Clinical cues used by nurses to recognize changes in patients' clinical states: A systematic review

The aim of this systematic review was to examine the clinical cues used by acute care nurses to recognize changes in clinical states of adult medical and surgical patients that occurred as usual consequence of acute illness and treatment. The Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines and checklist were followed. Four databases and reference lists of included studies were searched: from 1,049 studies, 38 were included. There were 26 subjective and 147 objective cues identified; only 6% of all cues described improvements in patients' clinical states. The most common clinical cues used were heart rate, blood pressure and temperature. Many studies (n = 31) focused on only one element of assessment, such as physiological stability, pain, or cognition. There was a paucity of studies detailing the complexity of acute care nurses' assessment practices as they would occur in clinical practice and a disproportionate focus on the objective assessment of deterioration. Studies are needed to understand the full breadth of cues acute care nurses use to recognize clinical change that includes both improvement and deterioration.     

临床护士对承担生活护理体验的质性研究

目的 了解临床护士承担生活护理的心理体验,为护理管理者制订护士有效落实生活护理的措施提供理论依据.方法 采用质性研究中现象学研究法,以半结构性的深入访谈方式对12名女性护士进行深入访谈,应用类属分析法分析资料.结果 提炼出3个主题:①对病人生活护理由护士承担的看法(护士没时间承担病人全部生活护理,病人生活护理没必要全部由护士来承担);②护士承担生活护理的负性感受(被迫、无奈、价值感丢失、自卑);③护士承担生活护理的正性感受(护患关系拉近了,病人认可).结论 护理管理者应保障护士的人力资源、重视临床护士的感受,引导护士转变观念,做好护士的分层使用,从而为病人提供优质护理服务.     

How clinical nurses in South Korea perceive the status of the nursing profession: A Q‐methodological approach

Professional self‐image among nurses is shaped by subjective perceptions, feelings, and tacit views. A perceived positive status reflects and influences the nurse's self‐esteem, professional empowerment, and nursing performance. The aim of this study was to examine the perceived status of the nursing profession among clinical nurses in South Korea. Q‐methodology was used with data collected from September to December 2014. Forty‐four Q statements were selected and scored by the 31 participants on a 9‐point scale with normal distribution. The data were analyzed using the pc‐QUANL program. Thirty‐one nurses were classified into 3 factors based on the following viewpoints: as professional (I am proud of my nursing job), subprofessional (I am not proud of my nursing job), and developmental (advocating for change and improvement). The major finding of this study included clinical nurses' subjective perception toward the status of nursing profession. The results indicated that to raise the status of nursing profession, nurses need to understand the value of nursing and their contribution to patients and public.     

护理人员对医院通报文化氛围感受的调查分析

目的评价上海市医院通报文化现状。方法运用自行设计的医院通报文化调查问卷,对上海市4所三级甲等医院和3所二级甲等医院411名护理人员进行问卷调查。结果护理人员对医院通报文化的感受(2.99±0.32)分,低于中等水平;多元逐步回归分析显示,护理人员的教育程度和职称是医院通报文化氛围感受的影响因素。结论护理人员对医院通报文化的总体氛围感受低于中等水平,较低学历和职称的护理人员尤为显著。     

低年资护士心理弹性的研究进展

目的 总结新入职护士的心理弹性状况,定义,影响因素和干预策略。 方法 文献调研万方,CNKI,pubmed,EBSCO和Cochrane等数据库,关键词为新入职护士,心理弹性。结果 将新入职护士心理弹性的影响因素分为人口统计学,个人和组织三类,详细阐述了各类因素对新入职护士心理弹性的影响,与并在此基础上总结了国内外学者提出的相关干预策略。结论 目前针对新入职护士心理弹性的研究有待加强,未来研究应研制本土化测评工具、建立心理弹性干预项目和拓展纵向研究等。     

西安市三级甲等医院临床护士科研能力现状及影响因素研究

目的调查西安市三级甲等医院临床护士的科研能力现状,并分析其影响因素。方法采用护理人员科研能力自评量表,对740名临床护士进行调查。结果临床护士科研能力总分为(27.54±22.16)分;77.16%的护士科研能力处于低水平,仅2.57%的护士科研能力处于高水平;各维度得分由高到低依次为论文书写技能、科研基础知识、统计学知识、软件操作技能。临床护士科研能力的主要影响因素为学历及职务(P0.01或P0.05)。结论西安市三级甲等医院临床护士科研能力总体水平偏低。应尽快完善护理科研管理工作,实施针对性护理科研培训,提升临床护士科研意识和科研能力。     

932名临床护士工作满意度的调查分析

目的了解广州市临床护士工作满意度现状,为提高护士工作满意度提供理论依据。方法采用工作满意指数(the index of work satisfaction,IWS)量表,对广州市7所综合医院的932名护士进行调查。结果临床护士工作满意度总得分为(127.35±15.25)分,其中互相合作得分最高(34.25±5.01)分,收入得分最低(11.57±4.21)分;不同医院等级、职称及职位的护士其工作满意度存在差异,组间比较,均P<0.01,差异具有统计学意义,三级甲等医院护士、主管护师及以上、区护士长及以上的护士工作满意度较高。结论临床护士工作满意度总得分不高,尤其是低收入者。因此,护理管理者应科学评估护理服务的价值,合理分配护士的收入,为护士提供长远的职业规划,以便提高护士工作满意度。     

Managing capacity issues in clinical placements for pre‐registration nurses

Aims and objectives. To explore influences on decision‐making concerning placement capacity planning for supporting nursing students in clinical placements. The research questions were:

• ? How are decisions relating to capacity planning and management of the learning environment made within the practice areas?
• ? What factors were or are perceived as important to take into consideration when making these decisions?

Background. It is already known that clinical placements are pivotal to pre‐registration nurse education. The recent large expansion of nurse education places means that more students require clinical placements than previously. This study explored decision‐making about placement capacity amongst mentors in one central English county. Design. A qualitative design using focus groups. Study and methods. Collecting data allowed researchers to engage mentors in discussions concerning their decisions about how many students they could support in practice and the learning environment they could provide. Twenty‐nine active nursing student mentors participated, representing three branches (Adult, Mental Health and Child Health Nursing) from various acute and community settings and professional roles. Results. Three themes emerged relating to capacity management issues in clinical placements:

• ? Capacity issues: how decisions are made in relation to capacity planning, by whom they are made and what influences them?
• ? Supporting learners and enhancing support in practice.
• ? Issues impacting on learning in practice.

Conclusions. This study adds further understanding of the need for robust information to support allocation decisions, coupled with greater clinical staff and mentors’ involvement in decisions about student support. The forthcoming Skills for Health Ensuring Quality in Partnership requirements may add authority and structure to student support activities. Relevance to clinical practice. Strategic practice and placement development links and joint appointments between UK NHS trusts and higher education institutions should be considered if placement capacity issues are to be addressed successfully and the quality of students’ placements are to be safeguarded.