The relationships among workplace stressors, coping methods, demographic characteristics, and health in Australian nurses.

Nursing is known to be stressful. Stress detrimentally can influence job satisfaction, psychological well-being, and physical health. There is a need for increased understanding of the stress that nurses experience and how best to manage it. Three hundred twenty Australian acute care public hospital nurses participated in a study by completing four questionnaires that examined (a) how various workplace stressors relate to ways of coping, demographic characteristics, and physical and mental health and (b) which workplace stressors, coping mechanisms, and demographic characteristics were the best predictors of physical and mental health. Significant correlations were found between stressors and physical and mental health. Multiple regression showed age to be the only significant predictor of physical health. The best coping predictors of mental health were escape-avoidance, distancing, and self-control. Other significant predictors of mental health were support in the workplace, the number of years worked in the unit, and workload. Mental health scores were higher for nurses working more years in the unit and for those who used distancing as a way of coping. Mental health scores were lower for nurses who used escape-avoidance, lacked workplace support, had high workload, and used self-control coping. The findings have implications for organizational management, particularly in terms of recommendations for stress management, social support, and workload reduction.     

Nurses' moral agency in negotiating parental participation in care

The purpose of this study was to investigate the issues for nurses in facilitating parental participation in the care of the hospitalized child. A qualitative study informed by grounded theory was undertaken. Nine nurses were recruited from an acute, high-dependency, 23-bed paediatric cardiac/renal unit in Melbourne, Australia. Data collection involved individual semistructured interviews, hospital policies related to family-centred care and a focus group interview. Constant comparative analysis was undertaken to develop an understanding of the data collected in the context of the nurses' experiences and the environment in which they work. Moral agency was identified as the central phenomenon of the study. Causal conditions related to this included the child's best interests, disputes about care and nurses' expectations. These causal conditions were seen to potentially lead to moral distress for the nurses. The coping mechanisms and strategies that affected moral agency have been identified.     

A silent conspiracy: coping with dying cancer patients on an acute surgical ward

The problems and strategies of coping with terminal cancer patients on an acute surgical ward form the focus of this paper. The effects of ward structure, organization, and communication are examined and particular attention is given to the problems of junior nurses who are primarily responsible for the care of these dying patients.     

Nursing Futures: A Process to Promote Change in the Delivery of Care

In this era of healthcare reform, performing care using resources in an efficient manner is essential. “Nursing Futures,” a process used by a 24-bed general rehabilitation unit in a 530-bed facility, helped the unit to identify key components of care, determine opportunities for improvement, and create a new system for the delivery of care that maximized resources and improved customer satisfaction. A Nursing Futures Committee, composed of nursing staff from all levels and from all shifts, used a continuous quality improvement process to focus on the problems in care delivery and developed ways to solve these problems using the time and talents of registered nurses in the most effective way. The committee also identified expectations of staff by various customer groups; analyzed the delivery system and defined its shortcomings; developed the ideal patient care unit within financial and institutional constraints; and executed the plan, considering cost and evaluation of patient and staff satisfaction before and after the system was implemented. The new system provided consistency in patient care assignments by reorganizing the unit into two nursing teams and by creating a new nursing position, the patient care manager.     

Stress and coping of Canadian rural nurses caring for trauma patients who are transferred out

INTRODUCTION: The present study investigated acute stress and coping among rural nurses who work with transfer trauma patients. METHODS: Nineteen rural nurses ages 34 to 53 years participated in 4 focus groups. Each group was asked to identify a specific stressful situation involving transfer of trauma/accident patients and to share their experience of the situation. RESULTS: Stressful situations encountered included system problems (EG, lack of resources; time pressures), lack of communication, visual impact, and professional discord. Coping responses included efforts to alter the problem (problem-focused coping) and efforts to control emotions (emotion-focused coping). Social support coping was identified as the most helpful way of coping with trauma. DISCUSSION: Overall the findings suggest that rural nurses face unique stressors not identified in the nursing literature, which most often reflects urban settings.     

Death of adolescents: parental grief and coping strategies

The death of an adolescent is a particularly complex issue. The process of grieving and coping can be complicated by the tension that may have existed in the parent/child relationship because of the conflict in terms of personal ideology at this stage in the adolescent's development. As a result, parents of adolescent children who die have the potential to experience abnormal grief reactions. Parental coping strategies vary according to the mode of death and outlook adopted by the parents, although some studies suggest parents bereaved of adolescent children do not exhibit marked difference in grieving or coping in comparison to other groups of parents. Healthcare professionals must recognize the specific and special needs of this parent group, and provide appropriate support to minimize the risk of harmful sequelae that may occur as a result of inappropriate and insensitive care.     

An exploration of the handover process of critically ill patients between nursing staff from the emergency department and the intensive care unit

The transfer of information between nurses from emergency departments (EDs) and critical care units is essential to achieve a continuity of effective, individualized and safe patient care. There has been much written in the nursing literature pertaining to the function and process of patient handover in general nursing practice; however, no studies were found pertaining to this handover process between nurses in the ED environment and those in the critical care environment. The aim was to explore the process of patient handover between ED and intensive care unit (ICU) nurses when transferring a patient from ED to the ICU. This study used a multi-method design that combined documentation review, semistructured individual interviews and focus group interviews. A multi-method approach combining individual interviews, focus group interviews and documentation review was used in this study. The respondents were selected from the ED and ICU of two acute hospitals within Northern Ireland. A total of 12 respondents were selected for individual interviews, three nurses from ED and ICU, respectively, from each acute hospital. Two focus groups interviews were carried out, each consisting of four ED and four ICU nurses, respectively. Qualitative analysis of the data revealed that there was no structured and consistent approach to how handovers actually occurred. Nurses from both ED and ICU lacked clarity as to when the actual handover process began. Nurses from both settings recognized the importance of the information given and received during handover and deemed it to have an important role in influencing quality and continuity of care. Nurses from both departments would benefit from a structured framework or aide memoir to guide the handover process. Collaborative work between the nursing teams in both departments would further enhance understanding of each others' roles and expectations.     

Learning to nurse: the family as the unit of care*

How can we prepare nurses who will have as their focus of practice, the health of the family unit? This paper describes the learning outcomes which were generated from a short term experience in a curriculum where the major thrust is learning to nurse families in a health promoting way. Students were provided with experience with families who were undergoing an important family event, e.g., coping with the short term hospitalization of a child. An exploration and analysis of these experiences revealed for students the content of nursing families who are in the process of dealing with this particular event of family living. This content related to the acquisition of nursing skills of an interpersonal, technical and decision-making nature as well as the development of knowledge which provides the basis for nursing the family as the unit of care.     

Inclusiveness: a mental health strategy for preventing future mental health problems among adolescents orphaned by AIDS

The purpose of this paper is to raise an argument that inclusiveness will lessen the pain of losing a parent among adolescents orphaned by AIDS and as a result, prevent future mental health problems that may occur because of inappropriate grieving and maladaptive coping strategies. Participation of adolescents orphaned by AIDS in decisions pertaining to their parents' illnesses and funeral arrangements, for example, may shorten the grieving process and allow for closure. The paper draws data from focus group discussions that were held with 15 adolescents orphaned by AIDS in urban South Africa. The focus group discussions that were structured around four themes: grieving patterns; coping strategies; experience with loss; and expectations. The results of the study demonstrate inclusiveness as an overarching factor in the healing process. The concept is thus a strong recommendation for mental health practice and further study.     

Interactions between nurses and men admitted with chest pain.

This paper reports on an analysis of the interactions that occurred between nurses and men admitted with acute chest pain. BACKGROUND AND AIM: Men admitted to hospital after experiencing chest pain were the focus of a study into men's transition from being well men to ill men. During the study it became apparent that nurses adopted strategies to manage the men through this early acute phase of their illness. METHODS: Data were collected through fieldwork using participant observation on an acute medical admissions ward and an intensive care unit with dedicated coronary care beds. Twenty-five men were included in the study with 10 followed through to discharge. An interpretive grounded theory was used to direct the data collection and analysis. RESULTS: The men and nurses were seen to be part of a complex interplay, but three main types of interaction were identified: supportive, controlling and educative/informative. Discussions with the men suggests a key factor in the men's experiences was the interactions they had with the nursing and medical staff. CONCLUSIONS: Attention should be given to nurses' awareness of men's coping strategies when faced with sudden health change and how their actions impact on their recovery.     

A pilot study on nurses' attitudes toward perinatal bereavement support: a cluster analysis

AIM: Nurses' attitudes towards perinatal bereavement care are explored by identifying profiles of nurses working in a Hong Kong Obstetrics and Gynaecology (OAG) unit. Relationships between nurses' attitudes towards bereavement support, need for bereavement training and hospital policy are explored. RESEARCH METHOD: 110 nurses recruited from the OAG unit of a large Hong Kong public hospital completed a structured questionnaire. OUTCOME MEASURES: Attitudes towards perinatal bereavement support; required support and training needs for nurses on bereavement care. RESULTS: Two-step cluster analysis yielded two clusters. Cluster A consisted of 55.5% (n = 49) and cluster B consisted of 44.5% (n = 61) of nurses. Cluster A nurses were younger, had less OAG experience, more junior ranking and less education than cluster B nurses. Cluster B nurses had additional midwifery and bereavement care training, personal grieving experiences and experience handling grieving clients. The majority held positive bereavement care attitudes. Significant differences towards perinatal bereavement support were found. Only 25.5% (n = 28) had bereavement related training. Attitudes towards bereavement care were positively correlated with training needs (rs = 0.59) and hospital policy support (rs = 0.60). CONCLUSION: Hong Kong nurses emphasized need for increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team members' support. Findings may be used to improve support of nurses, to ensure sensitive bereavement care in perinatal settings, and to enhance nursing curricula.     

Music during after‐death care: a focus group study

Background: The intensive care unit (ICU) is not only a place to recover from injuries incurred during accidents and from serious illness. For many patients, it is also a place where they might die. Nursing care does not stop when a patient dies; rather, it continues with the care of the deceased and with family support. The aims of this study were (1) to explore the experiences and attitudes of nurses towards the use of ambient music in the ICU during after‐death care and (2) to describe the feedback nurses received from relatives when music was used during the viewing. Method: A qualitative design employing focus group interviews was used. Three focus group interviews with 15 nurses were conducted. All the interviews were audiotaped, transcribed verbatim and analysed using qualitative content analysis. Findings: Six main categories of attitudes emerged from the analysis: (1) different attitudes among nurses towards the use of music; (2) music affects the atmosphere; (3) music affects emotions; (4) use of music was situational; (5) special choice of music and (6) positive feedback from the bereaved. Conclusion: This study demonstrates that music might be helpful for nurses during after‐death care as well as for the care of the relatives. Relevance to clinical practice: Including ambient music in an after‐death care programme can help nurses show respect for the deceased as the body is being prepared. Music played during the viewing may be a way of helping relatives in their time of grieving. It may ease the situation by making that event special and memorable. However, standardizing this intervention does not seem appropriate. Rather, the individual nurse and the family must decide whether music is to be used in a particular situation.     

Patient participation in nursing care: towards a concept clarification from a nurse perspective

Aim. The aim of this study was to investigate the meanings of the concept of patient participation in nursing care from a nurse perspective. Background. Participation is essential and increases patients’ motivation and satisfaction with received care. Studies of patient participation in nursing care are not congruent regarding definition, elements and processes. This lack of clarity is amplified by several terms used; patient/client/consumer involvement or collaboration, partnership and influence. Despite the fact that several nursing theories have emphasized the importance of patient participation, an empirically grounded theory has yet to be published. Methods. Seven focus group interviews were held with nurses providing inpatient physical care at five hospitals in West Sweden. The focus groups consisted of Registered Swedish nurses (n = 31) who described the meaning and implementation of patient participation in nursing care. A Grounded Theory approach has been applied to tape‐recorded data. Constant comparative analysis was used and saturation was achieved. Results. Mutuality in negotiation emerged as the core category for explaining nurses’ perspectives on patient participation in nursing care. It is characterized by four interrelated sub‐core categories: interpersonal procedure, therapeutic approach, focus on resources and opportunities for influence. Mutuality in negotiation constitutes the dynamic nurse–patient interaction process. Conclusions. The study clarifies that patient participation can be explained as an interactional process identified as mutuality in negotiation based on four components. Relevance to clinical practice. The results are important and can be used in nursing practice and education. Application in a clinical context means nursing care organized to include all the components presented. The results can also be used in quality assurance to improve and evaluate patient participation.