Patient-centred care and nurses' health: the role of nurses' caring orientation

Title.  Patient-centred care and nurses' health: the role of nurses' caring orientation.
Aim.  This paper is a report of a study of the moderating effect of caring orientation on the relationship of patient-centred care to nurses' physical and mental health.
Background.  Providing effective patient-centred care is well-accepted as an important contributor to a host of patients' health outcomes. Based on two theoretical perspectives – person–environment fit and emotional labour – I suggest that providing patient-centred care per se does not potentially harm nurses' health; the cause is the fit (or non-fit) of a nurse's caring orientation and the displayed patient-centred care behaviours.
Method.  Data were collected in 2007 with a random sample of 325 registered nurses working in the Israeli public healthcare sector in in-patient units. Caring orientation, health and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations.
Results.  The mental health of nurses who exhibited high caring orientation combined with high patient-centred care, or that of nurses who exhibited low caring orientation combined with low patient-centred care, was statistically significantly higher in comparison with the mental health of nurses who exhibited incongruent (low/high or high/low) caring orientation and patient-centred care behaviours. For nurses' physical health, the findings revealed that providing patient-centred care was associated with worsened health, and possessing a caring orientation was associated with better health.
Conclusions.  The findings support the hypotheses that were derived from person–environment fit and emotional labour only with regard to mental health. Separate theory needs to be developed on how to maintain nurses' physical health.     

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.     

Mental health nurses' attitudes towards severe perinatal mental illness

Title.  Mental health nurses' attitudes towards severe perinatal mental illness.
Aim.  This paper reports on a study exploring the experiences and attitudes of generic mental health nurses towards care of women with severe mental illness during the perinatal period.
Background.  Severe mental disorder in the perinatal period is a global public health concern. However, there are concerns that mental health nurses other than dedicated perinatal mental health teams may lack knowledge, skills and experience in caring for such disorders, because of their low prevalence.
Methods.  Sixteen generic Registered Mental Nurses working in public adult mental health services participated in three focus groups during 2007.
Findings.  Participants did not perceive any difference between symptoms during perinatal and non-perinatal periods. There were mixed attitudes towards caring for women with severe mental illness in the perinatal period. Fear and anxiety was expressed by the nurses when caring or feeling responsible for the babies of clients. Lack of communication between professional groups and decreased clinical decision-making following the introduction of the Edinburgh Post Natal Depression Scale caused frustration. Confidence was displayed when working with known and trusted colleagues.
Conclusion.  Generic mental health nurses would benefit from more education on perinatal mental health and there may be a need for them to be supported by specialist perinatal mental health practitioners.     

Identifying abuse among women: use of clinical guidelines by nurses and midwives

Title.  Identifying abuse among women: use of clinical guidelines by nurses and midwives.
Aim.  This aim of this study to identify the incidence of violence against women seeking healthcare services and evaluate the use of clinical guidelines to identify interpersonal violence.
Methods.  A cross-sectional survey was carried out. Data were collected over a period of 7 months in 2005 and 2006. The samples consisted of 14 nurses, 10 midwives and 208 women in Iceland (101 women visiting the Emergency Department and 107 receiving prenatal care at the High Risk Prenatal Care Clinic).
Results.  Twenty women (19·6%) who visited the Emergency Department and 21 women (19·8%) who came to the High Risk Prenatal Care Clinic had been sexually abused at some point in their lives by close family members. Within the preceding 12 months, 18 women at the Emergency Department (19·1%) and eight at the High Risk Prenatal Care Clinic (7·5%) reported physical abuse, and 22 women (22·2%) at the Emergency Department and 12 (11·5%) at the High Risk Prenatal Care Clinic reported emotional abuse. A majority of the nurses and midwives indicated that the guidelines were efficient for assessing/screening for gender violence in emergency and high risk clinical settings.
Conclusion.  Screening for abuse of women at emergency and high risk clinics is crucial, not only to offer the women the immediate interventions they might need, but also to ensure the future provision of appropriate healthcare services.     

The parent–nurse relationship in the neonatal intensive care unit context – closeness and emotional involvement

Aim and background:  Family-centred care, which acknowledges parents as partners in care, is a desirable and essential part of neonatal nursing. There has been extensive research on parents' experiences of parenting in neonatal intensive care units (NICU), but there is little research on nurses' experiences of being in these enduring close relationships. The aim of this paper is to explore parents' and nurses' experiences of the close parent–nurse relationship when a premature child is hospitalized.
Method:  The design was exploratory with a hermeneutic approach. The methods used were participant observation and in-depth interviews with six mothers, six fathers and six nurses in a Norwegian 13-bed NICU. Eighteen individual interviews and 160 hours of observations were conducted over 27 weeks from 2003 to 2004. This study complies with the principles of the Declaration of Helsinki. The Regional Committee for Medical Research Ethics, the Ombudsman for Privacy in Research at the Norwegian Social Science Data Services and the hospital's research department approved the study protocol.
Results:  The NICU context is a technological environment where human interaction is a crucial issue. The character of the context and the ongoing interactions drive parents and nurses into close relationships. Closeness increases the emotional involvement and the boundary between the professional and the personal approach is threatened. The commitment of being close, combined with the emotional involvement, can be an emotional burden to both parents and nurses.
Conclusion:  Parent–nurse closeness in NICU is desirable; however, the emotional burden of this closeness seems to be seldom problematized. Awareness about the need to strike a balance between closeness and distance can positively influence parents' independence and nurses' ability to maintain professional relationships with their primary care parents.     

Slovenian midwives' and nurses' views on post-natal depression: an exploratory study

Background:  Post-natal depression affects approximately 10–15% of women. The literature suggests that midwives and nurses are key professionals in dealing with post-natal mood disorders. However, this would be a new role in Slovenia for which it is not clear whether midwives and nurses are prepared.
Aim:  This study explored Slovenian midwives' and nurses' knowledge of, and attitudes towards, post-natal mood disorders.
Methods:  Two focus groups were conducted, each with five participants, working in the maternity hospital and in the community centre in Postojna.
Findings:  Data were grouped into three main themes – knowledge of post-natal mental health disorders, role in the management of these issues, and perceived problems and possible solutions in the health care of post-natally depressed women. Participants lacked knowledge on post-natal mental health and did not consider its management to be their role. They saw the main obstacle to caring for these women as being a lack of continuity of carer.
Conclusion:  Slovenian midwives and nurses should be appropriately educated regarding this subject in order to become more capable of managing post-natal mental health. Continuous relationships with women should be encouraged.
Limitations:  Further investigation is required and a questionnaire survey involving a larger sample of midwives and community nurses is planned on the basis of the findings of this study.     

Screening for and treating intimate partner violence in the workplace.

The WHO has declared that violence is a leading worldwide public health problem with intimate partner violence one of the most common forms of violence against women (2002). Health care providers are frequently among the first to see victims of intimate partner violence and must strive to provide appropriate and effective care to abused women. Violence by intimate partners can be prevented. Occupational health nurses have a unique opportunity to intervene with abused women. Routine screening for intimate partner violence increases the likelihood of violence identification, leading to early intervention that may prevent trauma and injury. Occupational health nurses can foster a caring and confidential workplace where abused women feel safe to disclose the violence in their lives and trust that the nurse will provide treatment. A safe and healthy workplace, where abused women feel comfortable disclosing intimate partner violence and seeking treatment may also protect coworkers from the stress and violence that may potentially affect them. Occupational health nurses need to add screening for and treatment of intimate partner violence to their current health promotion and prevention activities to benefit all employees.     

Nurses' understanding of domestic violence

Domestic violence is considered to be an important health care issue world wide. In order to provide appropriate support and treatment to women who have been abused, it is essential that nurses understand and recognise domestic violence. This study aimed to explore nurses' understanding of domestic violence issues utilising a grounded theory approach. A total of 41 emergency nurses was interviewed in selected Australian and Japanese emergency departments. Analysis of data identified six groups of nurse perceivers of domestic violence: nave perceivers, inexperienced perceivers, compassionate perceivers, proactive perceivers, acting perceivers and reluctant perceivers. Findings indicate that the provision of ongoing education and instigation of policy and protocol enable nurses to respond in a structured manner when they encounter women who have been abused. As a result, nurses can contribute to the amelioration of violence in society and enhance the wellbeing of these women.     

Jordanian nurses' knowledge and practice of breast self-examination

Title.  Jordanian nurses' knowledge and practice of breast self-examination.
Aim.  This paper is a report of a study to evaluate the knowledge and practice of Jordanian nurses in relation to breast self-examination.
Background.  Studies have shown that women who have learned about breast self-examination have positive attitudes toward breast cancer and practise breast self-examination more frequently, and that nurses who teach their clients about methods of early detection and breast self-examination are more knowledgeable about breast cancer screening and breast self-examination techniques than those who do not. Therefore, it is important to understand nurses' knowledge about breast cancer and its early detection.
Methods.  A cross-sectional design was used, with a convenience sample of 347 Registered Nurses at three large cities in Jordan (response rate 95%). Data collection took place in 2005 using a self-administrated questionnaire with three parts and based on the American Cancer Society's guidelines: demographics, knowledge, and practice of breast self-examination.
Results.  Nurses reported high levels of knowledge of breast self-examination (M = 7·6, sd . 2·7). A high proportion of nurses reported doing breast self-examination in the past 12 months (85%), but only 17·7% reported doing so on a monthly basis. None of the demographic characteristics was found to be associated with the practice of breast self-examination.
Conclusion.  More health education about monthly breast self-examination and prevention strategies is needed for nurses and their women patients, especially for Arabic women.     

Emotional labour in mental health nursing: An integrative systematic review

Emotional labour is the effort consumed by suppressing one's own emotions to care for others effectively while also caring for oneself. Mental health nurses are required to engage in effective therapeutic interactions in emotionally‐intense situations. The aim of the present integrative systematic review was to investigate the emotional labour of mental health work and how this manifested, the impacts, and the ways to mitigate these impacts. In June 2016, using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses methodology, a systematic search of the bibliographic databases was undertaken to identify relevant literature. Screening, data extraction, and synthesis were performed by three reviewers. The inclusion criteria included any original research that investigated the emotional work of mental health nurses. We identified a total of 20 papers to be included in this review. Thematic synthesis of the findings revealed three emergent themes: emotional labour and caring, emotional exhaustion, and self‐protection (expressed as emotional intelligence). Emotional labour, emotional exhaustion, and emotional intelligence were considered to be intrinsically linked, where they were both the influencing factor for burnout and a contributor to attrition. The results highlighted that emotional labour could inspire the development and personal growth of emotional intelligence in mental health nurses. In light of these findings, recommendations for clinical practice were considered; they included supportive work environments, involving nurses in shared decision‐making, and the provision of ongoing professional development opportunities that facilitate the development of emotional intelligence and resilience.     

The SARS crisis: reflections of Hong Kong nurses

Background:  Severe acute respiratory syndrome (SARS) exerted a massive toll on Hong Kong's healthcare system in 2003.
Aim:  This research examines front-line nurses' reflections on the time of SARS in Hong Kong in order to articulate: (1) the nature and complexity of their experience, and (2) what lessons can be learned for future disease crises.
Methods:  Personal reflective essays written in 2004 by seven senior nurses studying a part-time Masters in Nursing degree at a Hong Kong university were analysed using a form of content analysis.
Findings:  The nurses' stories report immense personal costs on nurses, on their families and on the wider community. The analysis of the narratives was used to build a model, indicating how nurses' personal lives were 'sandwiched' between, on the one hand, their commitment to families and local community and, on the other hand, their professional commitment to the needs of a health system in crisis.
Conclusion:  In dealing with future health crises, it is imperative that a multilevel approach be taken.     

Nurses' attitudes and perceptions of pain assessment in neonatal intensive care

Scand J Caring Sci; 2010; 24; 49–55
Nurses' attitudes and perceptions of pain assessment in neonatal intensive care
Background:  Pain assessment of premature infants continue to be ineffective. The problem may be partly because of misconceptions or lack of knowledge in the assessment of pain in children.
Aims:  This paper reports a study to describe nurses' attitudes towards and perceptions of pain assessment in neonatal intensive care and the demographic factors related to these attitudes and perceptions of pain.
Methods:  The participants consisted of 257 Finnish nurses who were recruited from all five of the country's university hospitals caring for the premature infants receiving intensive care or monitoring. We collected data by using a Likert-type questionnaire in spring 2006. The response rate was 71% from the represented population.
Findings:  Almost all (97%) of the nurses agreed that pain assessment in premature infants is important. However, over half (60%) of the respondents agreed that they could assess the premature infants pain reliably without pain scores. The respondents' perceptions of the premature infants' ability to sense and express pain indicated rather good knowledge of the topic. Nevertheless, one-fourth of the participants was unaware that a premature infant could be more sensitive in sensing pain than a full term counterpart. Education, work experience and the working unit were the demographic factors that were significantly related to the respondents' attitudes and perceptions.
Conclusions:  On average nurses' attitudes were positive towards the pain assessment in neonatal intensive care. However, there were some gaps in the knowledge concerning the respondents' perceptions of the items, which is a challenge to nursing and nursing education.     

Mother, daughter, patient, nurse: women's emotion work in aged care

This paper examines emotion work within the predominantly female environment of aged-care nursing, identifying phenomena which must be accounted for in a theory of emotional labour. These phenomena include the blurring of public and private in women's experiences and maternal models of care. Initial findings demonstrate the high levels of stress experienced by staff, related to emotional labour and to conflicts around the erosion of care standards. Sixteen women, from rural Australia, participated in the first stage of the research. The oldest was in her sixties, the youngest in her thirties. Length of aged-care experience ranged from 2 to 33 years. Although most of the women expected to still be in aged care in 5 years' time, they were negative in their attitudes to personal ageing, suggesting an ambivalence in their feelings about working in aged care. Three women nurses are the particular focus of this paper. Their narratives illustrate the intersection of private and public caring in nurses' lives and the implications of this for emotional labour. Phenomena such as dual caring, conflicts in insider-outsider roles, and transference are revealed in their narratives. We argue that the welfare of the recipient of gerontic nursing is linked to the well-being of the nurse-carer but that a cultural change is needed so as to recognize and value emotion work. However, endorsing Staden, we agree that such a change is dependent on the politicization of 'caring'. There is also need for further and broader research concerning the nature of emotional labour and the ethics of care.     

The emotional labour of nursing -- Defining and managing emotions in nursing work

Emotions in health organisations tend to remain tacit and in need of clarification. Often, emotions are made invisible in nursing and reduced to part and parcel of 'women's work' in the domestic sphere. Smith (1992) applied the notion of emotional labour to the study of student nursing, concluding that further research was required. This means investigating what is often seen as a tacit and uncodified skill. A follow-up qualitative study was conducted over a period of twelve months to re-examine the role of the emotional labour of nursing. Data were collected primarily from 16 in-depth and semi-structured interviews with nurses. Key themes elicited at interviews touch upon diverse topics in the emotional labour of nursing. In particular, this article will address nurse definitions of emotional labour; the routine aspects of emotional labour in nursing; traditional and modern images of nursing; and gender and professional barriers that involve emotional labour in health work. This is important in improving nurse training and best practice; investigating clinical settings of nurses' emotional labour; looking at changing techniques of patient consultation; and beginning to explore the potential therapeutic value of emotional labour.     

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.     

Emotional labour underlying caring: an evolutionary concept analysis

Title. Emotional labour underlying caring: an evolutionary concept analysis Aim. This paper is a report of a concept analysis of emotional labour. Background. Caring is considered as the essence of nursing. Underpinning caring, the internal regulation of emotions or the emotional labour of nurses is invisible. The concept of emotional labour is relatively underdeveloped in nursing. Data sources. A literature search using keywords ‘emotional labour’, ‘emotional work’ and ‘emotions’ was performed in CINAHL, PsycINFO and REPERE from 1990 to January 2008. We analysed 72 papers whose main focus of inquiry was on emotional labour. Review methods. We followed Rodgers’ evolutionary method of concept analysis. Results. Emotional labour is a process whereby nurses adopt a ‘work persona’ to express their autonomous, surface or deep emotions during patient encounters. Antecedents to this adoption of a work persona are events occurring during patient–nurse encounters, and which consist of three elements: organization (i.e. social norms, social support), nurse (i.e. role identification, professional commitment, work experience and interpersonal skills) and job (i.e. autonomy, task routine, degree of emotional demand, interaction frequency and work complexity). The attributes of emotional labour have two dimensions: nurses’ autonomous response and their work persona strategies (i.e. surface or deep acts). The consequences of emotional labour include organizational (i.e. productivity, ‘cheerful environment’) and nurse aspects (i.e. negative or positive). Conclusion. The concept of emotional labour should be introduced into preregistration programmes. Nurses also need to have time and a supportive environment to reflect, understand and discuss their emotional labour in caring for ‘difficult’ patients to deflate the dominant discourse about ‘problem’ patients.     

Personal and social determinants of rural nurses' willingness to care for persons with AIDS

The purpose of this study was to investigate the individual and social determinants of rural nurses' willingness to care for people with AIDS (PWAs). Willingness to care was viewed as a function of nurses' personal attitudes about AIDS care and PWAs; the influence of normative (significant others), comparative (the nursing profession), and generalized (the rural community) reference group norms on these attitudes; and how much importance respondents placed on membership in these reference groups. Responses to a mailed questionnaire from 615 rural nurses were analyzed. Individual determinants were nurses' feelings of preparedness and favorable attitudes about their personal safety when administering care. Social determinants were the degree of upset of respondents' significant others about their caring for AIDS patients and favorable attitudes of the respondents about professional and social concerns related to AIDS.