Families' Importance in Nursing Care: Nurses' Attitudes--an instrument development

This article describes the development and testing of a research instrument, Families' Importance in Nursing Care-Nurses' Attitudes (FINC-NA), designed to measure nurses' attitudes about the importance of involving families in nursing care. The instrument was inductively developed from a literature review and tested with a sample of Swedish nurses. An item-total correlation and a first principal component analysis were used to validate the final instrument, including a second principal component analysis to analyze dimensionality, and Cronbach's alpha was used to estimate internal consistency. The instrument consists of 26 items and reveals four factors: families as a resource in nursing care, family as a conversational partner, family as a burden, and family as its own resource. Cronbach's alpha was 0.88 for the total instrument and 0.69 to 0.80 for the subscales. The instrument requires further testing with other nurse populations.     

Nursing staff attitudes and behaviours regarding family presence in the hospital setting

Title. Nursing staff attitudes and behaviours regarding family presence in the hospital setting. Aim. This paper is a report of a study conducted to assess the attitudes and values of nursing staff towards family presence during routine nursing care. Background. Nursing staff attitudes are an important factor in the adoption of family‐centred care for children, and for all ages in the emergency room, special care units, and anaesthesia induction and recovery. Little is documented about nurse attitudes and behaviours related to family presence during day‐to‐day routine nursing care. Method. In 2006, primary data were collected with a convenience sample of 89 nursing staff using an 18‐item questionnaire developed by the authors and based on several family‐centred care instruments in the literature. Items assessed attitude and nurse behaviours related to family presence during routine nursing care. Findings. Nurses’ attitudes and behaviours towards family presence during routine nursing care were generally favourable. There was low agreement about family members being allowed to visit whenever the patient wished. Nursing staff attitudes were consistent with their self‐reported behaviours supporting family presence. Conclusion. Nursing staff who believe family presence is important are more likely to include families in daily care. The organization plays a key role in encouraging family‐centred care by providing appropriate education and support to nursing staff.     

Enhancing the quality of supportive supervisory behavior in long-term care facilities

The practices of managers and registered nurses (RNs) in long-term care facilities are frequently ineffective in assisting the licensed practical nurses (LPNs) and healthcare aides (HCAs) whom they supervise. Little research exists that examines the area of supportive relationships between nursing staff and supervisors in these settings. The purpose of this study was to gather data that could improve management practices in long-term care residential facilities and enhance the quality of the supervisory relationships between supervisors (nurse managers and RNs) and care providers (HCAs and LPNs) in these settings. The study also identified factors that influence the supervisors' ability to establish supportive relationships with care providers. The challenges and barriers to nurse managers and leaders related to enacting supportive behaviors are discussed as well as their implications for long-term care settings.     

Nurses attitudes towards the importance of families in psychiatric care following an educational and training intervention program

This study measures the attitudes of the psychiatric nurses, after having received an education and training intervention program (ETI-PROGRAM) in family systems nursing, towards the importance of the families in their care. Nurses' knowledge of the impact that family nursing intervention can have on family members may increase positive attitudes towards families. However, little is known about the impact that education and training intervention can have on nurses' attitudes, towards families in clinical practice. Quasi-experimental design was used to assess the change in nurses' attitudes towards families in psychiatric care after the intervention, which included a one-day seminar on the Calgary family nursing conceptual frameworks and skills training with clinical vignettes of families from psychiatry. The Families Importance in Nursing Care - Nurses' Attitude questionnaire was used to evaluate nurses' attitudes. A total of 81 nurses (65%) working in psychiatric care responded to the questionnaire. Nurses with more than 15 years of work experience were significantly more supportive of families in their care compared with less experienced nurses. Out of the 81 nurses, 52 (64%) answered the questionnaire again 14 months later. Furthermore, psychiatric nurses saw families significantly less burdensome after having participated in the ETI-PROGRAM.     

Supply and demand for cardiac nurses in Ontario: perceptions of CNOs

This article presents the results of a nursing survey of cardiac care hospitals undertaken by a Cardiac Care Network of Ontario Consensus Panel on Cardiovascular Human Resources. The focus of the Panel was to identify areas of current or pending shortages in human resources and make recommendations to the Ministry of Health and Long-Term Care about human resource management in adult cardiac care in Ontario. The article presents the number and mix of full-time, part-time and casual nursing staff, the age distribution of RNs, and the number of vacant Registered Nurse (RN) positions for a sample of cardiac care hospitals in Ontario. Next a sample of Chief Nursing Officer opinions about factors contributing to current difficulties in recruiting RNs and the outlook for future shortages are presented. Implications for nurse managers are offered, including development of new recruitment and retention strategies, identification of further efficiencies in care provision, and a need for nurse manager involvement in debates about the future of how health care is provided in Canada.     

Level of nurse supportive supervision and its influencing factors in long-term care facilities

Quality of care provided by personal support workers (PSWs) in long-term care facilities (LTCFs) is associated with the supportive supervisory performance of registered nurses (RNs). To determine the level of supportive supervision of RNs and its influencing factors in LTCFs in East China, a cross-sectional survey was conducted in 12 LTCFs using self-designed sociodemographic questionnaires and the Chinese version of the Supportive Supervisory Scale. A total of 643 PSWs supervised by 260 RNs were surveyed. The average supportive supervision score was 59.60 ± 7.53, representing a moderate level of supervisory support. Supportive supervision was found to be positively correlated with the PSW's years of working, the RN's education, position, number of years in nursing, having access to managerial training as well as the RN/PSW ratio in the unit (p < 0.05). These factors can be modified to potentially influence the supportive capacity of nurse supervisors in LTCFs.     

Neutral to positive views on the consequences of nurse prescribing: Results of a national survey among registered nurses,nurse specialists and physicians

Background

Over the last two decades, the number of countries where nurses are legally permitted to prescribe medication has grown considerably. A lack of peer support and/or objections by physicians can act as factors hampering nurse prescribing. Earlier research suggests that physicians are generally less supportive and more concerned about nurse prescribing than nurses are. However, direct comparisons between doctors’ and nurses’ views are scarce and are often based on small sample sizes.

Objectives

To gain insight into the views of Dutch registered nurses (RNs), nurse specialists (with a master's in Advanced Nursing Practice) and physicians on the consequences of nurse prescribing.

Design

Survey study.

Participants

Survey questionnaires were sent to national samples of RNs, nurse specialists and physicians.

Methods

The questionnaire addressed, among others, respondents’ general views on the consequences of nurse prescribing for the quality of care, the nursing and medical professions, and the relationship between the medical and nursing professions.

Results

The net response rate was 66.0% for RNs (n = 617), 28.3% for nurse specialists (n = 375) and 33.7% for physicians (n = 265). It was found that all groups agreed that nurse prescribing benefits nurses’ daily practice and the nursing profession. There were few concerns about negative consequences for physicians’ practice and the medical profession. Nurse specialists gave significantly (P < 0.05) more positive scores on most items than RNs and physicians. We found relatively little difference in views between RNs and physicians. It was only on issues surrounding the quality of care and patient safety that doctors showed more concerns, albeit mild, than RNs and nurse specialists.

Conclusions

RNs, nurse specialists and physicians generally hold neutral to moderately positive views on nurse prescribing. This is beneficial for the implementation and potential success of nurse prescribing in practice, as a lack of peer support and/or objections from physicians can be a hampering factor. However, concerns about the consequences of nurse prescribing for the quality of care and patient safety remain a point for attention, especially among physicians.     

Development of the Family Nurse Caring Belief Scale (FNCBS)

Measurement of family nursing practice phenomena needs particular attention. This study develops a new instrument, Family Nursing Caring Belief Scale (FNCBS), that measures nurse attitudes regarding provision of family-sensitive care to families in crisis and establishes initial psychometric properties. Classical test theory was used to construct a discriminative, summative instrument for measuring nurse attitudes. Internal consistency reliability in a randomly selected sample (N = 163) of pediatric intensive care unit and neonatal intensive care unit nurses was estimated at .81 (Cronbach's alpha) and .78 (Guttman split half). A four-factor structure was revealed: ethical caring practices, systems orientation to family, child advocacy, and normalizing milieu. The FNCBS demonstrated concurrent (r = .57) and criterion-related validities. The FNCBS demonstrated sound psychometric properties with a child-rearing population of families and has the potential for future use in family nursing research, education, and practice. It requires further assessment before testing with an adult population.     

'Relatives are a resource,but...': registered nurses' views and experiences of relatives of residents in nursing homes

Registered Nurses (RNs) working in nursing homes in Sweden have obligations towards the residents' relatives, besides the care of residents. Relatives' involvement and satisfaction with the care partly depend on their contacts and communication with the staff. This study aimed to explore and describe RNs' views and experiences of relatives of residents who live in nursing homes. Open interviews were conducted with 19 RNs at three nursing homes. The verbatim-transcribed interviews were subjected to qualitative content analysis. Relatives were seen as a resource (with some restrictions) and nice, although demanding. The RNs saw relatives as part of their work--a part that could be time-consuming and had low priority. Interviewees noticed a difference between young and old relatives, and between female and male relatives. A large proportion of accounts could be related to issues about communication and interpersonal relationships with relatives. Building a trusting relationship with relatives may result in them being involved in residents' care and thus giving the nurses time rather than consuming time.     

Oncology nursing education: nursing students' commitment of "presence" with the dying patient and the family

During an elective oncology nursing course, students expressed uncertainties about activities that would offer patient and family support during end-of-life care. Following a chaplain's lecture, students in a class reaction paper identified appropriate nurse responses and actions that would offer supportive care to the dying patient and the family. Six processes were extracted from student comments. A core category was identified as the importance of "nurse presence" at the bedside of the dying patient.     

Teaching in crisis. Patient and family education in critical care

Although the critical care setting is not always a positive teaching environment, it is possible to achieve the goal of optimal patient and family education. The critical care nurse must understand the unique learning needs of patients and families who are experiencing a life crisis a recognize that there are substantial obstacles to overcome to educate in this setting. In addition, it takes experience and resources to develop the teaching skills of the bedside nurse, so that those teachable moments are easily recognized and suitably used to give patients and family members valuable information in small doses. The advanced practice nurse is an essential nursing resource who can spearhead the development of teaching skills for all members of the health care team. In addition, the advanced practice nurse is a clinical expert who can assess the educational needs of patients and their families and provide more detailed and individualized health information from a different perspective. Achieving good patient and family education outcomes is possible when patient care continuity is a priority and the advanced practice nurse is an active part of the nursing team. Exploring the use of new technologies and resources to meet patient and family education needs is absolutely necessary. As hospitals continue to evolve and react to the financial demands placed on them, nursing leadership and critical care nurses will need to articulate clearly all of the essential components of patient care, including patient and family education. In keeping with the rich nursing tradition of patient and family education, critical care nurses and advanced practice nurses have the opportunity to demonstrate their unique teaching skills and continue to promote health education as a priority of patient care.     

Nursing care in labour and patient satisfaction: a descriptive study

This study examined the subjective needs of labouring patients. A convenience sample of 80 postpartum patients was interviewed. They described the nursing care they had received, indicated the most helpful nursing measure received, and rated their satisfaction with their nursing care. These answers were categorized into types of nursing care. These were supportive care nursing, physical care nursing, medications and combinations of these three. X2 calculations done between these categories and satisfaction scores indicated a significant relationship between the type of care a patient received and her satisfaction scores. Patients found combined care very satisfying, but supportive care was the decisive factor in the way patients viewed their nursing care. The most frequently mentioned element in supportive care was the ability of the nurse to be a sustaining presence. The nurse's ability to assess and to meet the patient's need or non-need for her presence was major factor in patient satisfaction with nursing care in this sample. The relationship between congruency (agreement between time wanted and time spent by the nurse at the bedside) and satisfaction scores was highly significant. Thus the ability to recognize and respond to the patient's need or non-need for her presence was a crucial factor in patient satisfaction and in the way in which a nurse allocated her time. The relationships between numbers of nurses caring for a patient, parity, length of labour, presence of visitors, worries about the baby and patient satisfaction scores were examined. All were non-significant. However numbers of nurses caring for a patient was defined as a contributing factor to the delivery of supportive care nursing. More nurses contributed to more supportive care nursing being given, but was not the major factor in the delivery of supportive care nursing. Finally it was shown that the administration of syntocinon to patients in this sample decreased patient satisfaction with nursing care. Implications and possible reasons for these results are discussed.     

Influence of registered nurses' attitudes toward bariatric patients on educational programming effectiveness

BACKGROUND AND OBJECTIVE: This study describes registered nurses' (RNs') attitudes toward obese adult patients using the Attitudes Toward Obese Adult Patients Instrument. METHODS: Full-time RNs (N = 119) employed in a medical center, acute rehabilitation institution, and skilled nursing facility participated in the study. RESULTS: Findings revealed that RNs have positive attitudes toward obese adults. RNs were concerned about personal and patient safety. Respondents recognized the complex care needs of bariatric patients and the increased workload associated with meeting these demands. There were differences in attitudes between medical center RNs and acute rehabilitation RNs, possibly related to differences in workload and length of stay. CONCLUSIONS: The effectiveness of bariatric educational programming may be improved if RN attitudes and concerns are measured and addressed.     

Critical care RN student elective: a recruitment approach

Recruiting experienced RNs into critical care is a valuable goal. In this article, the authors describe a senior year critical care nursing elective for registered nurse students in a BSN completion program entirely developed and presented by nursing service personnel. This program increases the exposure of RNs to critical care as a specialty which they might want to continue after graduation.     

The Rehabilitation Nurse in the Home Care Setting: Care of the Client with HIV or AIDS

People with HIV or AIDS who are experiencing pain, fatigue, sexual dysfunction, bowel and bladder dysfunction, and self-care deficits are being cared for by rehabilitation nurses in the home setting. The home care rehabilitation nurse provides instruction and care to clients, their families, and caregivers regarding physical manifestations of the disease and issues such as the importance of involving the client in household activities and activities of daily living. In addition to working with an interdisciplinary team to meet clients' needs, home care rehabilitation nurses work and consult with the generalist nursing staff to offer recommendations about rehabilitation nursing care for clients with HIV or AIDS.     

Enrolled nurses and the professionalisation of nursing: a comparison of nurse education and skill-mix in Australia and the UK.

In the UK prior to 1989 two levels of nurse were trained: first level, or 'Registered Nurses' (RNs), and second Level, or 'Enrolled Nurses' (ENs). In 1989 changes to nurse education driven by 'Project 2000' marked the end of EN training: nurse education moved into the higher education sector and a single type of RN education replaced the original split-level training. Yet in Australia, where RN training has followed a similar path into higher education, the split level training of ENs and RNs has been maintained. The reasons for this difference in approach to ENs are investigated and discussed. The paper goes on to explore the implications and possible outcomes of the two different approaches in terms of the professionalisation of nursing and skill-mix in the health care workforce. Now that some UK nursing bodies are pressing for a degree-led profession, it is suggested that the Australian model may have an advantage, as concerns are being raised that English nurses may 'price themselves out of the market', with the nursing role being encroached upon by non-nurse Health Care Assistants.     

Clinical group supervision in an intensive care unit: a space for relief,and for sharing emotions and experiences of care

Much has been written about models, aims and the concept of clinical group supervisional, although few studies are empirical or focus on intensive care. The aim of the study was to illuminate the process and describe, using qualitative content analysis, the content of conversations carried out during the course of clinical group supervision sessions among Registered Nurses (RN) and enrolled nurses (EN) working in an intensive care unit (ICU). During the supervision sessions, ENs talked about their life-world from a caring perspective, while RNs focused on their professional development. Both ENs and RNs regarded the supervision sessions as a space for relief and for sharing emotions and caring experiences, which helped to manage complex nursing care. The findings are viewed in the light of Roach's theoretical framework describing the attributes of professional care as five Cs. Clinical group supervision is interpreted as supportive in developing interpersonal skills and a sensitive nursing practice.