Factors affecting patients' rights practice: the lived experiences of Iranian nurses and physicians

Background:  The Iranian Ministry of Health and Medical Education published a 'Patient's Bill of Rights' in 2001.
Aim:  To gain insight into the perception and practice of patients' rights in Iran. This paper reports on Iranian nurses' and physicians' perceptions and lived experiences of respecting patients' rights.
Methods:  A purposeful sample of eight nurses and five physicians working in a central teaching hospital in Tehran were interviewed during 2005–2006 for a qualitative study. Data were analysed using thematic analysis.
Findings:  The emerging themes were categorized as 'barriers to patients' rights practice' and 'facilitators of patients' rights practice'. Under these themes three subgroups were discussed: awareness, resources and accountability.
Conclusion:  Healthcare professionals' lived experiences are an important source of data if managers and policy makers are to make changes and legislate for protecting and promoting patients' rights.     

Nursing and Health Policy

Purpose: To describe ways nurses are and are not effective in the development of health policy in the United States today, and to provide useful information for those interested in making nursing a more vital part of the policy arena.
Design: Qualitative examination of the career experiences and observations of a purposive sample of 27 American nurses currently active in health policy at the national, state, local, or organizational level.
Method: Semi-structured interviews regarding career path, contributing resources improvement of resources available to nurses, and the strengths and weaknesses of currently available information for policy work.
Findings: For nurse participants, policy involvement meant speaking for patients in arenas where those need of care have limited voice. Participation occured after assessment, diagnosis, and planning revealed the need for change in the way resources were allocated. Strong belief in the capacity and importance of people caring for themselves distinguished nurses in their policy roles. Policy makers responded to the experiences and determinants of health and illness as presented by nurses.
Conclusion: Once engaged, nurses seldom turned their backs on the world of policy-making. However, they did not report significant use of nursing research or information in policy making. Further investigation and testing of systems to connect nurse policymakers with nurse scholars are recommended.     

Lived experiences of immigrant nurses in New South Wales, Australia: searching for meaning

Recognising the potential value of immigrant nurses in multicultural Australia, this study sought to understand immigrant nurses' experiences in order to throw some light on their under representation in the nursing workforce. Using a Heideggerian phenomenological approach the purpose of this study was to explore, describe and analyse the lived experiences of five immigrant nurses, four from non-English-speaking backgrounds, practising in New South Wales, Australia. Through naturalistic open-ended interviews, the everyday experiences of immigrant nurses were described and hermeneutically analysed. The lived experiences, and the meaning of such experiences which emerged from analysis included: professional negation, experienced in lack of support; otherness, experienced in cultural separateness; silencing, experienced in language and communication difficulties and a number of other related experiences and feelings. The study highlights the continuing existence of a social and cultural distance between nurses of the dominant culture and nurses from culturally and linguistically diverse backgrounds.     

Prevention of further weight gain in overweight school children, a pilot study

Background:  Involving school nurses in weight gain prevention activities in already overweight children may be a means to address childhood obesity prevention.
Objective:  To describe and evaluate a treatment method aimed for implementation in school care centres.
Methods:  Twenty families (20 overweight children aged 7 years) were interviewed at baseline with standardized questionnaires, received simple dietary and lifestyle advice. Weight was measured and advice/support by school nurses was available monthly during the 1-year period. A follow-up was made after 1 year. Changes in wellbeing, life style and body mass index (BMI) z -score were recorded and analysed. Experiences from parents and nurses were also examined.
Results:  A good (91%) or fair (54%) adherence to dietary advice was found in children who decreased or maintained their z -score respectively. Mean BMI z -score reduced [−0.16 (p = 0.03)] during the intervention period. Generally, parents and school nurses were satisfied with the programme, helping them to set limits and be more self-confident in their role as 'health adviser' respectively.
Conclusions:  Overweight progression in younger children is possible to modify by increased awareness of the problem, of their food habits and lifestyle practices. Providing school nurses with the knowledge to address the problem and working in collaboration with dieticians and a healthcare team can be an effective means to prevent further weight gain in overweight school-age children. Possibility of stigmatization was expressed thus efforts will need to be made to carry out such a programme to preserve the children's integrity and run activities in a discrete manner in the school environment.     

Voices of internationally educated nurses: policy recommendations for credentialing

SINGH M.D. & SOCHAN A. (2010) Voices of internationally educated nurses: policy recommendations for credentialing. International Nursing Review 57 , 56–63
Background:  The authors advance general policy recommendations for credentialing Internationally Educated Nurses (IENs) who migrate to practice nursing in developed, high-income countries. While examples are drawn primarily from a qualitative study exploring IEN experiences in Canada, the suggestions presented have broader application to any nursing, or midwifery, internationally educated professionals wanting, or needing, to practice outside their home country of education. Examples of credential processing are drawn from Australia, the European Union, New Zealand, the UK and the USA.
Methods:  This study was guided by a biographical narrative (qualitative) research methodology. A convenience sample of 12 IENs volunteered to participate.
Results:  The IENs offered recommendations based on their personal experiences, all of which have policy implications to make transparent, standardize and harmonize the credentialing processes both prior to, and upon arrival in their destination country. Suggestions are offered to make relevant the content of IEN integration programmes.
Conclusions:  The authors also suggested that national immigration agencies and nursing regulatory bodies could better coordinate their activities when processing potential IEN migrant applications.     

Italian–Moldovan international nurse migration: rendering visible the loss of human capital

PALESE A., CRISTEA E., MESAGLIO M. & STEMPOVSCAIA E. (2010) Italian–Moldovan international nurse migration: rendering visible the loss of human capital. International Nursing Review 57 , 64–69
Aim:  To describe the process of the migration of Moldovan nurses to Italy.
Background:  Formerly a part of the Soviet Union, the Republic of Moldova gained independence in 1991. Currently, there are 25 848 nurses (60.6 per 10 000 inhabitants) working mainly in the public health system. Each year, around 2000 nurses leave the country in search of better working conditions and a better quality of life.
Methods:  A longitudinal study design was adopted (2006–2007). In the first phase, we contacted all known nurses living in Moldova and their available colleagues following a snowball sampling strategy. Inclusion criteria were nurses who had decided to migrate to Italy and had already prepared the migration documents and/or were awaiting their departure. In the second phase, we interviewed the same sample of nurses on arrival in Italy.
Findings:  After one year, only 25 nurses out of the 110 initially interviewed (22.7%) had arrived in Italy; none were working as nurses. The cost of the migration process incurred by each nurse was around 3278 euros, and the waiting time from the decision to leave until arrival was around 24 months.
Conclusions:  All Moldovan nurses involved in this study, once they arrived in Italy, ceased to exist from an official perspective. Policy and recommendations need to be developed to ensure the integration of Moldovan-educated nurses into the health-care system and to monitor the amount of human capital (in terms of care drain, brain drain and youth drain) that this process risks wasting.     

The learning experiences of immigrants who are graduates of an entry-level baccalaureate nursing program: A hermeneutic phenomenological study

International migration of individuals or families seeking to improve economic conditions or escape political oppression increases each year. With migrant movement, there is a need for appropriate health care to meet their health beliefs and cultural health traditions. Nurses comprise a large portion of the healthcare workforce and yet, the number of immigrant nurses educated in their adopted country remains low. The aim of this study was to understand the learning experiences of immigrant registered nurses who graduated from an entry-level baccalaureate nursing program in the United States. A hermeneutic phenomenological approach with a Gadamerian focus was utilized. Purposive sampling identified five immigrant graduates who were individually interviewed using several open-ended questions in a non-structured format. Analysis identified an overarching theme, “being on the outside.” Five subthemes emerged: harsh realities, disruptions, nurturance, resilience, and propagation. Recommendations from the interviews include: recognition and appreciation of each student, the nurse educator coming to know oneself first, followed by dialoguing with each student to perpetuate deeper understanding. Rather than accommodating the ethnically diverse immigrant nursing student through targeted interventions, the nurse educator should maintain an all-inclusive learning environment.     

Immigrant Women and Mental Health Care: Findings from an Environmental Scan

Immigrant women’s mental health is a growing public health policy issue. New immigrant mothers may be particularly vulnerable to less than optimal mental health following childbirth given the cultural and geographic isolation, socioeconomic factors, gender roles, and language difficulties that influence their postpartum experiences. The purpose of this environmental scan was to increase understanding of immigrant women’s perinatal mental health care services within the interior of a western Canadian province. Four interrelated themes emerged to impact postpartum health of immigrant women: (i) community capacity building, (ii) facilitators of mental health support and care, (iii) barriers of mental health promotion and support, and (iv) public policy and postpartum depression. Knowledge gained from this study contributes to healthy public policy and practices that promote mental health and support among immigrant women.     

A caring relationship with people who have cancer

Title.  A caring relationship with people who have cancer.
Aim.  This paper is a report of a study conducted to elucidate the meaning of a caring relationship with people with cancer.
Background.  A caring relationship becomes the most important focus of caregiving when treatment of the body has reached the limits where cure is no longer expected. Caring as perceived by people with cancer involves nurses having professional attitudes and skills in order to provide good care, including emotional and practical support.
Methods.  A phenomenological hermeneutic approach influenced by Ricoeur was used. Eight nurses working in an oncology unit in Iran were interviewed in 2007 about their experiences of caring relationships with people who have cancer.
Findings.  The findings were interpreted as getting involved in a mutual/demanding close relationship. Closeness demanded nurses to be present, to listen to patients, and to be compassionate. Closeness was also mutual and characterized both caregiving and receiving new insights into values in the nurses' own lives. The close relationship was at times frustrating when they were faced with situations that they could not handle and were out of their control.
Conclusion.  Closeness is an important foundation for caring, and acquires a special dimension in the care of people with cancer and their relatives. It derives from the personal and professional experiences of nurses in their own life stories. Nursing education should include a reflective approach in order to develop caring skills in oncology nursing that are not merely attuned to medical care.     

Night shift work experiences among Iranian nurses: a qualitative study

Aim:  To describe the perceptions held by Iranian registered nurses (IRNs) concerning their night shift work experiences.
Background:  Due to the nature of nursing work and the need for 24-h coverage every day, the majority of nurses work night shifts in their professional practice. Evidence from several studies indicates that night working is a challenge for most nurses. This situation can cause many forms of physical and emotional stress.
Methods:  A qualitative design was used with purposeful sampling. Eighteen IRNs from four different general educational hospitals in Iran took part in the study. Data were collected via semi-structured interviews and analysed according to qualitative content analysis.
Findings:  Three main themes were identified from the data: (a) socio-cultural impacts of night work, (b) health-related impacts of night work, and (c) night work as an opportunity for gaining more clinical experiences and learning more.
Conclusion:  The impact of shift work on nurses' daily professional behaviour and adverse health outcomes related to shift work should be well understood and considered when organizing healthcare systems. We need to identify ways to support nurses who work nights and also give attention to the caregiver's needs.     

Overseas nurses–effective therapeutic agents?

Factors affecting the effectiveness of overseas people employed as psychiatric nurses are discussed. Basic cultural influences, especially different value systems between the immigrant and the host population, are seen as unlikely to be greatly altered by the environment in which the immigrant nurses find themselves. In fact a greater divergence would seem more likely to occur. The different experiences of immigrant nurses compared with nurses recruited in Britain are considered under the following headings: expectations of the immigrants on entering nursing, their contact with the host culture, the reaction of the indigenous population to the immigrant, language difficulties, and the insecurity of employment. The conclusion drawn is that the cultural differences, recruitment methods, the immigrants' experiences in employment and lack of contact with the culture of the indigenous population (apart from their deviant members) are likely to adversely affect his/her ability to function as a therapeutic agent. This is particularly important where the form of treatment is based on the social model.     

Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study

Title.  Comfort as a basic need in hospitalized patients in Iran: a hermeneutic phenomenology study.
Aim.  This paper is a report of a study conducted to explore the comfort experiences of hospitalized patients during their admission to medical–surgical wards in an Iranian hospital.
Background.  Comfort has various definitions, ranging from a basic human need, to a process, function or an outcome of nursing. As comfort is a substantive need throughout life in health and illness, providing comfort is a major function and challenge for holistic nursing care.
Method.  This hermeneutic phenomenological study was conducted between July 2006 and April 2007 in six medical–surgical wards of one of a university hospital in Iran. Data were generated with 22 participants (16 hospitalized patients and six nurses), using in-depth interviews to capture their detailed experiences of comfort. Analysis based on the framework of Diekelmann enabled data interpretation and elaboration of shared themes.
Findings.  One constitutive pattern, 'Comfort: a need of hospitalized patients' and four related themes – A friend in hospital, Relief of suffering within a calm environment, Seeking God, and Presence among family – were identified in the data.
Conclusion.  These findings offer unique insight for planning and implementing appropriate clinical practices in Iran, especially in caring for Muslim patients. Two major implications are to: (1) consider comfort criteria during nursing assessment and planning of care during a patient's hospitalization and (2) note that Shiite people in particular are more comfortable and feel better when they are able to follow their religious principles.     

Patients' and nurses' perspectives on oxygen therapy: a qualitative study

Title.  Patients' and nurses' perspectives on oxygen therapy: a qualitative study.
Aim.  This paper is a report of a study to describe patients' and nurses' perspectives on oxygen therapy.
Background.  Failure to correct significant hypoxaemia may result in cardiac arrest, need for mechanical ventilation or death. Nurses frequently make clinical decisions about the selection and management of low-flow oxygen therapy devices. Better understanding of patients' and nurses' experiences of oxygen therapy could inform clinical decisions about oxygen administration using low-flow devices.
Methods.  Face-to-face interviews with a convenience sample of 37 adult patients (17 cardio-thoracic: 20 medical surgical) and 25 intensive care unit nurses were conducted from February 2007 to September 2007. Interviews were audio-taped, transcribed verbatim and then analysed using a thematic analysis approach.
Findings.  The patients identified three key factors that underpinned their compliance with oxygen therapy: (i) device comfort; (ii) ability to maintain activities of daily living; and (iii) therapeutic effect. The nurses identified factors, such as: (i) therapeutic effect, (ii) issues associated with compliance, (iii) strategies to optimize compliance, (iv) familiarity with device, (v) triggers for changing oxygen therapy devices, as being key to the effective management of oxygen therapy.
Conclusion.  Differences between the patients' and nurses' perspective of oxygen therapy illustrate the variety of factors that impact on effective oxygen administration. Further research should seek to provide a further in-depth understanding of the current oxygen administration practices of nurses and the patient factors that enhance or hinder effectiveness of oxygen therapy. Detailed information about nurse and patient factors that influence oxygen therapy will inform a sound evidence base for nurses' oxygen administration decisions.     

The aspects school health nurses find important for successful health promotion

Scand J Caring Sci; 2010; 24; 156–163
The aspects school health nurses find important for successful health promotion
Background:  The work of school health nurses has changed over time; today they focus on health promotion, i.e. encouraging and protecting pupils' health.
Aim:  The aim of this study was to explore school health nurses' conditions for health promotion work with pupils aged 13–15 years.
Methods:  Eight school health nurses from eight different municipalities in Sweden were interviewed. Since the focus was on describing school health nurses' own experiences of their conditions for health promotion work, the research method used was based on Graneheim and Lundman's qualitative content analysis.
Results:  The results showed that conditions for school health nurses' work with health promotion varied between the different municipalities. This had an influence on what they did and the extent to which they worked in this way. The school health nurses described three important aspects that were essential in order to enable successful health promotion work in schools: organisation, support and knowledge. Organisation : It was important to understand the role of school health nurses and the conditions for health promotion work. Without this, they could only work on an individual level. Support : A network of other professions, working in close collaboration for the health of the pupils, created an understanding of ill health and what could be done to promote health. Knowledge : Most school health nurses recognized a lack of general theories and methods, leading to different empirical working methods in the municipalities.
Conclusion:  In an organisation where the need for health promotion work was understood, and school health nurses had support and knowledge, health promotion could be performed not only on an individual- but also on a general level.     

The lifeworld characteristics of mental health nurses engaging in talk-based therapies: a qualitative study from Scotland and England

Twenty-four mental health nurses were interviewed to gain a greater understanding of their experiences of working within roles delivering talk-based therapies. The study participants, while echoing the broad direction and purpose of policy that supports mental health nurses expanding talk-based therapy roles, also offered insights into the challenges associated with embedding these roles into mental health settings. One area of findings analysed using Nvivo 8 software related to the characteristics of the environments in which these roles are, or will be enacted. Three key characteristics of these environments were: (1) low power and worth; (2) obstacles to success; and (3) uncertainty. Responses to the challenges found within this study are required from individual nurses, local organizations and strategic levels of nursing to ensure the successful implementation and uptake of talk-based therapy roles into the mental health nursing profession.     

Nurses' experiences of caring for South Asian minority ethnic patients in a general hospital in England

Healthcare provision for minority ethnic groups in the UK has generally revealed inequalities in access and differential service provision. British healthcare policy has started to address such issues. However, very few studies have specifically examined the experiences of nurses caring for minority ethnic patients. This paper focuses on the focus group interviews of a broader ethnographic study, aimed at describing nurses' experiences of caring for South Asian minority ethnic patients, in a general hospital in the south of England. A sample of 43 nurses of all grades from six medical wards took part in the focus groups: three ward sisters, 22 staff nurses and 18 care assistants; 40 participants were white, one was African-Caribbean and two were South Asian. Data analysis revealed eight themes: changes in service provision; false consciousness of equity; limited cultural knowledge; victim blaming; valuing of the relatives; denial of racism; ethnocentrism, and self-disclosure. The study revealed a good local service response to government policies in addressing inequality. However, there was a tendency to treat all minority ethnic patients the same, with evidence of ethnocentric practices, victim-blaming approaches and poor cultural competence in nursing staff, which raise questions about the quality of service provision. The study indicates that ongoing training and development in the area of cultural competence is necessary.