Qualitative and quantitative approaches in mental health nursing: moving the debate forward

In recent years, two distinct, and apparently opposing, positions have arisen in debates concerned with mental health nursing research, education and practice. Each of the two has its champions and 'gurus', and its detractors. Writers associated with the quantitative camp have argued in favour of: experimental research where the aims are the investigation of the outcomes of nursing care; multidisciplinary rather than unidisciplinary research; a physiological explanation for mental illness; clinical practice which is evidence based, and skills based education. Qualitative camp writers, on the other hand, have argued for: qualitative research to explore the experiences of illness, and of nursing; the preservation of nursing-only research; the relative irrelevance of physical explanations of mental illness, and holistic nursing practice in which clinical techniques are less important than interpersonal relationships. In this paper, we first review and criticize some key ideas associated with these two positions. In our subsequent analysis, we argue that, rather than differing at some fundamental level, the differences found between the two camps may be more a matter of emphasis. The possibilities of reconciliation and synthesis are, finally, presented and discussed.     

Graduate education for advanced practice public health nursing: at the crossroads

The complexity of public health problems and advancement of science framing public health demand an expansion of traditional educational approaches and curriculum to prepare a futuristic advanced practice public health nursing (APPHN) workforce. This position paper sponsored by the Association of Community Health Nursing Educators challenges nurse educators to apply innovative strategies in preparing public health nursing (PHN) professionals and to expand curriculum paradigms to promote PHN's ecological approach to solving problems. To meet the challenges of ensuring public health in the 21st century, advanced practice public health nurses must have greater foundational knowledge in critical content areas discussed in this document. Competence in these areas will enable advanced practice public health nurses to address future health care challenges such as rapidly changing social structures, escalating knowledge explosion, globalization, and growth of new technologies. This education will prepare nurses to forge new knowledge and establish health care teams to create effective solutions.     

Associations of nurse education level and nurse staffing with patient experiences of hospital care: A cross sectional study in China

Strengthening the nursing workforce is core to health system reform in China. Patient experiences of hospital care have been recognized as important in this endeavor. Studies exploring the relationships between nursing workforce and patient experiences of hospital care, however, are scarce. The aim of this cross-sectional study was to examine the associations between nurse education level, nurse staffing, and hospitalized patients’ experiences of hospital care. Participants were 1,582 nurses responsible for direct care and 1,305 hospitalized patients from 23 hospitals in Guangdong province, China in 2014. Education level of nurses was measured by the proportion of nurses holding a baccalaureate or higher degree. Nurse staffing was measured by the unit nurse-patient ratio. The Hospital Consumer Assessment of Health care Providers and Systems Scale was used to measure patient experiences of hospital care. Structural equation modeling demonstrated that a higher proportion of nurses holding a baccalaureate or higher degree was related directly to better patient perceptions of communication with nurses, responsiveness of nurses, pain management, and physical environment, and related indirectly to overall hospital ratings and recommendation of the hospital. A higher nurse-patient staffing ratio was associated directly with better patient perceptions of communication with nurses, education about new medications given in hospital, and physical environment, and indirectly with overall ratings and recommendation of the hospital. Our findings add new evidence in the Chinese societal context about the relationship between the nursing workforce and patient experiences of hospital care. Upgrading nurse education level and increasing nurse staffing could potentially improve patient experiences of hospital care.     

Evaluation of a statewide public health nursing training in Utah

Public health nurses continue to struggle to provide culturally relevant services that focus on the multiple needs of an ethnically diverse population while at the same time providing services to the population at large. This article describes the formative research, implementation, and results of a statewide effort to broaden UtahAEs public health nurses perception about their role and responsibility in addressing and serving the emerging needs of underserved and atrisk populations in Utah. A total of 51% of Utah state and local health department public health nurses participated in the training. There was a statistically significant increase in the mean level of perceived understanding of topic material from pretest to posttest, and 80% of participants reported applying what they learned in the training to their practice. Our experience demonstrates that even with limited resources, it is possible to deliver high quality training to a large proportion of public health nurses practicing in urban, rural, and frontier populations; observe significant results in their comprehension of training material and, most importantly; see application of what they learned in the training to their health care practice.     

How nurse practitioners make decisions regarding coronary heart disease risk: a social judgment analysis

PURPOSE: Understanding how nurse practitioners use clinical decision skills in practice has the potential to guide education programs to ensure safe, competent, and high quality advanced nursing practice. This study used the lens of social judgment theory to examine the clinical decision making of 60 nurse practitioners. METHODS: A three‐group pretest–posttest comparison design was used to evaluate how much insight nurse practitioners had into their clinical decision‐making process. FINDINGS: Nurse practitioners had modest insight into their clinical decision‐making process. CONCLUSION: Self‐insight has implications for enhancing nurses' decision making, improving education, and fostering agreement among advanced practice nurses. IMPLICATIONS FOR NURSING PRACTICE: Self‐insight has implications for developing professional decision making and promoting appropriate educational opportunities for advanced practice nurses.     

Matching a graduate curriculum in public/community health nursing to practice competencies: the Rush University experience

An evidence-based approach to Public/Community Health Nursing (P/CHN) requires that P/CHN educators prepare practitioners with the relevant skills, attitudes, and knowledge. Such education should be competency-based and have measurable outcomes to demonstrate student preparation. In 2003, the Quad Council competencies were developed to be applied at two levels of public health nursing practice: the staff nurse/generalist role and the manager/specialist/consultant role. This paper describes a process for evaluation and revision of a graduate curriculum to prepare Advanced Practice Clinical Nurse Specialists (CNS) in P/CHN, to ensure that the educational program addresses and develops knowledge and proficiency in all relevant competencies. This paper documents the process of integrating the competencies throughout the P/CHN graduate curriculum at varying levels, guiding students to achieve proficiency in each competency by the end of the program. Measurement of achievement in these competencies will be discussed, and examples provided. Advanced Practice Public Health Nurses educated via this competency-based approach will be prepared to sit for national certification as a CNS in Public/Community Health, and to assume leadership roles in public health nursing.     

冠心病病人的康复护理现状

综述了冠心病病人康复护理的有关措施,从康复治疗与护理、康复训练与护理、心理治疗、饮食的康复护理以及健康教育、冠心病危险因素的控制等方面进行探讨与归纳,为促进冠心病病人的健康,提高护理质量提供建设性意见。     

Education for new role development: the Community Matron in England

Title. Education for new role development: the Community Matron in England. Aim. This paper is a report of an evaluation of the English national pilot education programme preparing Community Matrons to fulfil their role. Background. Investment in community services has been important in introducing new ways of working in the United Kingdom National Health Service, particularly for patients with complex long‐term conditions. Development of the Community Matron role in England is an exemplar in the creation of modern nursing careers that are fit for purpose. Method. A mixed methods approach to data collection was adopted. This included documentary analysis of a range of sources used in the development and evaluation of the programme. In addition, during 2006, a self‐administered questionnaire was sent to all Community Matrons undertaking the programme (n = 70), with a response rate of 67% (n = 47). Individual telephone interviews were conducted with 17 students and six mentors. A focus group was also undertaken with the education programme Development Team (n = 5). Quantitative data were analysed using SPSS and qualitative data analysed using content and thematic analyses. Findings. The majority of students (n = 25) believed that the programme had met their expectations and had helped them to achieve the functions of the Community Matron role as defined in national competence statements. However, 17 students experienced difficulties in the level of organisational readiness to support them in their role, including, for example, lack of facilitation of their work‐based learning. Conclusion. In spite of the successful programme design, there is a need for organisations to develop their infrastructure to support new roles as well as offering protected time to learn in practice.     

护理干预对冠心病慢性心力衰竭患者的疗效分析

目的 探讨护理干预对冠心病慢性心力衰竭患者的临床效果.方法 以45例冠心病慢性心力衰竭患者作为试验组,给予护理干预;以同期收治的40例冠心病慢性心力衰竭患者作为对照组,给予常规基础护理及生活护理,比较两组不良生活方式改变及治疗依从性情况.结果 试验组在低盐饮食、低脂饮食、合理休息并锻炼、戒烟及戒酒等方面的改善优于对照组,差异有统计学意义(P<0.05);出院后随访6个月,试验组治疗依从率高于对照组,差异有统计学意义(P<0.05).结论 护理干预可改善患者生活质量,提高治疗依次性和整体护理质量.     

Nursing work in Jordan: an example of nursing work in the Middle East

Aim. The study aimed to investigate Jordanian nurses’ perceptions of their role in clinical practice. Background. The lack of regulation of nursing practice by the profession across the Middle East until now has led to each institution setting its own policies regarding the role of the nurse and the practice of nursing. No study to date has examined the role of the nurse working in the acute hospital environment nor explored the practice of nursing in this region. Design and methods. A cross‐sectional questionnaire survey was conducted using a quota sample. A total of 348 medical‐surgical staff nurses and practical nurses from the three healthcare sectors in Jordan participated in the study with a response rate of 77%. The results were analysed by constructing multiple response tables, chi‐square test, anova and log‐linear analysis. Results. Staff nurses in Jordan were expected to carry out the majority of nursing care activities. The role of the practical nurse was limited to the physical and professional domains of nursing care. Activities requiring higher levels of emotional or intellectual labour and interdisciplinary communication were attributed only to the staff nurse. The majority of the respondents reported nursing had not been their first choice of career. Male nurses had a higher intention to leave the nursing profession. The predominant method of care delivery used by nurses was task‐oriented. Conclusion. There was a general consensus regarding what constituted the nurse's work in the clinical area across the three healthcare sectors in Jordan. Role delineation between the two levels of nurses was also clear. There is a need to move from task‐oriented to patient‐centred care to promote quality patient care. Relevance to clinical practice. This study explores the role of the nurse working in the acute hospital environment in Jordan.     

Implementing a major stream in mental health nursing: Barriers to effectiveness

Changes to the educational preparation of the nursing workforce in mental health continue to have profound effects on the availability of sufficient numbers of skilled graduates willing to work in this field. The longevity of the problem has focused attention on possible solutions. Introducing a major stream in mental health nursing in undergraduate Bachelor of Nursing programmes was proposed and supported as a potentially beneficial strategy, adopted by some Australian universities. Despite the promise invested in this strategy, systematic evaluations to determine the effectiveness or otherwise of this approach were not initiated. A qualitative exploratory study was undertaken with Australian universities, which had implemented the major stream, regarding their experiences and observed outcomes. In‐depth interviews were conducted with a mental health nurse academic from each university. The barriers to the effectiveness of the major in mental health nursing are the specific focus of this paper. Thematic data analysis revealed three main barriers: clinical placements, lack of support from other academics, and integrated curricula. These barriers substantially limited the effectiveness of this strategy – in some instances, leading to the programme's termination – and must be assertively addressed to maximize the potential of the major in mental health nursing.     

An evaluation of the first year of family health nursing practice in Scotland

Scotland has led enactment of the new World Health Organisation (Europe) Family Health Nurse (FHN) concept. This paper presents research which evaluated the initial operation and impact of the role in remote and rural regions of Scotland. Through use of a multiplex research design informed by ideas from realistic evaluation, fourth generation evaluation and case study research, an initial typology of practice was constructed. The new FHN role typically supplemented, rather than supplanted, pre-existing community nursing services. Implications arising from key findings are discussed in relation to Scottish, UK and European nursing and primary care perspectives.     

Advanced nursing practice: policy, education and role development

Aims and objectives. This paper aims to explore the critical elements of advanced nursing practice in relation to policy, education and role development in order to highlight an optimal structure for clinical practice. Background. The evolution of advanced nursing practice has been influenced by changes in healthcare delivery, financial constraints and consumer demand. However, there has been wide divergence and variations in the emergence of the advanced nurse practitioner role. For the successful development and implementation of the role, policy, educational and regulatory standards are required. Conclusion. The paper highlights the value of a policy to guide the development of advanced nursing practice. Educational curricula need to be flexible and visionary to prepare the advanced nurse practitioner for practice. The core concepts for the advanced nursing practice role are: autonomy in clinical practice, pioneering professional and clinical leadership, expert practitioner and researcher. To achieve these core concepts the advanced nurse practitioner must develop advanced theoretical and clinical skills, meet the needs of the client, family and the community. Relevance to clinical practice. In a rapidly changing people‐centred healthcare environment the advanced nurse practitioner can make an important contribution to healthcare delivery. The challenges ahead are many, as the advanced nurse practitioner requires policy and appropriate educational preparation to practice at advanced level. This will enable the advanced practitioner articulate the role, to provide expert client care and to quantify their contribution to health care in outcomes research.     

A literature review of principles, policies and practice in extended nursing roles relating to UK intensive care settings

Aims. To provide an overview of the literature relating to the principles, policy and practice of extended nursing roles in UK intensive care settings to date; to review and critically assess evidence of impact, outcomes and effect on practice and provide suggestions for future research. Background. It is known that career development opportunities, new technologies, patient needs, as well as the reduction in junior doctors’ hours, are driving the development of new roles for nurses. Policy initiatives aim to expand nursing roles to support professional substitution. In adult, neonatal and paediatric intensive care, specialist trained nurses and designated advanced nursing practitioners are increasingly taking on extended practice of clinical tasks previously undertaken by medical staff. As yet there are no statutory regulations on the perceived scope and definition of the role of extended and advanced roles. Design. Systematic review. Methods. Search of electronic databases and selection of policy and peer‐reviewed reports and reviews of extended nursing roles or advanced nursing practitioners in UK intensive care settings. Results. Chronological review shows policy development proceeding in a relatively ad hoc way. There is limited information available about how extensively or effectively extended nursing roles are being implemented in intensive care settings in the UK, particularly in adult and paediatric intensive care. To test local initiative findings for reliability and generalisability, a more robust evidence base is required. Conclusions. More data are needed on definition and outcomes of extended nursing roles in intensive care and care process measures should be developed to better inform implementation of nurse role development in the UK. Relevance to clinical practice. The review of policy and research evidence in this paper may better inform clinicians working in adult, neonatal or paediatric intensive care, as they continue to be challenged by expansion and development of their role. It may also help to form a basis and evaluation for future research into extended and advanced nursing roles in intensive care settings.