Nurses' experiences of the encounter with elderly patients in acute confusional state in orthopaedic care

The aim of this study was to illuminate nurses' experiences of the encounter with elderly patients who developed acute confusional state (ACS) in orthopaedic care. Forty-eight nurses with professional background as registered (n=26) or licensed practical nurses (n=22) who took part in the nursing care of acute confused patients were involved. Open-ended unstructured interviews were conducted with regard to the course of events, experiences and interpretation of what had happened during the ACS as well as the nurses' actions and encounter with the confused patient. The texts were analysed using manifest and latent content analysis, revealing that the nurses had difficulties in reaching the patients and their reality, and thus in understanding their experiences. Interpretation of the nurses' experiences showed that the nurses found it difficult to reach the patients' reality because the patients were in a divided and/or different world. They interpreted the patients as seeking solitude or company, keeping a distance or being suspicious of the nurses. The findings indicated that the interaction in the encounter between the acutely confused patients and the nurses indicated insufficient and/or broken reciprocity. The nurses used various strategies to meet the patients, being a companion and/or being a surrogate. They acted in the encounter based on their view of the patient and their ability to enter into and understand the patients' situation. The strategies were more or less successful, sometimes resulting in contact and calming the patients and in other cases increasing the patients' irritation and anger. The results were more successful when the strategies were derived from the nurses' interpretation of the patients' situation and the nurses paid attention to the patients and confirmed them.     

Nurses as patients: the voyage of discovery

To facilitate an enhanced understanding of the experience of being a patient, an inquiry was undertaken into the experience of nurses receiving nursing care when hospitalized. Using a hermeneutic-phenomenological approach, an exploration was undertaken of registered nurses' interpretations of their experiences of receiving nursing care, as described in their individual stories. By interpreting the text generated by the inquiry, it was possible to explore the uniqueness and commonalities of these experiences. This resulted in 10 themes that exemplified the nurses' experiences. The interpretation uncovered the voice of the nurse in the experience of being a patient, insight into how patients perceive being a patient and reflections by the nurse patients on quality nursing care. This research has provided insight into the value of the relationship between the nurse and the patient and insight into the significance of the nature of care delivery.     

Oncology nursing: Finding the balance in a changing health care system.

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.     

The experience of gatekeeping: a psychiatric nurse in an emergency department

Emergency departments are increasingly identified as the entry point to mental health services. In the hope of facilitating the flow of psychiatric patients through a general hospital's emergency department, experienced psychiatric nurses were asked to participate in a pilot project in a general hospital in Canada. This paper is a reflection of one emergency psychiatric nurse's (EPN) experience of her role being transformed into that of a gatekeeper. The notion of "gatekeeper" as a metaphor highlights "keeping psychiatric patients out" of an already strained emergency system. As a means to balance fiscal demands with patient care, the EPN inadvertently served to obscure entry for patients with mental illness who were seeking emergency services.     

The Experience of Gatekeeping: A Psychiatric Nurse in an Emergency Department

Emergency departments are increasingly identified as the entry point to mental health services. In the hope of facilitating the flow of psychiatric patients through a general hospital's emergency department, experienced psychiatric nurses were asked to participate in a pilot project in a general hospital in Canada. This paper is a reflection of one emergency psychiatric nurse's (EPN) experience of her role being transformed into that of a gatekeeper. The notion of “gatekeeper” as a metaphor highlights “keeping psychiatric patients out” of an already strained emergency system. As a means to balance fiscal demands with patient care, the EPN inadvertently served to obscure entry for patients with mental illness who were seeking emergency services.     

Suicidal patients as experienced by psychiatric nurses in inpatient care

Psychiatric nurses have a major influence on the lives of patients with suicidal behaviour in inpatient care. Despite this, there is a lack of knowledge about how nurses experience patients with suicidal behaviour in a deeper sense. The aim of this study was to investigate how psychiatric nurses experience patients with suicidal behaviour within an inpatient psychiatric context. Semi-structured interviews were carried out with 11 psychiatric nurses, each of whom had more than 5 years of experience caring for patients with suicidal behaviour. Data were analysed using qualitative latent content analysis. Two main themes emerged from the data analysis. These are 'labelled' and 'suffering'. In the nurses' natural attitude, they saw patients as being labelled with different conditions and/or behaviours based on objective signs. These were categorized into different groups or identities such as psychiatric diagnosis, mask wearer, screened-off, or the social, relapsing or determined patient. On reflection, however, the nurses described the patients' suffering in terms related to feelings of hopelessness, meaninglessness, and being out of control. The nurses' experiences of the patients as suffering were based on their subjective reflective experience of the patients. The study gives support to the conclusion that two main logic systems are represented in the care of patients with suicidal behaviour: technical practical and nursing perspectives. In order to ensure that these two logic systems combine, it is necessary for the psychiatric care organization to intervene to support the nurses in reflecting on their everyday work.     

Standardization of telephone triage in pediatric oncology.

Nurses in pediatric oncology are often the main resource for overwhelmed parents and deal with complex patient issues over the telephone but often not without concerns about best patient care, liability, and accountability for the advice given. The question is whether using standardization of telephone triage practices can provide opportunities for improvement in the care of pediatric oncology patients. A review of the literature pertaining to telephone triage, standardization of practice, and the practice in outpatient oncology was conducted. The utilization of easy-to-use, accessible yet nonrestrictive resources and a well-designed documentation tool can help guide the decision-making process while addressing legal concerns and ensuring best possible patient care. An advantage that nurses in outpatient oncology settings have in performing telephone triage is the knowledge they have of their patient population and the disease process and treatments. Using a balanced approach to standardization of telephone triage practices can provide opportunities for improvements in care while still capitalizing on the intuitive knowledge and experience of the nurses involved.     

Experiences of adding nurses to increase medical competence at an emergency medical dispatch centre

INTRODUCTION: Prehospital care begins when the call is placed to the emergency medical dispatch (EMD) centre and ends when the patient is cared for at the emergency department. The highly technical and specialized character demands advanced medical competence. Communication problems, serious and unpredictable situations can often occur during the emergency calls. A two-year intervention study involved the addition of registered nurses to an EMD-centre team to increase medical competence. AIM: To describe registered nurses' and emergency-operators' experiences of working together at an EMD-centre after adding registered nurses to increase medical competence. METHODS: Qualitative content analysis was used to analyse the text from interviews with four registered nurses and 15 emergency-operators involved in the intervention. RESULTS: Initial frustration and scepticism changed to more positive experiences that resulted in improved cooperation and service. The registered nurses had difficulties dealing with the more urgently acute calls, while the emergency-operators had difficulties with the more complicated, somewhat diffuse cases. The two professions complemented each other. CONCLUSION: Combining the registered nurses' and emergency-operators' knowledge and experience at an EMD-centre can perhaps improve the prehospital care for those requiring emergency medical care.     

Nurses' lived experience of being a preceptor.

Registered nurses' lived experience of preceptorship was studied in this phenomenological study. To illuminate the meaning of registered nurses' experience of being a preceptor for student nurses, individual tape-recorded interviews were conducted with 17 registered nurses. They narrated their experience of being a personal preceptor for student nurses during practical training on a hospital unit, and the interviews transcribed verbatim were analyzed phenomenological-hermeneutically. The analysis revealed two main themes (1) including the student in their daily work and (2) increasing awareness of the process of learning, as well as six other themes, which contributed to a new comprehension of the meaning of being a preceptor. All the themes were related to the ongoing preceptor-preceptee relationship. The preceptors' thinking on past experiences and their ideas of nursing care in the future were present simultaneously. Nurses acting as preceptors were perceived as conscious individuals, demanding a balance of their daily work responsibility with increased awareness of the professional demands of nursing care. Preceptors gained increased awareness of and a desire to fulfill the student nurses' varied learning needs and increased awareness of their own learning process.     

Nurses and workplace violence: nurses' experiences of verbal and physical abuse at work

This paper describes nurses' experiences of violence and abuse in the workplace and the ways in which those experiences influence their abilities to care for patients. The original purpose of the research from which these findings derive was to explore nurses' work with abused women. The qualitative study utilizing a Social Constructivism approach was conducted in two countries: Canada and the United Kingdom. Forty-nine nurses from four clinical areas were interviewed, both in focus groups and individually, about factors influencing their care of abused women. In the course of the original study, the degree of verbal abuse and physical violence that nurses routinely encounter in their work became apparent. It also became clear that abuse against nurses is an important issue that has a significant impact on nurses' abilities to offer effective care. Findings indicated that nurses experience significant threat, frequently in the context of their work, at the hands of patients and their relatives; that verbal abuse is an almost daily occurrence; and that support from other healthcare professionals or from administration in addressing the issue, while improving somewhat, is inadequate. This work has implications not only for nurses' health and safety but also, in the broader sense, for the profession's ability to attract and retain nurses within the healthcare system.     

Influence of workplace demands on nurses' perception of patient safety

Abstract   Patient safety is an ongoing challenge in the design and delivery of health-care services. As registered nurses play an integral role in patient safety, further examination of the link between nursing work and patient safety is warranted. The present study examines the relationship between nurses' perceptions of job demands and nurses' perceptions of patient safety. Structural equation modeling is used to analyze the data collected from a survey of 430 registered nurses at two community hospitals in the USA. As hypothesized, nurses' perception of patient safety decreases as the job demands increase. The level of personal control over practice directly affects nurses' perception of the ability to assure patient well-being. Nurses who work full-time and are highly educated have a decreased perception of patient safety, as well. The significant relationship between job demands and patient safety confirms that nurses make a connection between their working conditions and the ability to deliver safe care.     

From unit to unit: Danish nurses' experiences of transfer of a small child to and from an intensive care unit.

In this study, Danish nurses' lived experience of transfer of a small child to and from the intensive care unit was explored. While there has been considerable research that has addressed transfer from the parents' perspective, little literature was found which addressed the transfer of small children from the nurses' perspective. A convenience sample of 19 nurses was interviewed once. Data were analysed following Spiegelberg's and Van Manen's phenomenological methodologies. Four themes emerged: being accountable; being supportive to the parents; being with the child; and experiencing safety and insecurity. Seven subthemes expanded and clarified the meaning of these themes. The study provides a thematic interpretation of how Danish nurses experience in-hospital transfers. Overall, the nurses were responsible to the transferred patient, the unhappy and worried parents, for technical procedures and the hospital team 'at home' on their own unit. However, responsibilities did not always include their colleagues on the receiving unit. It is recommended that transfer experiences be discussed more in clinical nursing, and that this explorative study needs to be followed by more studies exploring nurses' experiences of transfer.     

To handle the unexpected - the meaning of caring in pre-hospital emergency care

The patient's voice has not been present to the same degree as the professional perspective in caring research in a pre-hospital context. In order to further develop and improve pre-hospital care, it is therefore important to explore patients' situations not only in life threatening but also in non-traumatic situations. This is especially important as these patients might be defined as inappropriate attendees of ambulance services. The aim of this study was to interpret and explain experiences of caring in pre-hospital care situations that are not defined as traumatic or life threatening. Twenty informants aged between 34 and 82 years were interviewed. The design of the study was exploratory, and it used an interpretative approach in order to understand the meaning of pre-hospital caring. The findings show that pre-hospital caring can be understood and explained as a matter of interplay between carer(s) and patient with potentials for positive as well as negative outcomes. Our conclusion is that the initial meeting is of vital importance in how patients experience pre-hospital care. It is suggested that general public information on the development of Swedish pre-hospital care received in turn may facilitate the first encounter between patient and carer(s).     

Nurse empathy to caregivers of chronically ill elders

1. Findings showed that differences exist with regard to the amount of strain family caregivers experience and how caregivers perceive the nurses' empathy. 2. Caregivers to older persons requiring more health care services experienced more objective strain (ie, lack of time or more physical demands) than caregivers to persons who required less health care services. 3. Caregivers in isolated environments viewed nurses as more empathic compared with caregivers residing in areas where there was opportunity for more interaction with others.     

Implementing family-centred care: an exploration of the beliefs and practices of paediatric nurses.

OBJECTIVE: This study explored paediatric nurses' perceptions of how they include and involve parents in the care of hospitalised children. DESIGN: This qualitative study used individual unstructured interviews to gather data, the data was analysed using thematic coding. SETTING: Paediatric wards within two regional area health services of New South Wales, Australia. SUBJECTS: Fourteen paediatric nurses were asked to describe their beliefs and practices regarding the clinical application of family-centred care. MAIN OUTCOME MEASURE: Paediatric nurses' beliefs and practices about family-centred care were explored in an effort to explain how the concept was implemented. RESULTS: The findings are presented as four interconnected themes. The first describes how participants either allocated tasks to parents or retained them, the second relates to the nurses' professional identity, the third theme identifies barriers and constraints to the implementation of family-centred care, while the fourth describes the nurses' beliefs about their responsibilities when delivering family-centred care. CONCLUSIONS: Together these findings suggest that while nurses endorse the concept of family-centred care, the implementation into practice is more problematic. While it is not possible to generalise these findings to other paediatric nurses, the authors believe the insight gained will resonate with paediatric nurses internationally. The findings from this study are being used as the basis for the development of clinical practice guidelines to assist paediatric nurses to more consistently apply the concepts of family-centred care to their practice.     

Emotional burden of nurses in palliative sedation therapy

BACKGROUND: Palliative sedation therapy is often required in terminally ill cancer patients, and may cause emotional burden for nurses. The primary aims of this study were 1) to clarify the levels of nurses' emotional burden related to sedation, and 2) to identify the factors contributing to the burden levels. METHODS: A questionnaire survey of 3187 nurses, with a response rate of 82%. RESULTS: Eighty-two percent of the nurses (n = 2607) had clinical experience in continuous-deep sedation. Thirty per cent reported that they wanted to leave their current work situation due to sedation-related burden (answering occasionally, often, or always). Also, 12% of the nurses stated that being involved in sedation was a burden, 12% that they felt helpless when patients received sedation, 11% that they would avoid a situation in which they had to perform sedation if possible, and 4% that they felt what they had done was of no value when they performed sedation. The higher nurse-perceived burden was significantly associated with shorter clinical experience, nurse-perceived insufficient time in caring for patients, lack of common understanding of sedation between physicians and nurses, team conference unavailability, frequent experience of conflicting wishes for sedation between patient and family, nurse-perceived inadequate interpersonal skills, belief that it was difficult to diagnose refractory symptoms, belief that sedation would hasten death, belief that sedation was ethically indistinguishable from euthanasia, nurse-perceived inadequate coping with their own grief, and nurses' personal values contradictory to sedation therapy. CONCLUSIONS: A significant number of nurses felt serious emotional burden related to sedation. To relieve nurses' emotional burden, we encourage 1) management efforts to reduce work overload, 2) a team approach to resolving conflicting opinions, especially between physicians and nurses, 3) co-ordination of early patient-family meetings to clarify their preferred end-of-life care, 4) education and training about sedation specifically focused on interpersonal skills, systematic approaches to diagnosing refractory symptoms, minimum life-threatening potency in sedation, and ethical principals differentiating sedation from euthanasia, and 5) exploring nurses' personal values through the patient-centered principle.     

Dwelling with stories that haunt us: building a meaningful nursing practice

The purpose of this article is to reflect on pediatric critical care nurses' experience of grief by focusing on the meaning of the stories that haunt them. It is suggested that these stories are the nurses' attempt to find ways to journey through their grief and to live with the mystery of life and death. It is also the task of these stories to throw light on their experiences, a task that is never entirely finished. Dwelling with the stories that haunt them helps to provide nurses with a moral structure of critical care nursing practice. Their reflections upon the meaning of their experiences of grief can lead to a view of death that is not always perceived as an evil to flee, but is upheld as a source of value and revelation as critical care nurses strive to build who they are and how they practice the art of nursing.