Partnership Through Integration: Perianesthesia Policy Standardization

PurposeTo develop system-wide perianesthesia policies, through partnerships, across 11 acute care hospitals and 1 ambulatory surgery center.DesignA partnership culture was created and maintained throughout the development and integration of multiple site-based policies into system policies.MethodsPolicies were built using evidence-based practice and professional organizational standards with an emphasis on quality, safety, and standardization of patient care. Early and ongoing partnerships with key stakeholders were maintained in order to effectively develop the policies.FindingsMore than 50 independent policies across 11 acute care hospitals and 1 ambulatory surgery center were integrated and updated into 4 main perianesthesia nursing policies.ConclusionsFlexibility and partnership with key stakeholders throughout the policy process was instrumental for early detection of barriers and the successful development of perianesthesia nursing policies.     

Partnership caring: a theory of high blood pressure control in Iranian hypertensives

This study uses grounded theory methodology to generate a substantive theory that describes and explains the problem of high blood pressure control among Iranian patients. High blood pressure control is a major world health problem on which many studies have been carried out. Most of these studies have been done by quantitative research methods. The main purpose of this qualitative research was to determine the essential structure of high blood pressure control in an Iranian hypertensive population and to identify a theoretical explanation for this problem. Four interrelated concepts: 'non-compliance', 'lack of knowledge', 'lack of effective caring relationship', and 'necessity of partnership' were identified. Based on these processes, a partnership care theory was developed that provides an appropriate context for the active participation of patients, nurses and physicians in the control of hypertensive disease. This theory can be utilized in the control of hypertension as well as other chronic diseases.     

Partnership – success factors of interorganizational relationships

Aim  Key factors of successful interorganizational partnerships are applied to the context of nursing and midwifery education.
Background  Reports in nursing education emphasize the need for more collaborative partnerships between the education and healthcare sectors of nursing and midwifery education.
Evaluation  There is little research examining the implementation of interorganizational relationships particularly in nursing.
Key issues  Key success factors are grouped into seven areas of trust and valuing the partner, leadership and managing change, a partnership framework, communication and interaction, equity and involvement in decision making, power and the role of partnership coordinator.
Conclusion  There is a need for contextual research in relation to implementing partnership in nursing and midwifery.
Implications for nursing management  Partnership arrangements are essential for quality nursing and midwifery education. This article adds knowledge by way of application of these factors to organizations that provide nursing and midwifery education. Nurse managers have an important role in determining the quality of learning experience within the health service. It is essential, therefore that both nurse managers and nurse educationalist know the key factors which promote successful interoganizational relationships to ensure these factors are manifest in practice.     

'It's not the same as him being at home': creating caring partnerships following nursing home placement

Admission to a nursing home is a major life event for both older people and family carers. Despite a policy of community care in both the UK and the US, entry to nursing homes will be an increasingly common event. Family carers are often the key decision makers but little is known about their experience of placement, especially adjustment after the event. Antagonistic relationships can often develop between staff and relatives, as the former seek to take over care and the latter to develop new roles. There is a need to create a partnership between staff and family so that the care of the older person is improved and the carers' need to remain involved is acknowledged.     

Partnership Between an Educational Institution and a Healthcare Agency—Lessons Learned: Part I

PURPOSE.  The purpose of this paper is to provide a model of a partnership program between a major educational institution and a large community medical center that has become a win–win situation for both, which enabled the former to double its undergraduate nursing (BSN) program when it was on the verge of reducing enrollments by 33% because of repeated financial cuts, and a healthcare agency (HCA) to find a creative way of hiring BSN-educated registered nurses in perpetuity, thus reducing their $2 million a month recruitment expenses.
PROCESS.  This was a 5-year, $15 million partnership between California State University, Long Beach, School of Nursing and Long Beach Memorial Medical Center/Miller Children's Hospital. The HCA contributed the $10 million in funds and in in-kind contributions in the form of facilities and adjunct clinical professors, and the university contributed the $5 million, all in in-kind contribution by doubling the lecture classes without additional cost. The project started in the spring of 2004.
CONCLUSION.  To date, eight groups have graduated from this program for a total of 288 additional BSN graduates. Retention rate has been a minimum of 95%. Over 95% of the graduates have been hired by the participating HCA. Indeed, it has been a win–win situation for both.     

Creating a culture of caring: A collaborative academic‐practice approach to clinical education

Strong academic and practice partnerships are needed in the ever‐changing health care environment. Sometimes an invisible barrier exists between clinical practice and academia; academic‐practice partnerships are a way to bridge this barrier. Since 2008a team‐based model of clinical education known as the Culture of Caring (COC) has brought together three academic institutions with a large hospital system to develop a unified clinical experience and curriculum that improves the student, provider, and patient experience. In the COC model the team consists of academic‐practice leaders, clinical instructors, staff nurses, and students. Together they engage in a structured curriculum that is integrated into both the clinical environment and the academic setting. Each week of clinical the students focus on a topic that is paired with journal articles and learning activities that allow the team to engage in learning that is applicable to the clinical practice environment. The learning activities allow students to engage in learning about evidence‐based practice and quality improvement initiatives that are taking place on the unit. The implementation of this collaborative approach to a clinical nursing education model has had a positive impact on the working relationships between the academic partners and clinical practice leaders.     

Using an Academic‐Community Partnership Model and Blended Learning to Advance Community Health Nursing Pedagogy

This article describes a model of teaching community health nursing that evolved from a long‐term partnership with a community with limited existing health programs. The partnership supported RN–BSN students' integration in the community and resulted in reciprocal gains for faculty, students and community members. Community clients accessed public health services as a result of the partnership. A blended learning approach that combines face‐to‐face interactions, service learning and online activities was utilized to enhance students' learning. Following classroom sessions, students actively participated in community‐based educational process through comprehensive health needs assessments, planning and implementation of disease prevention and health promotion activities for community clients. Such active involvement in an underserved community deepened students' awareness of the fundamentals of community health practice. Students were challenged to view public health from a broader perspective while analyzing the impacts of social determinants of health on underserved populations. Through asynchronous online interactions, students synthesized classroom and community activities through critical thinking. This paper describes a model for teaching community health nursing that informs students' learning through blended learning, and meets the demands for community health nursing services delivery.     

Pattern recognition as a caring partnership in families with cancer

Pattern recognition as a caring partnership in families with cancer The purpose of this study was to address the process of a caring partnership by elaborating pattern recognition as nursing intervention with families with cancer. It is based on Newman's theory of health as expanding consciousness within the unitary-transformative paradigm and is an extension of a previous study of Japanese women with ovarian cancer. A hermeneutic, dialectic method was used to engage 10 Japanese families in which the wife-mothers were hospitalized because of cancer diagnosis. The family included at least the woman with cancer and her primary caregiver. Each of four nurse-researchers entered into partnership with a different family and conducted three interviews with each family. The participants were asked to describe the meaningful persons and events in their family history. The family's story was transmuted into a diagram of sequential patterns of interactional configurations and shared with the family at the second meeting. Evidence of pattern recognition and insight into the meaning of the family pattern were identified further in the remaining meetings. The data revealed five dimensions of a transformative process. Most families found meaning in their patterns and made a shift from separated individuals within the family to trustful caring relationships. One-third of them went through this process within two interviews. The families showed increasing openness, connectedness and trustfulness in caring relationships. In partnership with the family, each nurse-researcher grasped the pattern of the family as a whole and experienced the meaning of caring. Pattern recognition as nursing intervention was a meaning-making transforming process in the family-nurse partnership.     

A Comprehensive School-Based Clinic: University and Community Partnership

purpose . To describe the evolution and current status of a university and community partnership engaged in operating an urban elementary school-based clinic (SBC)
population . The children at the school who are eligible to receive care at the SBC include 500 elementary students and 200 adolescents who attend a magnet junior high school housed in the same building. The vast majority of the children attending the school are from families whose incomes are below the national poverty level. Eighty-five percent of the children are black. Fifteen percent are Hispanic, non-white.
conclusions . A variety of services and programs are offered to the children and their families for the promotion of health and the prevention of mental disorders. Service, education, and research occur simultaneously to achieve the multiple goals of the partners and participants.
practice implications . Advanced practice nurses can provide quality health and mental health care services for school-age children and their families through SBCs. Institutional partnerships, capitalizing on each other's strengths, can expand the availability of SBC offerings.     

Negotiating Rehabilitation Success: A Veterans Affairs‐Community Partnership

Crystal Barker is a restorative nurse in the rehabilitation ward, Joan Brosnan is associate director of Community Care, Donna Henriques is a staff nurse in the rehabilitation ward, and A. Wassen El Shaied is a rehabilitation social worker at the VA Greater Los Angeles Healthcare System. Address correspondence to Joan Brosnan, Associate Director of Community Care, 10H5, VA Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard, Los Angeles, CA 90073.     

Cultural conflict: the impact of western feminism(s) on nurses caring for women of non-English speaking background

Much research has been conducted for understanding the health needs of people of different cultural backgrounds and the problems they experience in seeking health care. In Australia, despite such research, it is argued that there remains an exclusionary health care culture that continues to affect equity and access for people of non-English speaking background. There was a need for research in which health professionals examined their own Anglo-Australian culture and its impact on other ethnic communities. Such concerns provided the impetus for a feminist praxis study to engage nurses in understanding and improving care for migrant women. This study was conducted with 26 nurses in a paediatric hospital in Melbourne, Australia. Five collaborative research groups were formed, each consisting of four to six nurses who were co-researchers. Together, the nurses and researchers explored the health care experiences of migrant women, using a variety of quantitative and qualitative data collection strategies. This paper explores a major finding of the study, which was the impact of liberal feminist approaches on the practices of Australian nurses who cared for women of different ethnicity and race. The study found that the efforts of liberal feminist nurses to "treat all people the same" meant that women from different cultural backgrounds did not always receive equity in care. Through the feminist praxis process the nurses were able to explore contradictions in their practice and focus on equity in care to meet the specific gendered and racially constructed needs of women of different cultural backgrounds. A number of strategies were adopted that included regular use of female health interpreters and provision of privacy for migrant women when caring for their children.     

Impaired autonomy–the challenge of caring

• ? The aim of this paper is to present an informed argument in favour of changing power relationships between learning disability nurses and their clients and to do so through an examination of the influence that they have on quality of life issues for people whose autonomy is impaired.
• ? The challenge of empowerment and enhanced autonomy is considered to be at the ‘cutting edge’ of the learning-disability agenda with its increasing focus on the provision of supported living opportunities for clients in the community.
• ? Features related to institutional methods of care delivery continue to exist in some services and as a result clients may still be expected to conform to the dominant themes of time, order, control and regimentation,
• ? The application of social and environmental engineering techniques to the field of learning disability care is prerequisite for the development of more positive alternatives to the mental-handicap hospital as a focus for care provision.
• ? The main requirement for persons whose autonomy is impaired will be the promotion of equal power sharing between clients and carer. This process will involve a number of transactional considerations such as advocacy, risk taking and shared action planning.
• ? The emergence of a new paradigm for nursing practice will result in the solution for shifting the balance of power in the emergent world of consumerism for clients whose autonomy is impaired.

     

Dependency in autonomous caring – night nurses’ working conditions for caring in nursing

Scand J Caring Sci; 2010; 24; 312–320
Dependency in autonomous caring – night nurses’ working conditions for caring in nursing Few research studies have focused on nurses’ working conditions for caring provided at night, and these studies have mainly described nurses’ work in hospital settings, not in a municipal, social‐care context. In Swedish municipal care, nurses have responsibility for hundreds of older people in need of care. This working condition compromises caring encounters; instead the nurses’ caring is mainly mediated through care staff (or relatives). In considering that caring based on caring encounters is fundamental to ethical nursing practice questions leads to the aim: to explore Swedish municipal night nurses’ experiences of their working conditions for caring in nursing. All municipal night‐duty nurses (n = 7) in a medium‐sized community in Sweden participated in interviews, while six of them also wrote diaries. Thematic content analysis has been used in analysing the data. The findings revealed that the nurses experienced their working conditions for caring in nursing in the themes of Dependency in the Organisation and Other Staff, Vocational Responsibility, Deficiency in Conditions for Caring and Autonomous Caring. The findings illustrate privileged, as well as, poor working conditions for caring in nursing. The nurses’ role as consultants emerge as their main function. The consultant function implies that nurses do not participate in ordinary bed‐side caring, which makes it easier for them to find time for caring in situations that arise when nurses’ skills, expertise and authority are called upon. Conversely the consultancy function entails short‐term solution of complex caring problems, which can signify deficient caring due to prevailing working conditions. The findings also point to nurses’ possible problems in fulfilling their own and vocational demands for ethics in the practice of caring in nursing related to existing working conditions.     

Family-nurse co-construction of meaning: a central phenomenon of family caring

The purpose of the study was to understand and interpret caring in the family health experience by exploring the interactional phenomenon of family-nurse co-construction of meaning in the paediatric intensive care unit (PICU). A hermeneutic phenomenological method within a framework of existentialism and symbolic interactionism was used in the investigation. The convenience sample for this study was four family-nurse dyads, that is four families of critically ill children (all with positive outcomes) and the four nurses assigned to their care who were participating in a larger study. Data were derived from semi-structured interviews regarding significant interactions throughout the child's illness and subsequent significant interactions of families with other nurses and nurses with other families. Trustworthiness of the study was addressed through the criteria of credibility, dependability, transferability and confirmability. Co-construction of meaning in the family health experience was found to have two dimensions: interdependent and independent. Both families and nurses described being like family as an essential component of the interdependent experience. Independent dimensions for families were journeying through troubled waters of learning the meaning of the illness event and sensing family comfort through the nurse's care. Independent dimensions described by nurses were journeying through troubled waters of learning to care for families and living with another's fear. The family-nurse interaction, the relational connection and the evolution of meanings that families and nurses construct, was affirmed as the major vehicle in the co-construction experience. Family caring is influenced by the existential meaning constructing, process-oriented, interactional nature of the family health experience. Caring in the family health experience is enhanced through actions the nurse performs on behalf of, and with, the family while understanding the family's unique situation. Caring enacted by nurses in participation with families holds abundant potential for enhancing the family health experience and honor the ethic of caring as central to nursing.     

Paediatric nursing and research ethics: is there a conflict?

• ? This paper briefly outlines the major ethical issues which need to be considered when conducting paediatric research.
• ? An overview of ethical theories and principles will highlight the difficulties which may be experienced when making decisions about children's competency to consent to participate in research.
• ? The congruency of the paediatric nurse as ‘researcher’ and ‘practitioner’ will be examined. Does the nurse involved in paediatric research experience a conflict between a commitment to research and safeguarding the interests and well-being of the child.

     

Complexity in caring for patients with advanced cancer

BACKGROUND: The gap between nursing research and practice is readily acknowledged in literature, with a variety of strategies suggested for reducing this gap. It is necessary not only to address problems of research implementation in practice, but also to find strategies that strengthen the influence of practitioners on research agendas through more collaborative relationships in order to have an impact on care of patients. A multi-centre research project was therefore initiated by two universities and three health care facilities, aiming to improve quality of care for patients with advanced cancer through a knowledge-exchange programme between nurse researchers, practitioners and students. AIM: The aim of this article is to explore how clinical staff reason about care provision for patients with advanced cancer, through analysis of 20 focus group discussions conducted with staff in three different health care facilities in two Swedish cities. An initial analysis based on grounded theory was complemented with consideration of the interactive process in the focus group discussions, and carried out by a team consisting of senior nurse researchers, clinical experts and nursing instructors. FINDINGS: The findings of the focus group discussions emphasize the complexity of caregiving for patients with advanced cancer. The tension between caregiving ideals and limits imposed by the realities of caregiving in today's health system were striking. Practitioners discussed the organization of care, different constellations of relationships between patients, family members and professionals, and theoretical and experiential knowledge as equally important aspects in dealing with all concrete situations in daily practice. The importance of reflective practice, use of self and ethical reasoning also permeated the focus group discussions. CONCLUSIONS: These findings highlight an integrated need both to influence organizational structures and working relationships, along with increasing knowledge, if sustainable change is to be effected.     

Partnership research with older people – moving towards making the rhetoric a reality

As nursing develops closer partnerships with older people in delivering care, it also needs to develop partnerships in order to create the knowledge base for practice in a way that challenges professional hegemony and empowers older people. However, the process of developing partnerships in research takes place against a background of academic research traditions and norms, which can present obstacles to collaboration. This paper is a reflection on the issues that have arisen in three projects where older people were involved in research at different levels, from sources of data to independent researchers. It points to some of the areas that need further exploration and development.