declan
to explore the nature of leadership styles used by the nursing management team, as perceived by nurses working at the bedside. leadership style is related to job satisfaction, staff retention, costs, and quality of care. The leadership styles of managers can be crucial in the healthcare setting, but very few studies have focused on them. the study employed qualitative methodology, involving 35 nurses working in different specialties of a medical city in Saudi Arabia. Data collection consisted of completing demographic and professional information and a semi-structured interview using open-ended questions. a phenomenologic-hermeneutic approach was used to identify major themes. the findings showed that participants described four types of leadership styles: relational leadership, preferential leadership, communication chain leadership, and ineffectual leadership. the leadership style employed by nurse managers has a major impact on nurses' satisfaction, turnover, and the quality of patient care they deliver.
Luzia, Melissa de Freitas; Almeida, Miriam de Abreu; Lucena, Amália de Fátima
Identifying the prescribed nursing care for hospitalized patients at risk of falls and comparing them with the interventions of the Nursing Interventions Classifications (NIC). A cross-sectional study carried out in a university hospital in southern Brazil. It was a retrospective data collection in the nursing records system. The sample consisted of 174 adult patients admitted to medical and surgical units with the Nursing Diagnosis of Risk for falls. The prescribed care were compared with the NIC interventions by the cross-mapping method. The most prevalent care were the following: keeping the bed rails, guiding patients/family regarding the risks and prevention of falls, keeping the bell within reach of patients, and maintaining patients' belongings nearby, mapped in the interventions Environmental Management: safety and Fall Prevention. The treatment prescribed in clinical practice was corroborated by the NIC reference.
Louise Passos Vigolvino Macêdo
Full Text Available Objective: Investigate the understanding of nurses who work at a teaching hospital, in relation to NCS and the nursing process; ascertain facilities/difficulties related to the applicability of the nursing process in that service; and verify the opinions of those professionals for the improvement and/or effectiveness of the nursing process at the hospitalization units of the hospital. Method: Exploratory, descriptive study, with a qualitative approach. The sample consisted of 42 nurses who answered a questionnaire. The empirical material was analyzed and categorized based on the content analysis technique and discussed in the light of the literature. Results: From the participants' discourses, two categories of analysis emerged: 1 understanding of NCS as a tool to organize the Nursing work process and improve the quality of care; and 2 applicability of the nursing process at the various hospitalization units of the institution. Conclusion: The implementation and applicability of that method depend on not only the knowledge and motivation of the nursing professionals, but also on a strategic planning involving management and staff, from the recognition of their importance in order to obtain adherence and effective operationalization in practice. Descriptors: Nursing; Nursing Process; Professional Practice.
Munshi, Medha N; Florez, Hermes; Huang, Elbert S; Kalyani, Rita R; Mupanomunda, Maria; Pandya, Naushira; Swift, Carrie S; Taveira, Tracey H; Haas, Linda B
Diabetes is more common in older adults, has a high prevalence in long-term care (LTC) facilities, and is associated with significant disease burden and higher cost. The heterogeneity of this population with regard to comorbidities and overall health status is critical to establishing personalized goals and treatments for diabetes. The risk of hypoglycemia is the most important factor in determining glycemic goals due to the catastrophic consequences in this population. Simplified treatment regimens are preferred, and the sole use of sliding scale insulin (SSI) should be avoided. This position statement provides a classification system for older adults in LTC settings, describes how diabetes goals and management should be tailored based on comorbidities, delineates key issues to consider when using glucose-lowering agents in this population, and provides recommendations on how to replace SSI in LTC facilities. As these patients transition from one setting to another, or from one provider to another, their risk for adverse events increases. Strategies are presented to reduce these risks and ensure safe transitions. This article addresses diabetes management at end of life and in those receiving palliative and hospice care. The integration of diabetes management into LTC facilities is important and requires an interprofessional team approach. To facilitate this approach, acceptance by administrative personnel is needed, as are protocols and possibly system changes. It is important for clinicians to understand the characteristics, challenges, and barriers related to the older population living in LTC facilities as well as the proper functioning of the facilities themselves. Once these challenges are identified, individualized approaches can be designed to improve diabetes management while lowering the risk of hypoglycemia and ultimately improving quality of life. © 2016 by the American Diabetes Association. Readers may use this article as long as the work is properly
A patient's refusal of nursing care concerns the caregivers. Future professionals must be prepared for it and student nurses are trained to deal with such situations. It is also important to empower patients and support them in their choice. This article presents the example of the Haute École Robert Schuman in Libramont, Belgium. Copyright © 2016 Elsevier Masson SAS. All rights reserved.
Meta-Analysis of the Ease of Care From the Nurses' Perspective Comparing Fentanyl Iontophoretic Transdermal System (ITS) Vs Morphine Intravenous Patient-Controlled Analgesia (IV PCA) in Postoperative Pain Management.
Pestano, Cecile R; Lindley, Pam; Ding, Li; Danesi, Hassan; Jones, James B
The aim of this meta-analysis was to compare the ease of care (EOC) of fentanyl iontophoretic transdermal system (ITS) vs the morphine intravenous patient-controlled analgesia (IV PCA) as assessed by the nurse. Meta-analysis of three phase 3B randomized active-comparator trials. This meta-analysis according to Cochrane's approach assessed EOC using a validated nurse questionnaire (22 items grouped into three subscales, which include time efficiency, convenience, and satisfaction) in adult patients treated with fentanyl ITS or morphine IV PCA for postoperative pain management. The weighted mean difference (WMD) between treatments was calculated. EOC analyses were based on responses to questionnaires from 848 (fentanyl ITS) and 761 (morphine IV PCA) nurses. Fentanyl ITS was reported to provide significant advantages compared with morphine IV PCA in terms of nurses' overall EOC (WMD = -0.57, P PCA. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
Numminen, Olivia; Laine, Tuija; Isoaho, Hannu; Hupli, Maija; Leino-Kilpi, Helena; Meretoja, Riitta
This study evaluated weather educational outcomes of nurse education meet the requirements of nursing practice by exploring the correspondence between nurse educators' and nurse managers' assessments of novice nurses' professional competence. The purpose was to find competence areas contributing to the acknowledged practice-theory gap. A cross-sectional, comparative design using the Nurse Competence Scale was applied. The sample comprised nurse educators (n = 86) and nurse managers (n = 141). Descriptive and inferential statistics were used in the data analysis. Educators assessed novice nurses' competence to a significantly higher level than managers in all competence areas (p competencies related to immediate patient care, commitment to ethical values, maintaining professional skills and nurses' care of the self. The biggest differences were in competencies related to developmental and evaluation tasks, coaching activities, use of evidence-based knowledge and in activities which required mastering a comprehensive view of care situations. However, differences between educators' and managers' assessments were strongly associated with their age and work experience. Active and improved collaboration should be focused on areas in which the differences between educators' and managers' assessments greatly differ in ensuring novice nurses' fitness for practice. © 2014 The Authors. Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.
Lu, Minmin; Ruan, Hui; Xing, Weijie; Hu, Yan
The investigators examined how nurse staffing affects nurse job satisfaction and quality of care. Inadequate nurse staffing is a worldwide issue with profound effects on nurse job satisfaction and quality of care. Few studies have examined the relationship between nurse staffing and job satisfaction and quality of care in China. A cross-sectional design was adopted, wherein 873 nurses were surveyed on demographics, nurse staffing, job-related burnout, job dissatisfaction, intent to leave, and quality of care. The median patient-nurse ratio was five; 45.1% nurses reported high levels of job-related burnout, and 55.6%, job dissatisfaction. In adjusted regression models, patient-nurse ratios of four or less were related to a decrease in the odds of job dissatisfaction (odds ratio 0.55, 95% confidence interval 0.36-0.85) and increase in the odds of quality of care (odds ratio 1.78, 95% confidence interval 1.02-2.82). Nurse staffing is associated with job dissatisfaction and quality of care. Nurse managers should maintain an adequate level of nurse staffing, referring to the patient-nurse ratio. They should create new initiatives to increase job satisfaction among nurses and to evaluate their effects. © 2013 John Wiley & Sons Ltd.
Moth, Grete; Andersen, Ane Birgitte Telén
In Denmark, management of care at hospitals is characterized by efficient medical treatment and short hospital stay. This results in a heavier and more complex workload on the primary health care sector. However, very little research has so far shed light on the area of home care performed by nur...... by nurses. The aim of the study was to examine the experience of home care from a nurse as well as a citizen perspective....
Piredda, M; Ghezzi, V; De Marinis, M G; Palese, A
Longitudinal three-time point study, addressing how neurological adult patient care dependency varies from the admission time to the 3rd day of acute hospitalization. Nursing care dependency was measured with the Care Dependency Scale (CDS) and a Latent Growth Modeling approach was used to analyse the CDS trend in 124 neurosurgical and stroke inpatients. Care dependence followed a decreasing linear trend. Results can help nurse-managers planning an appropriate amount of nursing care for acute neurological patients during their initial stage of hospitalization. Further studies are needed aimed at investigating the determinants of nursing care dependence during the entire in-hospital stay.
Gustafsson, Lena-Karin; Stenberg, Maja
It is of importance to understand and communicate caring ethics as a ground for qualitative caring environments. Research is needed on nursing attributes that are visible in nursing leadership since it may give bases for reflections related to the patterns of specific contexts. The aim of this study was to illuminate the meaning of crucial attributes in nursing leadership toward an ethical care of patients in psychiatric in-patient settings. The design of the study was descriptive and qualitative with a phenomenological hermeneutical approach. Participants and research context: The study comprised focus group interviews with nurses working in indoor psychiatric care who participated after giving informed consent. Ethical considerations: Since the topic and informants are not labeled as sensitive and subject to ethical approval, it is not covered by the ethics committee's aim and purpose according to Swedish law. However, careful procedures have been followed according to ethics expressed in the Declaration of Helsinki. When identifying the thematic structures, analysis resulted in three major themes: To supply, including the following aspects: to supply evidence, to supply common space, and to supply good structures; To support, including the following aspects: to be a role model, to show appreciation and care, and to harbor; To shield, including the following aspects: to advocate, to emit non-tolerance of unethical behavior, and to reprove. Leadership is challenging for nurses and plays an important role in ethical qualitative care. These findings should not be understood as a description about nurse manager's role, which probably has different attributes and more focus on an organizational level. Making the understanding about crucial attributes explicit, the nurse may receive confirmation and recognition of crucial attributes for ethical care in order to move toward an ethical care.
Morsiani, Giuliana; Bagnasco, Annamaria; Sasso, Loredana
To describe staff nurses' perceptions related to the leadership styles adopted by their nurse managers, identify which leadership style ensured job satisfaction in staff nurses and describe which behaviours nurse managers should change. Empirical literature suggests that leadership styles of nurse managers significantly influence staff satisfaction. However, few studies investigate how staff nurses perceive the leadership styles of their nurse managers, and how these impact upon the staff nurses' job satisfaction. This was a mixed method study, which included the administration of the Multi-factor Leadership Questionnaire and three focus groups. Ward nurse managers mostly adopted a transactional leadership style ('Management by exception active') aimed at monitoring errors and intervening to correct errors and punish, which had a negative impact on staff nurses' levels of job satisfaction. In contrast, the transformational leadership style, which is mostly correlated with satisfaction ('Idealized Influence Attributed', which staff nurses perceived as 'respect', 'caring for others', 'professional development' and 'appreciation'), was rarely practiced by nurse managers. The transformational leadership skills of Italian nurse managers need to be improved through behaviours based on greater respect, caring for others, professional development and appreciation. The present study could also serve as model to improve the leadership style of nurse managers in other countries. The themes of transformational leadership could serve as a guide for nurse managers to help them improve their leadership style, and improve the levels of job satisfaction in staff nurses. Owing to the complexity and the importance of this issue, classroom educational interventions would not be sufficient: it should be dealt as a strategic priority by nursing directors. © 2016 John Wiley & Sons Ltd.
Lydia V. Monareng
Full Text Available Although the concept ‘spiritual nursing care’ has its roots in the history of the nursing profession, many nurses in practice have difficulty integrating the concept into practice. There is an ongoing debate in the empirical literature about its definition, clarity and application in nursing practice. The study aimed to develop an operational definition of the concept and its application in clinical practice. A qualitative study was conducted to explore and describe how professional nurses render spiritual nursing care. A purposive sampling method was used to recruit the sample. Individual and focus group interviews were audio-taped and transcribed verbatim. Trustworthiness was ensured through strategies of truth value, applicability, consistency and neutrality. Data were analysed using the NUD*IST power version 4 software, constant comparison, open, axial and selective coding. Tech’s eight steps of analysis were also used, which led to the emergence of themes, categories and sub-categories. Concept analysis was conducted through a comprehensive literature review and as a result ‘caring presence’ was identified as the core variable from which all the other characteristics of spiritual nursing care arise. An operational definition of spiritual nursing care based on the findings was that humane care is demonstrated by showing caring presence, respect and concern for meeting the needs not only of the body and mind of patients, but also their spiritual needs of hope and meaning in the midst of health crisis, which demand equal attention for optimal care from both religious and nonreligious nurses.
Artero-López, Consuelo; Márquez-Hernández, Verónica V; Estevez-Morales, María Teresa; Granados-Gámez, Genoveva
To assess the existence of therapeutic inertia in the nursing care of patients with urinary incontinence during the patient's time in hospital, together with the sociodemographic and professional variables involved. Inertia in care is a problem which appears in the nursing care process. Actions related to inertia can be attributed to not adhering to protocols, clinical guidelines and the lack of prevention measures which have undesirable effects on the efficiency of care. This was a prospective observational study. A total of 132 nursing professionals participated over two consecutive months. Data were collected randomly through the method of systematic, nonparticipative observation of medical practice units and patients' medical records. The results showed a pattern of severely compromised action in the assessment of the pattern of urinary elimination, in actions related to urinary continence, in therapeutic behaviour and in patient satisfaction and were found to be consistent with professional experience (p inertia exists in nursing care in the hospital environment while the patient is hospitalised, in prevention care, in the treatment of urinary incontinence and in the management of records. Contributing to the understanding of the existence of inertia in nursing care raises questions regarding its causes and interventions to predict or monitor it. © 2018 John Wiley & Sons Ltd.
Dijk, C.E. van; Verheij, R.A.; Hansen, J.; Velden, L. van der; Nijpels, G.; Groenewegen, P.P.; Bakker, D.H. de
BACKGROUND: Primary care nurses play an important role in diabetes care, and were introduced in GP-practice partly to shift care from hospital to primary care. The aim of this study was to assess whether the referral rate for hospital treatment for diabetes type II (T2DM) patients has changed with
Mmamma, Mogale L; Mothiba, Tebogo M; Nancy, Malema R
Staff turnover of professional nurses remains a concern for public and private hospitals management because it has an impact on the morale of nurses and it may also lead to poor patient care. The objectives of this study were to explore and describe the experiences of nursing unit managers with regard to the turnover of professional nurses who were under their supervision. A qualitative, explorative, descriptive research design was used to determine the experiences of nursing unit managers related to the turnover of professional nurses. Data collection was done by using semi-structured one-to-one interviews with professional nurses .Two groups of participants were interviewed: Those working day duty (n = 9) and those working night duty (n = 3) who were at work on the anticipated days for data collection. The findings revealed that every unit was experiencing a shortage of professional nurses, which caused other nurses to work overtime with an inevitable increase in workload. That led to tiredness, conflict amongst professional nurses, job dissatisfaction, and absenteeism which compromised nursing care. This resulted in patient dissatisfaction and sometimes led to deaths that could have been prevented. It is recommended that staff turnover should be addressed by the hospital top management implementing several strategies. For example, top management could ensure that staff members work in a healthy environment with resources that they need during the provision of care, address the effects of the staff turnover, support the staff members and refrain from putting pressure on nursing unit managers whilst they are attending to problems.
Piredda, Michela; Matarese, Maria; Mastroianni, Chiara; D'Angelo, Daniela; Hammer, Marilyn J; De Marinis, Maria Grazia
Care dependence can be associated with suffering and humiliation. Nurses' awareness of patients' perception of care dependence is crucial to enable them in helping the dependent persons. This study aimed to describe adult patients' experience of nursing care dependence. A metasynthesis was conducted to integrate qualitative findings from 18 studies published through December 2014 on adult patients' experiences of care dependency. Procedures included the Johanna Briggs Institute approach for data extraction, quality appraisal, and integration of findings. The experience of dependence revealed the concept of the embodied person, particularly in relation to care of the physical body. The relationship between the individual and nurses within the context of care had a major impact for dependent patients. When the care relation was perceived as positive, the experience led to the development of the person in finding new balances in life, but when it was perceived as negative, it increased patient' suffering. Care dependence is manifested mostly as bodily dependence and is consistent with its relational nature. The nurse-patient relationship is important to the dependent patients' experience. A greater understanding of patients' experiences of dependence is crucial to enable nurses in improving care and decreasing patient suffering. © 2015 Sigma Theta Tau International.
Ingrid Schivre's nursing practice in an emergency department has evolved towards more relaxing approaches which allow for a greater focus on the notion of caring. Copyright Â© 2016 Elsevier Masson SAS. All rights reserved.
Barra, Daniela Couto Carvalho; Waterkemper, Roberta; Kempfer, Silvana Silveira; Carraro, Telma Elisa; Radünz, Vera
Qualitative research whose purpose was to reflect and argue about the relationship between hospitality, care and nursing according to experiences of PhD students. The research was developed from theoretic and practical meeting carried through by disciplines "the care in Nursing and Health" of PhD nursing Program at Santa Catarina Federal University. Its chosen theoretical frame of Hospitality perspective while nursing care. Data were collected applying a semi-structured questionnaire at ten doctoral students. The analysis of the data was carried through under the perspective of the content analysis according to Bardin. Hospitality it is imperative for the individuals adaptation in the hospital context or any area where it is looking for health care.
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
Hocker, Susan M; Trofino, Joan
Management philosophy and culture of any organization must match the nursing professions' core value of caring. Organizational conflict symptomology includes communication barriers and widely differing values. Employment of accountability based systems and bringing nurses into governance prevents conflict and improves job satisfaction. This article identifies the barriers to case management program development and discusses strategies for its successful implementation. Today's most successful organizations will implement an institution-wide commitment to a culture within which excellence flourishes. Creative staffing models and professional practice partnerships such as nursing case management will be supported and encouraged by executive leadership; they work as a team and will be jointly accountable for positive outcomes The United States Army Nurse Corps has the framework necessary to develop a premiere nursing organization. Case management departments may adopt these techniques to improve working relationships and leadership capacity within their organizations.
The role of nurse manager of an acute or critical care unit is one of the most difficult roles in healthcare today. This individual must juggle patient care issues, staff concerns, medical staff relationships, supply inadequacies, and organizational initiatives--and then balance all of this with a personal life. The only way in which any of this is remotely possible is if the patient care unit provides a supportive environment for patients, families, and staff. The nurse manager is a pivotal person in this effort: research repeatedly shows that people don't leave their jobs, they leave their managers. This article describes how the nurse manager of an acute neurosciences unit worked with her staff to define, create, and maintain a work environment in which patient care improved, people enjoyed working, and retention of staff increased.
Finnegan, Alan; Finnegan, Sara; Bates, David; Ritsperis, Debra; McCourt, Kath; Thomas, Mike
This paper forms part of the first British Armed forces qualitative nursing research study undertaken on deployment. To provide an analysis of the impact and effectiveness of the pre-deployment educational preparation and clinical placements provided for military nurses. A Constructivist Grounded Theory was utilised with data collected through semi-structured interviews with 18 nurses based in Camp Bastion Hospital, Afghanistan during 2013. Initial coding indicated 21 educational preparation and clinical placement categories that influenced the delivery of nursing care. Analysis of these elements led to the identification of four major clusters: Military Nursing Care; Military Nurse Education; Unique Hospital Environment and Clinical Placements. Educational preparation consists of completing deployable operational nursing competencies, specialist training and individual tailored courses. This strategy was viewed as proving the appropriate academic requirement. However, training would be enhanced by introducing a formalised military preceptorship programme focussing on fundamental nursing skills. Caring for children was a particular concern, and it was emphasised that educational courses must be combined with a standardised clinical placement policy. Adequate clinical exposure can be challenging as nurses are not routinely exposed to War Zone levels of trauma in the UK. Clinical placements need to be standardised and harmonised, and located in areas where nurses cared for patients with similar injury patterns to those witnessed on deployment. Current NHS Trust placements can reduce the opportunities for employment in suitable clinical environments and diminishing the openings for collective military training. Better use should be made of clinical rotation programmes, including high dependency units, elective surgery, medical assessment units, paediatrics, and outreach teams such as burns and plastic surgery and pain management. Practice Educators should be utilised
Baydoun, Mohamed; Dumit, Nuhad; Daouk-Öyry, Lina
To explore nurses' sickness absenteeism from the perspective of nurse managers. Sickness absenteeism among health-care providers, especially nurses, remains a significant problem in an era of challenges to provide high quality care with the required skill mix. This in turn compromises the quality of care and adds to the costs of an organisation. A qualitative descriptive design was used. Data were collected from a governmental academic hospital in Lebanon. In-depth tape-recorded interviews were conducted with a total of 20 nurse managers. Data were analysed through a content analysis approach. Data analysis yielded three domains as follows: work-related, individual and organisational factors that lead to nurses' sickness absenteeism. This study conceptualised nurses' absenteeism from the nurse managers' perspective, and it revealed absence antecedents that are rarely reported elsewhere in the literature. The findings from this study can be utilised to design reform initiatives concerned with nurses' absenteeism and to decrease its negative consequences in terms of quality and cost. © 2015 John Wiley & Sons Ltd.
Full Text Available Background: Chronic diseases such as cancer would lead to various health needs in patients and their families. To meet needs, developing new educational nursing courses is necessary. Therefore this study was conducted to empower nurses through designing and conducting short-term educational courses for training palliative care nurses. Materials and Methods: This study was a community-based action research which was conducted at Isfahan hospitals that provide services for cancer patients during 2015 at four stages (planning, acting, reflection, and evaluation. Participants (33 samples included nurses, head nurses, managers of nursing services, nursing professors and professors of oncology department. Data were gathered through individual and group interviews and analyzed using content analysis. Results: Data analysis resulted in 3 categories of "professional development of nursing in palliative care" which included subcategories of: knowledge-based performance and positive change in attitude, "obstacles to provide palliative care" with subcategories of: insufficient professional responsibility, insufficient ability in managing some of patients' symptoms and inappropriate interaction between nurses and physicians and "strategies for improving provision of palliative care" with subcategories of: improving the interactions between physicians and nurses, continuous trainings for palliative care and the necessity of developing palliative care in the country. Conclusions: To facilitate the process of providing palliative care to cancer patients, necessary actions and measures must be conducted including improvement of interaction between the members of health team, organizing continuing educational courses on palliative care and development of providing palliative care all over the country by managers of health centers.
Silvia Helena Henriques Camelo
Full Text Available Objective. The aim in this study was to identify how Intensive Care Unit nurses perceive professional competences in thecare team. Methodology. Qualitative multiple case study with an exploratory focus. The sample consisted of 24 nurses from Intensive Care Units (ICU at two large hospitals. To collect the information, direct observation and - structured, non-structuredand participant - interviews were used. Results. Ninety-six percent of the participants were women, 79% were less than 40 years old, and 63% possessed less than five years of professional experience in ICU. Data analysis revealed three study categories: teamwork as a nursing management tool, improving teamwork, and interpersonal communication for teamwork. Conclusion. At the ICU where the nurses work, a teamwork strategy is observed, which demands cooperation and participation by other disciplines.
Luís Felipe Pissaia
Full Text Available Justification and objective: This study has the objective check the use of Information and Communication Technologies (ICT in care processes of nursing through the methodology of Systematization of Nursing Assistance (SNA in a hospital in the interior of Rio Grande do Sul, Brasil. Methods: Descriptive and exploratory study with a qualitative approach carried out six nurses of a hospital service. Results: The lack of knowledge about the importance of ICT, the deficit in the provision of continuing education to professionals and cultural prejudice to new working methods were list as existing weaknesses. Contributions are relate to organizing and planning your activities, as well as an effective personnel management based on the principles of comprehensive care provided to the client. Conclusion: This study demonstrated that ICT help in the implementation of processes and implementation of SNA, promoting new models of work to nurses and encouraging compliance by the hospitals.
Talley, Linda B; Thorgrimson, Diane H; Robinson, Nellie C
Grooming nurses at all levels of the organization to master health care executive skills is critical to the organization's success and the individual's growth. Selecting and executing next steps for nursing leadership team development is critical to success. Leaders must make it their responsibility to provide nurses with increased exposure to quality, safety, and financial data, thereby allowing nurses to translate data while achieving and sustaining successful outcomes. The work of the CNO Dashboard to measure, report, trend, and translate clinical and non-clinical outcomes must be integrated throughout all levels of nursing staff so that nursing practice is positioned to continually strive for best practice. The education and evolution of nurses as business managers is critical to building a strong RN workforce.
Hamid Hosein Poor
Full Text Available Costs of human resources include a high percentage of hospital’s costs; therefore, determination of number of real and optimal employees needed for organizations is very important. In the meantime, the optimal organization of nurses, as the biggest human resource in health care organizations, is of great importance. The present study aimed to assess the distribution of nurses’ activities in shifts and the results of productivity in human resources management in Imam Khomeini hospital in Shirvan. The present cross-sectional study was conducted in 2016. All nurses, working in three shifts of morning, afternoon, and evening in emergency unit and general units of Imam Khomeini hospital, Shirvan, were enrolled into the study through census methods. The instrument, used in this study, was the checklist of timing activities and patients’ satisfaction from nurses. The statistical software SPSS was used for analysis. Mean age of employees in these two units/wards was 31 years and mean duration of work experience was 5.24 years, The difference was significant between the two wards. necessity of the work, especially in emergency unit, are issues that need more assessment and need to be adjusted. Given the high volume of non-care matters of nursing staff, including writing services, including completing paper records and work with HIS (Hospital Information System, which has been emphasized in several studies, new definition of service and use of artificial intelligence with high efficacy is proposed. The status of the available equipment, availability, and efficiency of digital equipment and hoteling state of wards and hospitals also play an important factor in the distribution of time of nursing care activities. Employment of nurses to perform non-nursing duties, because of the shortage of other classes or lack of their permanent presence and based on Although there were differences in standard time of direct and indirect care in emergency unit and
van der Biezen, Mieke; Derckx, Emmy; Wensing, Michel; Laurant, Miranda
Due to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation. A qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP. Employment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs' caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs. In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees' motivation to start the master's programme and GPs' prior experience with PAs/NPs. Knowledge about
Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B
To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.
Cowin, Leanne S
Poor collegial relations can cause communication breakdown, staff attrition and difficulties attracting new nursing staff. Underestimating the potential power of nursing team relationships means that opportunities to create better working environments and increase the quality of nursing care can be missed. Previous research on improving collegiality indicates that professionalism and work satisfaction increases and that staff attrition decreases. This study explores challenges, strengths and strategies used in nursing team communication in order to build collegial relationships. A qualitative approach was employed to gather nurses experiences and discussion of communication within their nursing teams and a constant comparison method was utilised for data analysis. A convenience sampling technique was employed to access both Registered Nurses and Enrolled Nurses to partake in six focus groups. Thirty mostly female nurses (ratio of 5:1) participated in the study. Inclusion criteria consisted of being a nurse currently working in acute care settings and the exclusion criteria included nursing staff currently working in closed specialty units (i.e. intensive care units). Results revealed three main themes: (1) externalisation and internalisation of nursing team communication breakdown, (2) the importance of collegiality for retention of nurses and (3) loss of respect, and civility across the healthcare workplace. A clear division between hierarchies of nurses was apparent in how nursing team communication was delivered and managed. Open, respectful and collegial communication is essential in today's dynamic and complex health environments. The nurses in this study highlighted how important nursing communication can be to work motivation and how leadership fosters teamwork.
Park, Eun-Jun; Kim, Chunmi
The purpose of this study was to develop a substantive theory of case management (CM) practice by investigating the experience of nurse case managers caring for Medical Aid enrollees in Korea. A total of 12 nurses were interviewed regarding their own experience in CM practice. Data were recorded and analyzed using grounded theory. Empowerment was the core category of CM for Medical Aid enrollees. The case managers engaged in five phases as follows, phase of inquiring in advance, building a relationship with the client, giving the client critical mind, facilitating positive changes in the client's use of healthcare services, and maintaining relationship bonds. These phases moved gradually and were circular if necessary. Also, they were accelerated or slowed depending on factors including clients' characteristics, case managers' competency level, families' support level, and availability of community resources. This study helps understand what CM practice is and how nurses are performing this innovative CM role. It is recommended that nurse leaders and policy makers integrate empowerment as a core category and the five critical CM phases into future CM programs.
DeJesus, Ramona S; Howell, Lisa; Williams, Mark; Hathaway, Julie; Vickers, Kristin S
Chronic disease management in the primary care setting increasingly involves self-management support from a nurse care manager. Prior research had shown patient acceptance and willingness to work with care managers. This survey study evaluated patient-perceived satisfaction with care management and patient opinions on the effectiveness of care management in promoting self-management. Qualitative and quantitative survey responses were collected from 125 patients (79% female; average age 46; 94% Caucasian) enrolled in care management for depression. Qualitative responses were coded with methods of content analysis by 2 independent analysts. Patients were satisfied with depression care management. Patients felt that care management improved their treatment above and beyond other aspects of their depression treatment (mean score, 6.7 [SD, 2]; 10 = Very much), increased their understanding of depression self-management (mean score, 7.2 [SD, 2]; 10 = Very much), and increased the frequency of self-management goal setting (mean score, 6.9 [SD, 3]; 10 = Very much). Predominant qualitative themes emphasized that patients value emotional, motivational, and relational aspects of the care manager relationship. Patients viewed care managers as caring and supportive, helpful in creating accountability for patients and knowledgeable in the area of depression care. Care managers empower patients to take on an active role in depression self-management. Some logistical challenges associated with a telephonic intervention are described. Care manager training should include communication and motivation strategies, specifically self-management education, as these strategies are valued by patients. Barriers to care management, such as scheduling telephone calls, should be addressed in future care management implementation and study.
Al-Hamdan, Zaid; Shukri, Raghda; Anthony, Denis
The study aimed at investigating the conflict management styles used by nurse managers in the Sultanate of Oman. Conflict is inevitable in daily nursing work. Several styles are used to manage conflict situations. In previous studies conducted in Western countries, avoiding and compromising conflict management styles appear to be the first choices for the nurses. In Arab countries, no study to date has examined the conflict management styles used by nurse managers to compare with the results from studies conducted in Western countries. Survey. A questionnaire was distributed to all nurse managers working in the three-management levels from nine referral hospitals in Sultanate of Oman, 271 were returned, a response rate of 86%. The results were analysed using spss version 16. Nurse managers in Oman used all five conflict management styles, with integrating style as the first choice followed in order by compromising, obliging, dominating and avoiding. These results differ from the results of the studies conducted on nurses in other countries. The results of this study have implications for people who work in the hospitals, whether practitioners or policy makers. Recommendations are offered to improve nurse managers' work environment. Conflict can affect patient care if handled badly. Poorly handled conflict results in lower staff morale and poorer retention, both adversely affect patient care. © 2011 Blackwell Publishing Ltd.
There is obvious need to have the safest working environments and the best quality of health care delivery to patients by nurses working in the hospitals. Effective stress management and coping strategies is one very important step towards this goal. This research aims to identify the major stressors for nurses and the most effective management and coping strategies as contained in literature. This involved excellent review of relevant articles in addition to deductive content analysis of the...
Shift work is a common practice in the health care field to maintain 24-hour patient care. The purpose of this article is to recognize the negative impact of shift work on critical care nurses, and identify strategies to mitigate these effects. A review of the literature was completed, using the search terms: 'shift work, 'critical care', impact, and health. The literature revealed that shift work has an adverse effect on the health of a nurse. Some of the health implications include stress, sleep deprivation, cardiovascular disease, gastrointestinal symptoms, and mental health illnesses. Furthermore, shift work impacts a nurse's social life and may result in patient harm. Strategies to reduce the negative impact of shift work will be focused on educating critical care nurses and managers. These strategies include frontline staff maintaining a moderate amount of exercise, sustaining a well-balanced diet, using relaxation techniques, reducing the use of cigarettes, working an eight-hour work day, and napping during scheduled breaks. Recommendations for managers include implementing quiet time at the workplace, providing a safe space for staff to nap during breaks, facilitating an eight-hour work day, and encouraging a multidisciplinary team approach when managing workload.
Introduction: Domestic violence (DV) against women has been identified as a serious public health problem. Primary care nurses usually play an important role in managing battered women. They must be equipped with the necessary knowledge, training and experience. Objective: The aim of this work was to study the ...
Huang, Ching-Chi; Chen, Jih-Yuan; Chiang, Hsien-Hsien
Despite the recent increase in attention to end-of-life hospice care, little empirical evidence regarding the process of emotional or mental transformation in caregivers is available. This study explores the transformative process that occurs in nurses because of the spiritual suffering and conflict associated with after caring for dying patients. A phenomenological approach was used to investigate eight nurses (27-40 years old) working in the hospice ward of a medical center in Taipei. Data were collected through open-ended questions using semistructured interviews and were analyzed reflectively. A three-stage transformation in the emotional processes of participants was observed. In the first stage, the participants experienced acute emotional suffering because of facing the death of their patients, potentially exacerbated by their own memories of losing family members. In the second stage, the participants adopted coping strategies to improve self-care. These strategies included attempting to soothe patients, helping patients face or deal with unfulfilled business, and participating in funeral or memorial services. In the third stage, the participants learned to provide better care through emancipatory reflection and a reassertion of responsibilities toward the self, patients, and patient families. After the third stage, the initial emotional impact morphed into a medium for self-strengthening, and participants became more adept at detecting patient needs and at providing care to complete the transformational process fully. Emotional suffering was the primary factor that induced participants to transform their personal and professional selves. Adequate emotional self-management, dialogue with other nurses, and personal reflection are crucial actions that nurses may use to cultivate personal growth, implement ethical practice, interact with other nurses, and engage in personal reflection. Strategies such as caring for patients, implementing reflective nursing
Verpoort, Charlotte; Gastmans, Chris; Dierckx de Casterlé, Bernadette
In debates on euthanasia legalization in Belgium, the voices of nurses were scarcely heard. Yet studies have shown that nurses are involved in the caring process surrounding euthanasia. Consequently, they are in a position to offer valuable ideas about this problem. For this reason, the views of these nurses are important because of their palliative expertise and their daily confrontation with dying patients. The aim of this paper is to report a study of the views of palliative care nurses about euthanasia. A grounded theory approach was chosen, and interviews were carried out with a convenience sample of 12 palliative care nurses in Flanders (Belgium). The data were collected between December 2001 and April 2002. The majority of the nurses were not a priori for or against euthanasia, and their views were largely dependent on the situation. What counted was the degree of suffering and available palliative options. Depending on the situation, we noted both resistance and acceptance towards euthanasia. The underlying arguments for resistance included respect for life and belief in the capabilities of palliative care; arguments underlying acceptance included the quality of life and respect for patient autonomy. The nurses commented that working in palliative care had a considerable influence on one's opinion about euthanasia. In light of the worldwide debate on euthanasia, it is essential to know how nurses, who are confronted with terminally ill patients every day, think about it. Knowledge of these views can also contribute to a realistic and qualified view on euthanasia itself. This can be enlightening to the personal views of caregivers working in a diverse range of care settings.
McDonald, Katie; Rubarth, Lori Baas; Miers, Linda J
The purpose of this study was to describe the job satisfaction of neonatal intensive care unit (NICU) nurses in the Midwestern United States. The factors explored in job satisfaction were monetary compensation (pay), job stress, caring for patients in stressful situations, level of autonomy, organizational support, level of knowledge of the specialty, work environment, staffing levels, communication with physicians, communication with neonatal nurse practitioners, interdisciplinary communication, team spirit, and the amount of required "floating" to other nursing units. Participants were 109 NICU nurses working as either staff nurses (n = 72) or advanced practice nurses (n = 37). Of the participants, 96% worked in a level 3 NICU. A descriptive, correlational design was used to study job satisfaction among NICU nurses. Nurses were recruited at 2 regional NICU conferences in 2009 and 2010. The questionnaire was a researcher-developed survey consisting of 14 questions in a Likert-type response rating 1 to 5, with an area for comments. Descriptive statistics and correlations were used to analyze the resulting data. The majority of participants were moderately satisfied overall in their current position and workplace (mean ranking = 4.07 out of 5.0). Kendall's Tau b (TB) revealed that the strongest positive correlations were between organizational support and team spirit with overall job satisfaction (TB = 0.53). : The individual factors with the highest mean scores were caring for patients in a stressful situation, level of autonomy, and communication between nurses and neonatal nurse practitioners. This indicates that our population of NICU nurses feels most satisfied caring for patients in stressful situations (m = 4.48), are satisfied with their level of autonomy (M = 4.17), and are satisfied with the interdisciplinary communication in their units (m = 4.13). Nurses in the NICU are relatively satisfied with their jobs. The small sample size (n = 109) of Midwest NICU
Gurses, Ayse P; Carayon, Pascale
High nursing workload, poor patient safety, and poor nursing quality of working life (QWL) are major issues in intensive care units (ICUs). Characteristics of the ICU and performance obstacles may contribute to these issues. The goal of this study was to comprehensively identify the performance obstacles perceived by ICU nurses. We used a qualitative research design and conducted semi-structured interviews with 15 ICU nurses of a medical-surgical ICU. Based on this qualitative study and a previously reported quantitative study, we identified seven main types of performance obstacles experienced by ICU nurses. Obstacles related to the physical environment (e.g., noise, amount of space), family relations (e.g., distractions caused by family, lack of time to spend with family), and equipment (e.g., unavailability, misplacement) were the most frequently experienced performance obstacles. The qualitative interview data provided rich information regarding the factors contributing to the performance obstacles. Overall, ICU nurses experience a variety of performance obstacles in their work on a daily basis. Future research is needed to understand the impact of performance obstacles on nursing workload, nursing QWL, and quality and safety of care.
Al-Kindi, Sadeer G; Zeinah, Ghaith F Abu; Hassan, Azza Adel
Formal palliative care (PC) education is lacking in the middle eastern state of Qatar. This study was done to assess the need for PC education among oncology nurses in Qatar. In March 2012, a self-constructed questionnaire was distributed to 115 nurses at the Qatar National Center for Cancer Care and Research. A total of 115 nurses responded to the questionnaire. The majority (87.8%) were female. Although 60% had more than 10 years of work experience, only 31% had received formal training in PC, with only 6.1% having completed postgraduate training. The majority (63%) of responders attributed this issue to unavailability of PC courses rather than lack of time, interest, or financial issues. Currently, only 16.7% did not express interest in the field, with 56% showing some kind of interest. In terms of knowledge, 54% of the responders were familiar with the World Health Organization ladder for pain relief. Only 43.6% know about Palliative Performance Scale, and half of the nurses know the Edmonton Symptom Assessment System. Overall, 56% of the nurses indicated a need for training in more than 1 aspect. These aspects included training in care of the dying patients (14.6%), communication strategies (22%), caregiver support (10.6%), psychosocial care (15%), pain management (10.2%), other symptom management (13%), and other ethical/spiritual issues (14.2%). There is a clear deficiency in formal PC education among the nurses at the National Center for Cancer Care and Research, in Qatar. This is reflected by their lack of experience and exposure to PC and their mediocre knowledge in the field. This could be attributed to the fact that formal PC service was established only recently in Qatar (2008). Formal training courses in PC nursing are required. © The Author(s) 2013.
Denyson Santana PEREIRA
Full Text Available The study aimed to assess occupational stressors among nurses working in urgent and emergency care facilities. It is a descriptive research developed in two public hospitals of different complexity degrees, with 49 nurses. Data were collected from June to September 2011. The Bianchi's Stress Scale, which is composed of six domains: Relationship, Unit functioning, Staff management, Nursing care, Unit coordination, and Work conditions was used to assess occupational stressors based on the regular activities performed by nurses. Data were analyzed by using descriptive statistics and Mann Whitney-U test. For the nurses working in the high complexity healthcare facility - hospital A the most stressful domain was Nursing care, while for those professionals working in the medium complexity healthcare facility - hospital B, Staff management was the most stressful domain. The nurses from hospital A perceived care-related activities as more stressful, while for those in hospital B administrative activities were considered more stressful.
Peters, Louise; Cant, Robyn; Sellick, Kenneth; O'Connor, Margaret; Lee, Susan; Burney, Sue; Karimi, Leila
Palliative care nurses are at risk of work stress because their role involves exposure to frequent deaths and family grieving. Little is known about their degree of stress or whether they suffer stress or burnout more than nurses in other disciplines. The aim of this paper is to critically examine the current literature concerning stress and burnout in palliative care nurses. Sixteen papers were included in the review. Although work demands were a common cause of stress in the studies reported, there was no strong evidence that palliative care or hospice nurses experienced higher levels of stress than nurses in other disciplines. Common causes of stress were the work environment, role conflict, and issues with patients and their families. Constructive coping styles appeared to help nurses to manage stress. Managers have a key role in providing education and training for palliative care nurses to support their personal development and to help reduce vulnerability to and the impact of stress in the workplace.
Wendler, M Cecilia; Olson-Sitki, Kristi; Prater, Marsha
The nursing shortage affects all levels, including the pivotal role of nurse managers, who may find themselves functioning in a complex, stressful work environment. In this increasingly difficult milieu, succession planning for nurse manager turnover is imperative. The authors describe an evidence-based, theoretically driven nurse management internship that allows staff nurses to explore the nurse manager role.
Miller, Donna M; Neelon, Lisa; Kish-Smith, Kathleen; Whitney, Laura; Burant, Christopher J
The purpose of this study was to identify pressure injury knowledge in critical care nurses related to prevention and staging following multimodal education initiatives. Postintervention descriptive study. The sample comprised 32 RNs employed in medical intensive care/coronary intensive care or surgical intensive care units. The study setting was a 237-bed Veterans Affairs acute care hospital in the Midwestern United States. Critical care RNs were asked to participate in this project over a 3-week period following a multimodal 2-year education initiative. Nurses completed the paper version of the 72-item Pieper-Zulkowski Pressure Ulcer Knowledge Test (PZ-PUKT) to determine pressure injury knowledge level. Calculated mean cumulative scores and subscores for items related to prevention and staging, respectively. Pearson correlations were used to examine associations between nursing staff characteristics and the PZ-PUKT prevention and staging scores. The cumulative score on the PZ-PUKT was 51.66 (72%); nurses with 5 to 10 years' experience had a higher mean score than nurses with experiences of 20 years or more (mean ± SD = 54.25 ± 4.37 vs 49.5 ± 7.12), but the difference was not statistically significant. Nurses scored higher on the staging system-related items as compared to the prevention-related items (81% vs 70%). Nurses achieved higher staging subscale scores if they were younger (r =-0.41, P < .05), had less experience (r =-0.43, P < .05), and if they worked in the medical intensive care unit (r = 0.37, P < .05). Study findings indicate gaps in knowledge related to pressure injury practice; participants had greater knowledge of staging rather than prevention. Cumulative and subscale findings can be used to direct educational efforts needed to improve and maintain an effective pressure injury prevention program.
James Avoka Asamani
Full Text Available Introduction: Nursing is a people-centred profession and therefore the issue of leadership is crucial for success. Nurse managers’ leadership styles are believed to be important determinant of nurses’ job satisfaction and retention. In the wake of a global nursing shortage, maldistribution of health workforce, increasing healthcare costs and expanding workload, it has become imperative to examine the role of nurse managers’ leadership styles on their staff outcomes. Using the Path-Goal Leadership theory as an organised framework, this study investigated the leadership styles of nurse managers and how they influence the nursing staff job satisfaction and intentions to stay at their current workplaces.Methods: The study employed a cross-sectional survey design to collect data from a sample of 273 nursing staff in five hospitals in the Eastern Region of Ghana. Descriptive and regression analyses were performed using SPSS version 18.0Results: Nurse managers used different leadership styles depending on the situation, but were more inclined to the supportive leadership style, followed by the achievement-oriented leadership style and participative leadership style. The nursing staff exhibited moderate levels of job satisfaction. The nurse managers’ leadership styles together explained 29% of the variance in the staff job satisfaction. The intention to stay at the current workplace was low (2.64 out of 5 among the nursing staff. More than half (51.7% of the nursing staff intended to leave their current workplaces, and 20% of them were actively seeking the opportunities to leave. The nurse managers’ leadership styles statistically explained 13.3% of the staff intention to stay at their current job position.Conclusions: These findings have enormous implications for nursing practice, management, education, and human resource for health policy that could lead to better staff retention and job satisfaction, and ultimately improve patient care.
Raup, Glenn H
Nurse managers with effective leadership skills are an essential component to the solution for ending the nursing shortage. Empirical studies of existing ED nurse manager leadership styles and their impact on key nurse management outcomes such as staff nurse turnover and patient satisfaction have not been performed. The specific aims of this study were to determine what types of leadership styles were used by ED nurse managers in academic health center hospitals and examine their influence on staff nurse turnover and patient satisfaction. ED nurse managers were asked to complete the Multifactor Leadership Questionnaire and a 10-item researcher defined nurse manager role and practice demographics survey. Completed surveys (15 managers and 30 staff nurses) representing 15 out of 98 possible U.S. academic health centers were obtained. Fisher's exact test with 95% confidence intervals were used to analyze the data. The sample percentage of managers who exhibited Transformational leadership styles and demographic findings of nurse manager age, total years experience and length of time in current position matched current reports in the literature. A trend of lower staff nurse turnover with Transformational leadership style compared to non-Trasformational leadership styles was identified. However, the type of leadership style did not appear to have an effect on patient satisfaction. The ED is an ever-changing, highly regulated, critical-care environment. Effective ED nurse manager leadership strategies are vital to maintaining the standards of professional emergency nursing practice to create an environment that can produce management outcomes of decreased staff nurse turnover, thereby enhancing staff nurse retention and potentially impacting patient satisfaction.
Bahrmann, A; Wörz, E; Specht-Leible, N; Oster, P; Bahrmann, P
The goal of this study was to perform a structured analysis of the treatment quality and acute complications of geriatric patients with diabetes mellitus (DM) cared for by nursing services and nursing home facilities. Secondly, structural problems and potentials for improvement in the care of multimorbid older people with DM treated by nursing homes and nursing services were analysed from the viewpoint of geriatric nurses, managers of nursing homes and general practitioners. In all, 77 older persons with DM from 13 nursing homes and 3 nursing services were included in the analysis (76.6% female, HbA1c 6.9 ± 1.4%, age 81.6 ± 9.9 years). Structural problems and potentials for improvement were collected from 95 geriatric nurses, 9 managers of nursing homes and 6 general practitioners using semistandardized questionnaires. Metabolic control was too strict in care-dependent older people with DM (mean HbA1c value: 6.9 ± 1.4 %; recommended by guidelines: 7-8%). The measurement of HbA1c was performed in 16 of 77 people (20.8%) within the last year despite a high visitation frequency of the general practitioners (12.7 ± 7.7 within the last 6 months). The incidence of severe hypoglycemia was 7.8%/patient/year. Regarding the management in case of diabetes-related acute complications 33 geriatric nurses (34.7%) stated not having any written standard (nursing home 39%, geriatric services 16.7%). Complex insulin therapies are still used in older people with DM with the consequence of a high incidence of severe hypoglycemia. Concrete management standards in the case of diabetes-related acute complications for geriatric nurses are lacking for more than one third of the nursing services.
The application of the Total Quality Management (TQM) philosophy within the health care sector would enhance the development of nursing power, leadership and knowledge. TQM challenges conventional management techniques as it requires a participative management style in order to be effective. There are many potential benefits for nurses, when quality assurance monitoring within a hierarchical management structure, is replaced with a focus on continuous quality improvement by every member of staff. These benefits are described within the context of both organisational and personal commitment to Total Quality Management.
Wei, Quan; Courtney, Karen L
Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making. This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta's LTC facilities between May 2014 and August 2015. The constant comparative method (CCM) of joint coding was used for data analysis. Nine RNs from six LTC facilities participated in the study. The RN practice environment includes two essential RN information management aspects: information resources and information spaces. Ten commonly used information resources by RNs included: (1) RN-personal notes; (2) facility-specific templates/forms; (3) nursing processes/tasks; (4) paper-based resident profile; (5) daily care plans; (6) RN-notebooks; (7) medication administration records (MARs); (8) reporting software application (RAI-MDS); (9) people (care providers); and (10) references (i.e., books). Nurses used a combination of shared information spaces, such as the Nurses Station or RN-notebook, and personal information spaces, such as personal notebooks or "sticky" notes. Four essential RN information management functions were identified: collection, classification, storage, and distribution. Six sets of information were necessary to perform RN care tasks and communication, including: (1) admission, discharge, and transfer (ADT); (2) assessment; (3) care plan; (4) intervention (with two subsets: medication and care procedure); (5) report; and (6) reference. Based on the RN information management system requirements, a graphic information flow model was constructed. This baseline study identified key components of a current LTC nursing information management system. The information flow model may assist health information
Nguyen, Ly Thuy; Yates, Patsy; Osborne, Yvonne
To explore palliative care knowledge, attitudes and perceived self-competence of nurses working in oncology settings in Hanoi, Vietnam. The study employed a cross-sectional descriptive survey design. The self-administered questionnaires consisted of three validated instruments: the Expertise and Insight Test for Palliative Care, the Attitude Toward Care of the Dying Scale B and the Palliative Care Nursing Self Competence Scale. The sample consisted of 251 nurses caring for cancer patients in three oncology hospitals in Vietnam. The responses identified low scores in nurses' palliative care knowledge related to pain and other symptom management and psychological and spiritual aspects. Nurses' responses reflected discomfort in communicating about death and establishing therapeutic relationship with oncology patients who require palliative care. Additionally, nurses reported low scores in perceived self-competence when providing pain management and addressing social and spiritual domains of palliative care. The findings also revealed that nurses who had higher palliative care knowledge scores demonstrated attitudes which were more positive and expressed greater perceived self-competence. Nurses working in oncology wards need more education to develop their knowledge and skills of palliative care, especially in the areas of pain management, psychological and spiritual care, and communication.
De Vliegher, Kristel; Aertgeerts, Bert; Declercq, Anja; Moons, Philip
Are home nurses (also known as community nurses) ready for their changing role in primary care? A quantitative study was performed in home nursing in Flanders, Belgium, to explore the activity profile of home nurses and health care assistants, using the 24-hour recall instrument for home nursing. Seven dates were determined, covering each day of the week and the weekend, on which data collection would take place. All the home nurses and health care assistants from the participating organisations across Flanders were invited to participate in the study. All data were measured at nominal level. A total of 2478 home nurses and 277 health care assistants registered 336 128 (47 977 patients) and 36 905 (4558 patients) activities, respectively. Home nurses and health care assistants mainly perform 'self-care facilitation' activities in combination with 'psychosocial care' activities. Health care assistants also support home nurses in the 'selfcare facilitation' of patients who do not have a specific nursing indication.
du Plessis, E
To report on an appreciation of caring presence practised by nurses in South Africa in order to facilitate an appreciative discourse in nursing and a return to caring values and attitudes. Appreciative reports on caring presence are often overlooked. Media may provide a platform for facilitating appreciation for caring presence practised by nurses. Such an appreciation may foster further practice of caring presence and re-ignite a caring ethos in nursing. This article provides an appreciative discourse on caring presence in nursing in the form of examples of caring presence practised by nurses. An anecdotal approach was followed. Social media, namely narratives on caring presence shared by nurses on a Facebook page, and formal media, namely news reports in which nurses are appreciated for their efforts, were used. Deductive content analysis was applied to analyse the narratives and news reports in relation to a definition of caring presence and types of caring presence. The analysis of the narratives and news reports resulted in an appreciative discourse in which examples of nurses practising caring presence could be provided. Examples of nurses practising caring presence could be found, and an appreciative discourse could be initiated. Appreciation ignites positive action and ownership of high-quality health care. Leadership should thus cultivate a culture of appreciating nurses, through using media, and encourage nurses to share how caring presence impact on quality in health care. © 2016 International Council of Nurses.
Nursing unit teams matter: Impact of unit-level nurse practice environment, nurse work characteristics, and burnout on nurse reported job outcomes, and quality of care, and patient adverse events--a cross-sectional survey.
Van Bogaert, Peter; Timmermans, Olaf; Weeks, Susan Mace; van Heusden, Danny; Wouters, Kristien; Franck, Erik
To investigate the impact of nurse practice environment factors, nurse work characteristics, and burnout on nurse reported job outcomes, quality of care, and patient adverse events variables at the nursing unit level. Nurse practice environment studies show growing insights and knowledge about determining factors for nurse workforce stability, quality of care, and patient safety. Until now, international studies have primarily focused on variability at the hospital level; however, insights at the nursing unit level can reveal key factors in the nurse practice environment. A cross-sectional design with a survey. In a cross-sectional survey, a sample of 1108 nurses assigned to 96 nursing units completed a structured questionnaire composed of various validated instruments measuring nurse practice environment factors, nurse work characteristics, burnout, nurse reported job outcomes, quality of care, and patient adverse events. Associations between the variables were examined using multilevel modelling techniques. Various unit-level associations (simple models) were identified between nurse practice environment factors, nurse work characteristics, burnout dimensions, and nurse reported outcome variables. Multiple multilevel models showed various independent variables such as nursing management at the unit level, social capital, emotional exhaustion, and depersonalization as important predictors of nurse reported outcome variables such job satisfaction, turnover intentions, quality of care (at the unit, the last shift, and in the hospital within the last year), patient and family complaints, patient and family verbal abuse, patient falls, nosocomial infections, and medications errors. Results suggested a stable nurse work force, with the capability to achieve superior quality and patient safety outcomes, is associated with unit-level favourable perceptions of nurse work environment factors, workload, decision latitude, and social capital, as well low levels of burnout
Nurse health and lifestyle modification versus standard care in 40 to 70 year old regional adults: study protocol of the Management to Optimise Diabetes and mEtabolic syndrome Risk reduction via Nurse-led intervention (MODERN) randomized controlled trial.
Carrington, Melinda J; Zimmet, Paul
Metabolic syndrome (MetS), the clustering of multiple leading risk factors, predisposes individuals to increased risk for developing type 2 diabetes and/or cardiovascular disease (CVD). Cardio-metabolic disease risk increases with greater remoteness where specialist services are scarce. Nurse-led interventions are effective for the management of chronic disease. The aim of this clinical trial is to determine whether a nurse-implemented health and lifestyle modification program is more beneficial than standard care to reduce cardio-metabolic abnormalities and future risk of CVD and diabetes in individuals with MetS. MODERN is a multi-centre, open, parallel group randomized controlled trial in regional Victoria, Australia. Participants were self-selected and individuals aged 40 to 70 years with MetS who had no evidence of CVD or other chronic disease were recruited. Those attending a screening visit with any 3 or more risk factors of central obesity, dyslipidemia (high triglycerides or low high density lipoprotein cholesterol) elevated blood pressure and dysglycemia were randomized to either nurse-led health and lifestyle modification (intervention) or standard care (control). The intervention included risk factor management, health education, care planning and scheduled follow-up commensurate with level of risk. The primary cardio-metabolic end-point was achievement of risk factor thresholds to eliminate MetS or minimal clinically meaningful changes for at least 3 risk factors that characterise MetS over 2 year follow-up. Pre-specified secondary endpoints to evaluate between group variations in cardio-metabolic risk, general health and lifestyle behaviours and new onset CVD and type 2 diabetes will be evaluated. Key outcomes will be measured at baseline, 12 and 24 months via questionnaires, physical examinations, pathology and other diagnostic tests. Health economic analyses will be undertaken to establish the cost-effectiveness of the intervention. The MODERN
Duan, Xia; Shi, Yan
Background: The quality evaluation of nursing care is a key link in medical quality management. It is important and worth studying for the nursing supervisors to know the disadvantages during the process of quality evaluation of nursing care and then to improve the whole nursing quality. This study was to provide director insight on the current status of quality evaluation of nursing care from Nursing Quality Control Centers (NQCCs). Material and Methods: This qualitative study used a sample of 12 directors from NQCCs who were recruited from 12 provinces in China to evaluate the current status of quality evaluation of nursing care. Data were collected by in-depth interviews. Content analysis method was used to analyze the data. Results: Four themes emerged from the data: 1) lag of evaluation index; 2) limitations of evaluation content; 3) simplicity of evaluation method; 4) excessive emphasis on terminal quality. Conclusion: It is of great realistic significance to ameliorate nursing quality evaluation criteria, modify the evaluation content based on patient needs-oriented idea, adopt scientific evaluation method to evaluate nursing quality, and scientifically and reasonably draw horizontal comparisons of nursing quality between hospitals, as well as longitudinal comparisons of a hospital’s nursing quality. These methods mentioned above can all enhance a hospital’s core competitiveness and benefit more patients. PMID:25419427
Chi, Shu-Ching; Yeh, Lily; Lu, Meei-Shiow; Lin, Pei-Yu
Post-acute care (PAC) service is becoming increasingly important in Taiwan as a core focus of government policies that are designed to ensure continuity of care. In order to improve PAC nursing education and quality of care, the present study applies a modified Delphi method to identify the core competences of nurses who provide PAC services to acute stroke patients. We surveyed 18 experts in post-acute care and long-term care anonymously using a 29-question questionnaire in order to identify the essential professional skills that are required to perform PAC effectively. The results of this survey indicate that the core competences of PAC may be divided into two categories: Case Management and Care Management. Case Management includes Direct Care, Communication, Health Care Education, Nursing Consulting, and Family Assessment & Health Care. Care Management includes Interdisciplinary Teamwork, Patient Care Management, and Resource Integration. The importance and practicality of each item was evaluated using a 7-point Likert scale. The experts required 2 rounds to reach a consensus about the importance and 3 rounds to determine the practicality of PAC core competences. This process highlighted the differing points of view that are held by professionals in the realms of nursing, medicine, and national health policy. The PAC in-job training program in its current form inadequately cul-tivates core competence in Care Management. The results of the present study may be used to inform the development of PAC nurse orientation training programs and continuing education courses.
Team work is required in the treatment of the thermally injured patient--nursing staff being part of the team. The nurses are with the patient for 24 hours a day and they have to understand the objectives of all other members of the team involved in the treatment as well as thoroughly mastering their own work. For the nursing staff the care of the thermally injured patient is a challenge. The work demands strong motivation and interest--it includes at times painful treatment, isolation and also constant alertness. It is important that the nursing staff is given continuous training so that they are able to give the required care efficiently and to keep up active interest. Practical work is the best way of getting aquainted with the complex forms of treatment of the thermally injured patient. It also lessens the fear of a badly burned patient. Nursing care of the thermally injured patient consists of good basic care, local attention and active observation. The basic care consists of basic hygiene, diet, observation of the patient's psychological condition, giving emotional support, encouraging initiative physiotherapy and postural treatment.
Norful, Allison A; de Jacq, Krystyna; Carlino, Richard; Poghosyan, Lusine
Various models of care delivery have been investigated to meet the increasing demands in primary care. One proposed model is comanagement of patients by more than 1 primary care clinician. Comanagement has been investigated in acute care with surgical teams and in outpatient settings with primary care physicians and specialists. Because nurse practitioners are increasingly managing patient care as independent clinicians, our study objective was to propose a model of nurse practitioner-physician comanagement. We conducted a literature search using the following key words: comanagement; primary care; nurse practitioner OR advanced practice nurse. From 156 studies, we extracted information about nurse practitioner-physician comanagement antecedents, attributes, and consequences. A systematic review of the findings helped determine effects of nurse practitioner-physician comanagement on patient care. Then, we performed 26 interviews with nurse practitioners and physicians to obtain their perspectives on nurse practitioner-physician comanagement. Results were compiled to create our conceptual nurse practitioner-physician comanagement model. Our model of nurse practitioner-physician comanagement has 3 elements: effective communication; mutual respect and trust; and clinical alignment/shared philosophy of care. Interviews indicated that successful comanagement can alleviate individual workload, prevent burnout, improve patient care quality, and lead to increased patient access to care. Legal and organizational barriers, however, inhibit the ability of nurse practitioners to practice autonomously or with equal care management resources as primary care physicians. Future research should focus on developing instruments to measure and further assess nurse practitioner-physician comanagement in the primary care practice setting. © 2018 Annals of Family Medicine, Inc.
Lavoie-Tremblay, Mélanie; Feeley, Nancy; Lavigne, Geneviève L; Genest, Christine; Robins, Stéphanie; Fréchette, Julie
There is some research on the impact of open-ward unit design on the health of babies and the stress experienced by parents and nurses in neonatal intensive care units. However, few studies have explored the factors associated with nurse stress and work satisfaction among nurses practicing in open-ward neonatal intensive care units. The purpose of this study was to examine what factors are associated with nurse stress and work satisfaction among nurses practicing in an open-ward neonatal intensive care unit. A cross-sectional correlational design was used in this study. Participants were nurses employed in a 34-bed open-ward neonatal intensive care unit in a major university-affiliated hospital in Montréal, Quebec, Canada. A total of 94 nurses were eligible, and 86 completed questionnaires (91% response rate). Descriptive statistics were computed to describe the participants' characteristics. To identify factors associated with nurse stress and work satisfaction, correlational analysis and multiple regression analyses were performed with the Nurse Stress Scale and the Global Work Satisfaction scores as the dependent variables. Different factors predict neonatal intensive care unit nurses' stress and job satisfaction, including support, family-centered care, performance obstacles, work schedule, education, and employment status. In order to provide neonatal intensive care units nurses with a supportive environment, managers can provide direct social support to nurses and influence the culture around teamwork.
Meehan, Therese Connell; Timmins, Fiona; Burke, Jacqueline
To propose the Careful Nursing Philosophy and Professional Practice Model © as a conceptual and practice solution to current fundamental nursing care erosion and deficits. There is growing awareness of the crucial importance of fundamental care. Efforts are underway to heighten nurses' awareness of values that motivate fundamental care and thereby increase their attention to effective provision of fundamental care. However, there remains a need for nursing frameworks which motivate nurses to bring fundamental care values to life in their practice and strengthen their commitment to provide fundamental care. This descriptive position paper builds on the Careful Nursing Philosophy and Professional Practice Model © (Careful Nursing). Careful Nursing elaborates explicit nursing values and addresses both relational and pragmatic aspects of nursing practice, offering an ideal guide to provision of fundamental nursing care. A comparative alignment approach is used to review the capacity of Careful Nursing to address fundamentals of nursing care. Careful Nursing provides a value-based comprehensive and practical framework which can strengthen clinical nurses' ability to articulate and control their practice and, thereby, more effectively fulfil their responsibility to provide fundamental care and measure its effectiveness. This explicitly value-based nursing philosophy and professional practice model offers nurses a comprehensive, pragmatic and engaging framework designed to strengthen their control over their practice and ability to provide high-quality fundamental nursing care. © 2018 John Wiley & Sons Ltd.
Carter, M.W.; Hans, Elias W.; Kolisch, R.
Health care operations management has become a major topic for health care service providers and society. Operations research already has and further will make considerable contributions for the effective and efficient delivery of health care services. This special issue collects seven carefully
Maintaining continence lies at the heart of a sense of adulthood and is essential to preserving dignity, a core and universal nursing value. This article explores the reasons why poor continence care was found at Mid Staffordshire Foundation Trust, the changes to the culture of the health service that led to it, and why it is so important for nurses to maintain patients' dignity. Recommendations for changing this culture in the future are discussed.
Brannon, D; Bucher, J A
Quality assurance and effective nurse management can be viewed as intersecting goals. Objective feedback derived from quality assurance data is a potentially powerful means of enhancing nurses' performance and job satisfaction. The use of automated information systems to provide such direct feedback offers the additional advantage of recognizing nurses as self-monitoring, self-correcting professionals. The need, opportunity, and challenge involved in meshing quality assurance with human resource management through computer-generated feedback are discussed in the context of the home health care setting.
Weidema, F.C.; Molewijk, A.C.; Kamsteeg, F.; Widdershoven, G.A.M.
Aims: Providing management insights regarding moral case deliberation (MCD) from the experiential perspective of nursing managers. Background: MCD concerns systematic group-wise reflection on ethical issues. Attention to implementing MCD in health care is increasing, and managers' experiences
Laschinger, Heather K Spence; Wong, Carol A; MacDonald-Rencz, Sandra; Burkoski, Vanessa; Cummings, Greta; D'Amour, Danielle; Grinspun, Doris; Gurnham, Mary-Ellen; Huckstep, Sherri; Leiter, Michael; Perkin, Karen; MacPhee, Maura; Matthews, Sue; O'Brien-Pallas, Linda; Ritchie, Judith; Ruffolo, Maurio; Vincent, Leslie; Wilk, Piotr; Almost, Joan; Purdy, Nancy; Daniels, Frieda; Grau, Ashley
To examine the influence of personal and situational factors on direct-care nurses' interests in pursuing nursing management roles. Nursing managers are ageing and nurses do not appear to be interested in nursing management roles, raising concerns about a nursing leadership shortage in the next decade. Little research has focused on factors influencing nurses' career aspirations to nursing management roles. A national survey of nurses from nine Canadian provinces was conducted (n = 1241). Multiple regression was used to test a model of personal and situational predictors of nurses' career aspirations to management roles. Twenty-four per cent of nurses expressed interest in pursuing nursing management roles. Personal and situational factors explained 60.2% of nurses' aspirations to management roles. Age, educational preparation, feasibility of further education, leadership self-efficacy, career motivation, and opportunity to motivate others were the strongest predictors of aspirations for management roles. Personal factors were more strongly associated with career aspirations than situational factors. There is a steady decline in interest in management roles with increasing age. Nursing leadership training to develop leadership self-efficacy (particularly for younger nurses) and organizational support for pursuing advanced education may encourage nurses to pursue nursing management roles. © 2012 Blackwell Publishing Ltd.
Harden, Karen; Price, Deborah; Duffy, Elizabeth; Galunas, Laura; Rodgers, Cheryl
Oncology nurses affect patient care at every point along the cancer journey. This creates the perfect opportunity to educate patients and caregivers about palliative care early and often throughout treatment. However, healthcare providers frequently do not have the knowledge and confidence to engage in meaningful conversations about palliative care. . The specific aims were to improve oncology nurses' palliative care knowledge, attitudes, and behaviors by providing a palliative care nursing education program. An additional aim was to increase the number of conversations with patients and families about palliative care. . This project had a pre-/post-test design to assess knowledge, attitudes, and behaviors at baseline and one month after implementation of an established education curriculum. The teaching strategy included one four-hour class for oncology RNs with topics about the definition of palliative care, pain and symptom management, and how to have palliative care conversations. . Results showed a statistically significant difference after the educational intervention for knowledge, attitudes, and behaviors. The number of conversations with patients and caregivers about palliative and end-of-life care increased significantly.
Smith, H L; Reinow, F D; Reid, R A
Does Japanese management possess sufficient practical validity to warrant retraining of nursing administrators and their staffs? Can Japanese management really address the complexities of contemporary nursing administration? Before espousing the benefits of Theory Z and implementing quality circles in your hospital, read this analysis of the advantages and disadvantages of Japanese management--the benefits can be substantial but so can the costs!
Schmitz, Eudinéia Luz; Gelbcke, Francine Lima; Bruggmann, Mario Sérgio; Luz, Susian Cássia Liz
To build the Nursing Philosophy and Conceptual Framework that will support the Nursing Care Systematization in a hospital in southern Brazil with the active participation of the institution's nurses. Convergent Care Research Data collection took place from July to October 2014, through two workshops and four meetings, with 42 nurses. As a result, the nursing philosophy and conceptual framework were created and the theory was chosen. Data analysis was performed based on Morse and Field. The philosophy involves the following beliefs: team nursing; team work; holistic care; service excellence; leadership/coordination; interdisciplinary team commitment. The conceptual framework brings concepts such as: human being; nursing; nursing care, safe care. The nursing theory defined was that of Wanda de Aguiar Horta. As a contribution, it brought the construction of the institutions' nursing philosophy and conceptual framework, and the definition of a nursing theory.
Strandås, Maria; Fredriksen, Sven-Tore D
Neonatal nurses report a great deal of ethical challenges in their everyday work. Seemingly trivial everyday choices nurses make are no more value-neutral than life-and-death choices. Everyday ethical challenges should also be recognized as ethical dilemmas in clinical practice. The purpose of this study is to investigate which types of ethical challenges neonatal nurses experience in their day-to-day care for critically ill newborns. Data were collected through semi-structured qualitative in-depth interviews. Phenomenological-hermeneutic analysis was applied to interpret the data. Six nurses from neonatal intensive care units at two Norwegian hospitals were interviewed on-site. The study is designed to comply with Ethical Guidelines for Nursing Research in the Nordic Countries and the Helsinki declaration. Findings suggest that nurses experience a diverse range of everyday ethical challenges related to challenging interactions with parents and colleagues, emotional strain, protecting the vulnerable infant, finding the balance between sensitivity and authority, ensuring continuity of treatment, and miscommunication and professional disagreement. A major finding in this study is how different agents involved in caring for the newborn experience their realities differently. When these realities collide, ethical challenges arise. Findings suggest that acting in the best interests of the child becomes more difficult in situations involving many agents with different perceptions of reality. The study presents new aspects which increases knowledge and understanding of the reality of nursing in a neonatal intensive care unit, while also demanding increased research in this field of care. © The Author(s) 2014.
Care means taking care, paying extreme attention to others in vulnerable situations, "helping and not hurting". Admitting that ethical care exists would require recognizing that there are also treatments which are not ethical. However, care can only be ethical. Copyright © 2015 Elsevier Masson SAS. All rights reserved.
Bullich-Marín, Ingrid; Miralles Basseda, Ramón; Torres Egea, Pilar; Planas-Campmany, Carme; Juvé-Udina, María Eulalia
A favourable work environment contributes to greater job satisfaction and improved working conditions for nurses, a fact that could influence the quality of patient outcomes. The aim of the study is two-fold: Identifying types of centres, according to the working environment assessment made by nurses in intermediate care units, and describing the individual characteristics of nurses related to this assessment. An observational, descriptive, prospective, cross-sectional, and multicentre study was conducted in the last quarter of 2014. Nurses in intermediate care units were given a questionnaire containing the Practice Environment Scale of the Nursing Work Index (PES-NWI) which assesses five factors of the work environment using 31 items. Sociodemographic, employment conditions, professional and educational variables were also collected. From a sample of 501 nurses from 14 centres, 388 nurses participated (77% response). The mean score on the PES-NWI was 84.75. Nine centres scored a "favourable" working environment and five "mixed". The best valued factor was "work relations" and the worst was "resource provision/adaptation". Rotating shift work, working in several units at the same time, having management responsibilities, and having a master degree were the characteristics related to a better perception of the nursing work environment. In most centres, the working environment was perceived as favourable. Some employment conditions, professional, and educational characteristics of nurses were related to the work environment assessment. Copyright © 2015 SEGG. Publicado por Elsevier España, S.L.U. All rights reserved.
Bakker, Debra; Fitch, Margaret I; Green, Esther; Butler, Lorna; Olson, Karin
Health care restructuring has resulted in significant changes in the workload and work environment for oncology nurses. While recent studies describe the impact of these changes on the general nursing workforce in several countries, there have been no published studies that have focused on worklife issues of Canadian oncology nurses. Therefore, a qualitative study was conducted to gain insight about how oncology nursing has changed over the past decade and how Canadian oncology nurses are managing these changes. Analysis of telephone interviews with 51 practising oncology nurses employed across Canada revealed three major themes. The first theme, "health care milieu", portrayed a picture of the cancer care environment and patient and professional changes that occurred over the past decade. The second theme, "conflicting demands", reflects how the elements of change and social forces have challenged professional oncology nursing practice. The third theme, "finding the way", describes the patterns of behaviour that nurses used to manage the changing health care environment and make meaning out of nurses' work in cancer care. Overall, the findings portray a picture of Canadian oncology nurses in "survival mode". They face many workplace challenges, but are able to keep going "for now" because they find ways to balance their responsibilities on a daily basis and because they know and believe that their specialized nursing knowledge and skills make a difference in patient care.
Murphy, Lyn S; Walker, Mark S
Healthcare today is challenged to provide care that goes beyond the medical model of meeting physical needs. Despite a strong historical foundation in spiritual whole person care, nurses struggle with holistic caring. We propose that for the Christian nurse, holistic nursing can be described as Spirit-guided care--removing oneself as the moiatiating force and allowing Christ, in the furm of the Holy Spirit, to flow through and guide the nurse in care of patients and families.
Roch, Geneviève; Dubois, Carl-Ardy; Clarke, Sean P
Organizational climate in healthcare settings influences patient outcomes, but its effect on nursing care delivery remains poorly understood. In this mixed-methods study, nurse surveys (N = 292) were combined with a qualitative case study of 15 direct-care registered nurses (RNs), nursing personnel, and managers. Organizational climate explained 11% of the variation in RNs' reported frequency of caring practices. Qualitative data suggested that caring practices were affected by the interplay of organizational climate dimensions with patients and nurses characteristics. Workload intensity and role ambiguity led RNs to leave many caring practices to practical nurses and assistive personnel. Systemic interventions are needed to improve organizational climate and to support RNs' involvement in a full range of caring practices. © 2014 Wiley Periodicals, Inc.
Feng Jianyu; Tian Ye; Wang Junlan
Because of the particularity of the interventional therapy,that is,the interventional management covers a large scope in clinical application and involves the diagnosis and treatment of various diseases of multiple systems and organs,the clinical interventional practice has really brought an unprecedented challenge for the administration of the nursing care in the intervention ward. In our hospital, independent nursing group for the intervention ward was established two years ago. For the past two years, we have constantly groped and summarized the reasonable and effect administration of interventional nursing care. Pertinent administrative measures, such as nurse training, strengthening of communication with physicians and focusing on key links in nursing care and promptly finding out the weak points in clinical work, have effectively improved the quality of clinical nursing, in this way the clinical nursing practice has been integrated into the interventional therapy and the safe and high-quality nursing service has been provided to the patients. (authors)
Hinno, S; Partanen, P; Vehviläinen-Julkunen, K
In several European countries, the availability of qualified nurses is insufficient to meet current healthcare requirements. Nurses are highly dissatisfied with the rising demands of the healthcare environment and increasingly considering leaving their jobs. The study aims to investigate the relationships between the characteristics of hospital nurses' work environment and the quality of care provided, and furthermore to examine Dutch nurses' career plans. A cross-sectional, questionnaire survey of registered nurses (n = 334) working in the academic and district hospitals was conducted in 2005/2006. Previously validated questionnaires translated into the participants' language were used. Factor and regression analysis were used for data analysis. Overall, nurses rated their work environment rather favourably. Five work environment characteristics were identified: support for professional development, adequate staffing, nursing competence, supportive management and teamwork. Significant relationships were found between nurses' perceptions of their work environment characteristics and quality of care provided and nurses' career plans. When work environment characteristics were evaluated to be better, nurse-assessed quality of care also increased and intentions to leave current job decreased linearly. Study findings suggest that nurses' perceptions of their work environment are important for nurse outcomes in hospital settings. Further research is needed to explore the predictive ability of the work environment for nurse, patient and organizational outcomes in hospitals. © 2011 The Authors. International Nursing Review © 2011 International Council of Nurses.
Titzer, Jennifer L; Shirey, Maria R; Hauck, Sheila
Perceptions of leadership and management competency after a formal nurse manager succession planning program were evaluated. A lack of strategic workforce planning and development of a leadership pipeline contributes to a predicted nurse manager shortage. To meet the anticipated needs for future leadership, evidence-based action is critical. A quasi-experimental mixed-methods, 1-group pretest/posttest research design was used. Nurses working in an acute care hospital were recruited for the study and selected using an objective evaluative process. Participant perceptions regarding their leadership and management competencies significantly increased after the leadership program. Program evaluations confirmed that participants found the program beneficial. One year after program completion, 100% of the program participants have been retained at the organization and 73% had transitioned to leadership roles. Succession planning and leadership development serve as beneficial and strategic mechanisms for identifying and developing high-potential individuals for leadership positions, contributing toward the future nursing leadership pipeline.
Gea-Caballero, Vicente; Castro-Sánchez, Enrique; Júarez-Vela, Raúl; Díaz-Herrera, Miguel Ángel; de Miguel-Montoya, Isabel; Martínez-Riera, José Ramón
Nursing work environments are key determinants of care quality. Our study aimed to evaluate the characteristics of nursing environments in primary care settings in the Canary Islands, and identify crucial components of such environments to improve quality. We conducted a cross-sectional study in primary care organisations using the Practice Environment Scale - Nursing Work Index tool. We collected sociodemographic variables, scores, and selected the essential items conducive to optimal care. Appropriate parametric and non-parametric statistical tests were used to analyse relations between variables (CI = 95%, error = 5%). One hundred and forty-four nurses participated. The mean total score was 81.6. The results for the five dimensions included in the Practice Environment Scale - Nursing Work Index ranged from 2.25 - 2.92 (Mean). Twelve key items for quality of care were selected; six were positive in the Canary Islands, two were mixed, and four negative. 7/12 items were included in Dimension 2 (fundamentals of nursing). Being a manager was statistically associated with higher scores (p<.000). Years of experience was inversely associated with scores in the 12 items (p<.021). Nursing work environments in primary care settings in the Canary Islands are comparable to others previously studied in Spain. Areas to improve were human resources and participation of nurses in management decisions. Nurse managers must be knowledgeable about their working environments so they can focus on improvements in key dimensions. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.
Full Text Available Introduction. The TISS-28 scale, which may be used for nursing staff scheduling in ICU, does not reflect the complete scope of nursing resulting from varied cultural and organizational conditions of individual systems of health care. Aim. The objective of the study was an attempt to provide an answer to the question what scope of nursing care provided by Polish nurses in ICU does the TISS-28 scale reflect? Material and Methods. The methods of working time measurement were used in the study. For the needs of the study, 252 hours of continuous observation (day-long observation and 3.697 time-schedule measurements were carried out. Results. The total nursing time was 4125.79 min. (68.76 hours, that is, 60.15% of the total working time of Polish nurses during the period analyzed. Based on the median test, the difference was observed on the level of χ2=16945.8, P<0.001 between the nurses’ workload resulting from performance of activities qualified into the TISS-28 scale and load resulting from performance of interventions within the scopes of care not considered in this scale in Polish ICUs. Conclusions. The original version of the TISS-28 scale does not fully reflect the workload among Polish nurses employed in ICUs.
To apply Habermas' (1995) Theory of Moral Consciousness and Communicative Action to the nurse-patient relationship, offering a different interpretation to the nurse-patient relationship that is caring in nursing. Many authors have described the nurse-patient relationship, but Habermas' theory synthesizes the components into a complex matrix that is caring in nursing. The theory offers three claims to normative validity: the claim to truth which is the factual objective knowledge; the claim to truthfulness which refers to the intrasubjective self; and the claim to right which is the intersubjective interaction. The validity claims explain the patient's personal and illness self, the nurse's personal and professional self, and the interaction/discourse. The interaction is situation specific, and is identified as moral because dialogue/discourse requires a 'considerateness' of each for the other. 'Considerateness' in discourse requires certain rules, including that each participant has an equal voice, be followed in order for the Principle of Universalization to occur. Habermas draws on Kohlberg's (1981), and Selman's (1980) work to develop three levels of moral maturity of communication. These are preconventional, conventional, and postconventional. Initial moral maturity is egocentric, subjective, and obedient to authority. Maturity develops with recognition of other and reciprocity. At the postconventional level there is mutuality and the ability for abstract reasoning. There is a third person objectivity combining speaker and addressee/listener perspectives. Norms are not just accepted, they are reasoned through. This leads to justification of the norm, which is then accepted as valid. When the three validity claims are met and there is genuine 'considerateness' in the interaction there is communicative action. The reverse is strategic action, where the communication is coercive. When there is communicative action both patient and nurse are validated with a sense
Full Text Available This qualitative study explored the impact and appropriateness of structured pro-active care reviews by practice nurses for patients with chronic or recurrent depression and dysthymia within the ProCEED trial. ProCEED (Pro-active Care and its Evaluation for Enduring Depression was a United Kingdom wide randomised controlled trial, comparing usual general practitioner care with structured 'pro-active care' which involved 3 monthly review appointments with practice nurses over 2 years for patients with chronic or recurrent depression.In-depth interviews were completed with 41 participants: 26 patients receiving pro-active care and 15 practice nurses providing this care. Interview transcripts were analysed thematically using a 'framework' approach.Patients perceived the practice nurses to be appropriate professionals to engage with regarding their depression and most nurses felt confident in a case management role. The development of a therapeutic alliance between the patient and nurse was central to this model and, where it appeared lacking, dissatisfaction was felt by both patients and nurses with a likely negative impact on outcomes. Patient and nurse factors impacting on the therapeutic alliance were identified and nurse typologies explored.Pro-active care reviews utilising practice nurses as case managers were found acceptable by the majority of patients and practice nurses and may be a suitable way to provide care for patients with long-term depression in primary care. Motivated and interested practice nurses could be an appropriate and valuable resource for this patient group. This has implications for resource decisions by clinicians and commissioners within primary care.
Dubourg, Laurence; Ahmling, Janette A; Bujas, Lenka
Addressing employer reluctance to employ nurse managers in a job-sharing capacity, the aim of this paper is to explore job sharing among nurse managers. The literature highlighted potential fragmentation of leadership, breakdown of communication and higher costs as issues, with the retention of experienced highly motivated managers identified as an advantage. A staff survey explored whether the job-sharing arrangement trialled in a day surgery setting by two nurse managers was successful compared with similar roles held by full-time managers. This paper suggests that nurse managers can successfully job share. Overall, this paper recommends that employers consider a job-sharing arrangement when they wish to retain experienced nurse managers, and highlights aspects that can enhance a successful outcome.
Fairbrother, Greg; Chiarella, Mary; Braithwaite, Jeffrey
This paper provides an overview of the developmental history of models of care (MOC) in nursing since Florence Nightingale introduced nurse training programs in a drive to make nursing a discipline-based career option. The four principal choices of models of nursing care delivery (primary nursing, individual patient allocation, team nursing and functional nursing) are outlined and discussed, and recent MOC literature reviewed. The paper suggests that, given the ways work is being rapidly reconfigured in healthcare services and the pressures on the nursing workforce projected into the future, team nursing seems to offer the best solutions.
Beaulieu, Richard; Humphreys, Janice
Nurse-managed health centers face increasing obstacles to financial viability. Efficient use of clinic resources and timely and appropriate patient care are necessary for sustainability. A registered nurse with adequate education and support can provide high-quality triage and advice in community-based practice sites. The purpose of this program evaluation was to examine the effect of a telephone advice nurse service on parent/caregiver satisfaction and access to care. A quasi-experimental separate pre-post sample design study investigated parent/caregiver satisfaction with a telephone advice nurse in an urban pediatric nurse-managed health center. The clinic medical information system was used to retrieve client visit data prior to the service and in the first year of the program. Statistically significant differences were found on two items from the satisfaction with the advice nurse survey: the reason for calling (P decision making (P nurse may increase both parent/caregiver and provider satisfaction and access to care.
Jarzembski, W B
Today, health care engineering management is merely a concept of dreamers, with most engineering decisions in health care being made by nonengineers. It is the purpose of this paper to present a rationale for an integrated hospital engineering group, and to acquaint the clinical engineer with some of the salient features of management concepts. Included are general management concepts, organization, personnel management, and hospital engineering systems.