Registered nurse unions and patient outcomes

Although research shows substantial relationships between several organizational characteristics in hospitals and patient outcomes, the relationship between nurse unions and patient outcomes has not been explored. Because of the workplace chaos of the last half of the 1990s, some nurses are rethinking their relationships with unions; some have the perception that union activity has increased. It is not always clear whether changes in healthcare are associated with patient outcomes, but it is clear that hospitals/health systems with unions often engage in spirited rhetoric about what is best for patients with little objective evidence to support either view. This study examines the relationship between the presence of a bargaining unit for registered nurses and the acute myocardial infarction mortality rate for acute care hospitals in California. The authors also discuss how registered nurse wage, hospital bed size, volume of patients, and other organizational factors may influence and confound this relationship.     

Low back pain characteristics from undergraduate student to working nurse in Australia: a cross-sectional survey

Background

Nurses are known to be a high risk group for occupational low back pain (LBP). The periods of greatest risk for developing low back pain in this population are not well defined. Recent literature suggests current preventative strategies are not consistently effective in improving low back injury statistics among health care populations.

Objectives

To identify the relative contributions of age and occupational exposure on the prevalence, duration and severity of low back pain episodes among undergraduate nursing students and recently graduated nurses.

Design

Cross-sectional survey.

Settings

Two university undergraduate nursing schools and one public teaching hospital graduate nurse training program in Western Australia.

Participants

897 undergraduate nursing students (years 1, 2 and 3) and 111 graduate nurses recruited by personal invitation during lectures.

Methods

Using a modified version of the Nordic Low Back Questionnaire, information regarding low back pain episode prevalence, impact, duration, frequency and causes was obtained.

Results

Mean age was consistent across all groups (26.7 ± 9.0 years) and had no significant effect on lifetime low back pain prevalence (p = 0.30). Very high lifetime (79%), 12 month (71%) and 7 day (31%) low back pain prevalence rates were consistent across all 3 year groups of undergraduate nursing students, but were significantly higher after 12 months of full-time employment [lifetime (95.5%), 12 month (90%) and 7 day (39%)]. Around 60% of all respondents with low back pain utilised at least one of (a) treatment, (b) medication, or (c) a reduction in activity. Nursing students and graduate nurses attributed the majority of their low back pain to bending or lifting despite recent efforts to reduce manual workplace demands (lifting) on nurses. Strategies for managing low back pain differed between nursing students and graduate nurses.

Conclusions

These results may suggest a rise in occupational exposure from student to working nurse is the primary cause of the increase in low back pain. Increased exposure may be to physical as well as psychological stressors. Given that prevalence rates are very high prior to commencing work, nursing student populations should be a target group for low back pain preventative strategies.     

Registered nurses' judgments of the classification and risk level of patient care errors

As frontline clinicians, nurses play a critical role in mitigating patient harm, recovery from health care errors, and overall improvement of patient safety. This cross-sectional study asked nurse respondents to make judgments about the classification and severity of errors in 4 clinical vignettes. Our results showed that agreement about error classification and associated risk among registered nurses is less than optimal. Further research is needed to advance our understanding of how nurses working in complex patient care situations can improve their ability to recognize subtle cues to facilitate early recognition of potential errors.     

Influences of patient behavior on clinical nurses' pain assessment: implications for continuing education

Pain management is an important consideration in the promotion of patients' comfort. However, research continues to indicate patients' pain management is poor. The nursing literature cites nurses' lack of knowledge as a significant determinant of poor pain management practices. The impetus for this study arose from poor attendance by nurses at inservice sessions discussing pain assessment and management. Knowledge of existing nursing practice and accompanying beliefs and attitudes in relation to pain management is paramount in the development of relevant continuing education for registered nurses. The aim of this investigation was to study nurses' intention to treat pain in different patients. A 10-page questionnaire with eight different patient scenarios was distributed to 886 nurses across all clinical divisions of an acute tertiary facility. Results indicate knowledge deficits regarding optimum pain relief for patients. This article highlights the need for innovative teaching strategies and approaches in the clinical context to heighten nurses' awareness of their lack of knowledge of pain assessment and management.     

A comparison of nurse teachers' and student nurses' attitudes toward hospitalised older adults

Studies have demonstrated that gerontological content can have a positive effect on student nurses' attitudes toward older adults. However, few studies have attempted to investigate nurse teachers' attitudes toward older people. Yet authors acknowledge the importance of both clinical nurses and teachers in the socialisation process. The aim of this study is to compare the attitudes of student nurses with those of nurse teachers toward working with hospitalised older adults. A questionnaire was developed, piloted and refined until the final outcome was a 20 item questionnaire. The questionnaire was distributed to nurse teachers (n=59); first year student nurses who had completed their first term of theory (n=82); student nurses who had completed a theory and a clinical placement (n=80). Statistical analysis of the data included ANOVA with a post hoc comparison. Results indicated that nurse teachers were most positive for a number of items on the questionnaire. However, they were least positive about their role in promoting an interest in older people and keeping up to date about advances in the field of older people. It is the responsibility of both teachers and clinical staff to dispel stereotypes that student nurses bring in to nursing.     

Benefits of nurse prescribing for patients in pain: nurses' views

Title. Benefits of nurse prescribing for patients in pain: nurses’ views. Aim This paper is a report of a study to explore nurses’ views on the benefits of adopting the role of prescribing for patients with acute and chronic pain. Background. It was envisioned that the advent of nurse prescribing would be beneficial to the efficiency and effectiveness of the United Kingdom National Health Service. Research to date does indeed indicate that nurse prescribing can be beneficial to patients, nurses and the health service in general. Despite the expansion of nurse prescribing, there is little evidence of its impact according to nurses working in specialist areas, such as with patients in acute and chronic pain. Method. Interviews were conducted during 2006 and 2007 with 26 nurses qualified to prescribe medicines for patients in acute and chronic pain. This was a qualitative study and a thematic analysis was conducted. Findings. Nurses reported a number of benefits, including faster access to treatment, improved quality of care, more appropriate prescribing of medication, improved safety, improved relations and communication with patients, greater efficiency and cost effectiveness. Nurses benefited from increased job satisfaction, credibility with patients and healthcare professionals and also gained knowledge through prescribing. Conclusion. There is potential for the benefits of nurse prescribing to be expanded beyond the United Kingdom in settings where nurses hold similar roles in the treatment of pain, although further research using a wider range of research methods is recommended to substantiate these findings.     

Factors influencing nurses' pain assessment and interventions in children

Research is lacking on factors influencing nurses' decision-making directed at the diagnosis of pain in children and its related interventions This paper reports on two studies, namely a qualitative study and its replication, in which we explored factors influencing nurses' pain assessments and interventions in children Those factors found to influence nurses' decisions were medical diagnosis, child's expressions, age, and parents, and the nurses' knowledge, experience, attitude and workload Some of these factors seem to have more influence than others For example, the presence of a medical diagnosis seems to legitimate being in pain Furthermore, it is suggested that mainly vocal expressions, especially crying, influence nurses' decisions to administer analgesics Finally, nurses' negative views on non-narcotic analgesics were striking In this paper, the results of both studies and their relationship to information reported in the literature are further elaborated and discussed, and hypotheses on strength and direction of influence of factors on pain assessment and intervention are generated     

Investigating patient characteristics on pain assessment using virtual human technology

Pain assessment and treatment is challenging and can be influenced by patient demographic characteristics. Few research studies have been able to specifically examine these influences experimentally. The present study investigated the effects of patients’ sex, race, age, and pain expression on healthcare students’ assessment of pain and pain‐related sequelae using virtual human (VH) technology. A lens model design was employed, which is an analogue method for capturing how individuals use environmental information to make judgments. In this study, decision‐making policies were captured at the nomothetic and idiographic level. Participants included 107 healthcare students who viewed 32 VH patients that differed in sex, race, age, and pain expression in an online study. Participants provided ratings on a 100‐point scale on the VH pain intensity, pain unpleasantness, negative mood, coping, and need for medical treatment. Nomothetic analyses revealed that female, African–American, older, and high pain expression VH were rated higher than male, Caucasian, younger, and low pain expression VH, respectively, on most of the five ratings. Idiographic analyses revealed detailed findings for individuals’ decision‐making policies. VH technology and the lens model design were shown to be highly effective in examining individuals’ decision‐making policies. Pain assessment often varied among individuals based on patient demographic and facial expression cues. This study could serve as a model for future investigations of pain assessment and treatment in healthcare students and providers.