Narratives,memorable cases and metaphors of night nursing: findings from an interpretative phenomenological study

The aim of the study was to explore the experiences of night nurses. An interpretative phenomenological study was undertaken, and 35 nurses working in Italian medical, surgical and intensive care units were purposely recruited. Data were gathered in 2010 by semi‐structured interviews, collecting nurses' narratives, memorable cases and metaphors, aimed at summarising the essence of work as a nurse during the night. The experience of night nursing is based on four interconnected themes: (i) working in a state of alert, (ii) growing by expanding autonomy and responsibility, (iii) assuring sensitive surveillance and (iv) experiencing deep intimacy. Memorable episodes were polarised along (i) expected/unexpected events; (ii) positive/negative epilogues; and (iii) life/death issues. Many of the emergent metaphors described working during the night as being in the middle of a space where an apparent calm scene takes place, but unpredictable factors may suddenly change the order of events and the outcomes, creating chaos. Working during the night alerts nurses, who increase autonomy, expanding their role and assuming more responsibility with respect to that assumed during daily shifts. The nurses' clinical reasoning is based on data they carefully listen to, and on the meaning that nurses give time by time to different noises and silence. While in the past a sense of companionships was reported, a loneliness or a ‘neutral’ experience concerning the relationships with colleagues seems to prevail during night nursing. Working night shifts is a complex task, and specific training must be assured to students/novices.     

Interprofessional collaboration between junior doctors and nurses in the general ward setting: A qualitative exploratory study

Aim

To explore the collaboration experiences of junior physicians and nurses in the general ward setting.

Background

Junior physicians and nurses do not always work collaboratively and this could affect the quality of patient care. The understanding of the issues affecting junior physicians and nurses working together is needed to inform strategies to improve interprofessional collaboration.

Methods

Nineteen junior physicians and nurses were interviewed in 2012 and 2013. Interviews were transcribed and analysed using thematic analysis.

Results

Junior physicians and nurses acknowledged the importance of working collaboratively to achieve better patient care, but they are struggling to cope due to heavy clinical workload, organisational constraints and differing power relationships. Nurses have to take on more responsibilities in the decision‐making process of patients’ care to foster effective interprofessional collaboration.

Conclusion

The study calls for educational and organisational strategies to improve interprofessional collaboration between junior physicians and nurses.

Implications for nursing management

Nurse leaders should ensure that ward nurses are given a designated time to participate in ward rounds with physicians and have access to a communication tool that assists them in contributing proactively in the decision‐making process of patient care.     

二级医院夜班护士睡眠质量现状与影响因素的调查分析

目的了解二级医院夜班护士的睡眠质量及影响因素,为制订管理对策提供依据。方法采用匹兹堡睡眠质量昔表对淮安市8所二级医院581名夜班护士进行调查。结果夜班护士匹兹堡睡眠质量得分高于国内正常成人（P〈0．01）;44．92％的夜班护士存在睡眠障碍;夜班护士睡眠质昔的影响因素为科室和有无二线班（P〈0．O1或P〈0．05）。结论准安市二级医院夜班护士睡眠问题比较突出,应引起社会、有关管理层及护士自身的重视,建议从社会、医院、护士自身方面采取相应的对策。     

实行夜班加强辅助班与护理住院总值班对妇产科夜班护士压力的影响

目的 探讨通过实行夜班加强辅助班及护理二线住院总查房制度,对减轻妇产科夜班护士压力的影响.方法 通过对夜班实行加强辅助班及开展夜间护理住院总值班制度,实施前后采用护士工作压力量表对48名一线夜班护士进行的压力状态比较.结果 实施后护士在患者护理方面、工作量及时间分配方面、护理专业及工作方面的压力得分分别为（1.91±0.32）,（1.73±0.48）,（1.48±0.61）分,均低于实施前的（3.35±0.76）,（3.35±0.47）,（2.92±0.67）分,差异具有统计学意义（t值分别为2.44,2.35,2.25;P ＜0.05）,管理及人际关系方面的问题、工作环境及资源方面实施前后比较,差异无统计学意义（P＞0.05）;在实施加强班和护理住院总值班后,夜班护士前5位压力源均减轻,与实施前比较差异均有统计学意义（P＜0.01）.结论 通过实行夜班加强辅助班和护理总值班制度,减轻了妇产科一线夜班护士的压力,保障了护理质量安全.     

群体突发事件救治中护士心理体验的质性研究

目的:深入了解突发事件救护中护士的真实心理体验。方法:运用质性研究中现象学研究法,深入访谈不同科室9名参与群体突发事件救治的护士。结果:护士在突发事件救治的心理反应有5个主题:紧张和恐惧感、悲伤感、职业责任感和愤怒感、不可控感以及创伤后应激反应,主要采取寻找最有效的个人宣泄方法及回避的应对方式。结论:突发事件中救治护士心理疏导至关重要,管理者应在硬件支持尤其是物资方面准备充分,做到有备无患。     

Perspectives and experiences of Iranian nurses regarding nurse–physician communication: A content analysis study

Background: Nurse–physician communication in the healthcare setting is an important subject that requires international attention because of its relationship with nurses' job satisfaction, turnover, patient safety, and above all, the quality of care. The importance of conducting studies on communication in different cultures and contexts in order to increase nurses' knowledge regarding nurse–physician communication cannot be overemphasized. Aim: The purpose of this study was to explore the perspectives and experiences of Iranian nurses regarding nurse–physician communication. Methods: A qualitative study, using the content analysis approach, was conducted. Semistructured interviews were held with 22 female nurses with a Bachelor's degree who were working in two teaching hospitals in an urban area of Iran. Results: During the data analysis, three main themes emerged: “no independence in decision‐making”, “lack of acknowledgment of nurses' capabilities”, and “unequal support by the healthcare system”. Conclusion: Healthcare team members and administrators should listen to nurses' perspectives and try to address the problematic areas of nurse–physician communication if they are improving the quality of nursing care that is expected.     

深化护理夜班制度改革的实践与效果

目的规范护理夜班管理,为护理人员岗位绩效薪酬制度改革奠定基础。方法调整各护理单元护理人员结构,明确各护理单元在常规情况下夜班岗位数的设置,明确各级、各类护理人员每月应完成的基本夜班数要求,实施护理夜班岗位绩效奖励制度。结果护理人员特别是高年资护理人员承担夜班工作的积极性增加,聘用护士离职率降低。结论规范夜班管理及建立夜班岗位绩效奖励制度是护理夜班安排更加合理化、人性化的重要途径。     

夜班护理工作中存在的问题分析与对策

目的了解晚夜班护理工作中存在的问题,比较不同特征的护士值班接受查房结果的差别,以及探讨问题发生与值班护士工作年限的关系.方法回顾性分析该院2005年1月至2006年10月护士长晚夜班查房的情况,分别对查房中存在的问题进行描述性分析,对不同查房时段以及被接受查房的值班护士聘用形式、工作年限的问题进行比较和相关性分析.结果①晚夜班护理工作中存在的问题最多的是无菌物品及药品管理,其次是冰箱管理、服务态度及行为规范等方面.②正式在编护士与合同制护士查房得分比较有统计学差异(t= 5.917,P＜0.001).③护士工作年限与其接受查房得分呈正相关(Pearson=0.15,P＜0.001).结论加强低年资护士的培养和聘用制护士的管理,督促晚夜班护士严格执行规章制度和操作规程才是保证晚夜班护理工作安全和质量的关键.     

A qualitative study of mental health nurse identities: Many roles,one profession

The aim of the study was to clarify and build upon current understandings of mental health nurse (MHN) identity. The study adopted a framework of social constructionism and qualitative methodology. Semistructured interviews were conducted, which were thematically analyzed using Nvivo software. Twenty‐five MHN were recruited across three geographical sites in the UK. Participants constructed a cluster of seven MHN identity characteristics that constituted a unique contribution to talk‐based therapies. These themes of characteristics are: (i) the MHN as generic specialist; (ii) the MHN as adopting a service‐user focus; (iii) the MHN as positioning and utilizing the personal self; (iv) the MHN as spending time with the service user; (v) the MHN as delivering talk‐based therapies in versatile ways; (vi) the MHN as having an everyday attitude; and (vii) the MHN as having transferable skills. The distinctiveness, and thus, professional identity of mental health nursing, must be understood as a cluster of capabilities rather than a search for a singular point of difference. The breadth of capabilities employed by MHN highlights the value and worth of their contribution to service‐user care.     

联合病区夜班护理二线值班制度的实施方法及体会

目的探讨联合病区夜班护理二线值班制度实施的可行性和效果。方法实施联合病区护理二线值班,将全院病区以护理内容具有的相似性和普遍性分为6个小组,在普通护理联合值班制度的基础上对参与人员、值班方法、工作职责和待遇等问题进行修改和补充。结果二线值班的工作内容集中在指导危重抢救、协助困难操作、排除急救仪器故障、分担常规工作和解决医患矛盾等方面。结论联合病区夜班护理二线值班制度整合了护理人力,实现了资源共享;保证夜间护理质量,降低护理差错发生率;锻炼了中高层护理人员队伍。     

夜班护理加强班工作情况的调查分析

目的:调查护理夜班加强班工作情况,以期改进工作,保证夜班护理质量。方法:应用自行设计“夜班护理加强班工作情况专项检查表”和“夜班护理加强班评价调查表”对全院40个科室(44个护理单元)夜班护理加强班工作情况进行调查。结果:夜班护理加强班的设置对病房的夜间护理质量能起到较好的作用,同时通过夜班加强班制度能间接地培养骨干护士的管理能力和业务能力,但夜班加强班制度尚需进一步完善。     

Skill mix change between physicians,nurse practitioners,physician assistants,and nurses in nursing homes: A qualitative study

Nursing home physicians face heavy workloads, because of the aging population and rising number of older adults with one or more chronic diseases. Skill mix change, in which professionals perform tasks previously reserved for physicians independently or under supervision, could be an answer to this challenge. The aim of this study was to describe how skill mix change in nursing homes is organized from four monodisciplinary perspectives and the interdisciplinary perspective, what influences it, and what its effects are. The study focused particularly on skill mix change through the substitution of nurse practitioners, physician assistants, or registered nurses for nursing home physicians. Five focus group interviews were conducted in the Netherlands. Variation in tasks and responsibilities was found. Despite this variation, stakeholders reported increased quality of health care, patient centeredness, and support for care teams. A clear vision on skill mix change, acceptance of nurse practitioners, physician assistants, and registered nurses, and a reduction of legal insecurity are needed that might maximize the added value of nurse practitioners, physician assistants, and registered nurses.     

专职夜班及固定班次在临床实施中的效果与评价

目的 :探索科学、合理的排班方法。方法 :将在岗护士 6 2名随机分为实验组和对照组 ,对实验组的护士采用专职夜班及固定班次排班 ,对照组为常规排班法 ,对两组心理健康状况进行问卷调查、实验对比 ,对护士的心理健康状况、学习兴趣、学习记忆力、工作质量、效率及病人满意度的提高等指标进行对照研究。结果 :两组护士的心理健康状况、学习效果、工作质量、效率及病人满意度统计学分析有明显的差异 (P <0 .0 5 )。结论 :实行专职夜班、固定班次排班法是科学可行的 ,有利于临床护士对本班工作程序的熟悉和身心健康     

Factors affecting quality of nurse shift handover in the emergency department

Aim

The aim of this study was to explore and test factors hypothesized to influence quality of Emergency Department nurse‐to‐nurse shift handover communication.

Background

Nurse‐to‐nurse shift handover communication includes the transfer of information and responsibility for patients at shift change. The unique environment of the Emergency Department, where there is a high degree of patient unpredictability, increased patient volumes and rapid patient turnover, can create challenges for high quality handover communication. There is considerable literature addressing handover communication and factors that influence quality or effectiveness. However, few studies have empirically tested those factors.

Design

A quantitative, cross‐sectional design was used to test a conceptual model of factors hypothesized to influence quality of handover communication.

Methods

In 2014, data were gathered using surveys mailed to Emergency Department nurses across Ontario, Canada.

Results

The final eligible sample was 231 of 576 for an overall response rate of 40.1%. Analysis was performed using backwards elimination stepwise multiple linear regression. Four statistically significant explanatory variables were retained in the final multiple regression model, explaining 34% (p < .0001) of variance in handover quality. Handover quality was increased when patients flowed smoothly through triage, when nurses experienced positive intrusions, in the presence of a positive safety climate and when there were positive relationships between incoming and outgoing nurses.

Conclusions

By understanding those factors that contribute to handover quality, it is possible to develop targeted interventions aimed at improving the quality of Emergency Department nurse‐to‐nurse shift handover.