Searching for value: the influence of policy and reform on nurses' sense of value in long-term aged care in Australia

Contemporary literature on long-term aged care focuses heavily on issues associated with the recruitment and retention of nursing staff, such as job satisfaction and attitudes towards caring for older people. This paper aims to highlight one aspect of a larger study of registered nurses' experiences in long-term aged care in Australia and the influence that government policy and reform has in shaping that experience. This insight into aspects of nurses' everyday experience also contributes to a broader understanding of job satisfaction in long-term care. Findings from this study suggest that registered nurses experience tension in their search for value in their practice, which incorporates professional, political and social mediators of value and worth. These issues are discussed in relation to the impact of policy and reform on nurses' sense of value in long-term aged care and highlight the need for sensitive policy initiatives that support issues of value in nursing practice.     

Community development: theoretical and practical issues for community health nursing in Canada

Despite the importance currently given to community development as an increasingly significant role for community nurses, there is little analysis of the role in the nursing literature This paper provides background information on the historical origins of community development work through an extensive review of the literature As well, four models of community development are synthesised from literature in sociology, social psychology, education and political science These include economic development models, education models both formal and informal, confrontational models, and empowerment models Each is discussed, and the relevance for community health nursing practice is critiqued Finally, issues which may arise when community health nurses attempt to practice within a community development model are discussed Issues are examined related to the structures of organizations in which nurses work, characteristics of nurses themselves, and the communities which nurses serve The argument is advanced that despite the pitfalls and problems, this new role shows promise as an important mechanism for community health nurses to promote the community's health However, much additional work will be needed to test out models for community development in actual practice Evaluation of the role will also be important to determine the degree to which it can be implemented and the resultant health outcomes for the population     

Social justice advocacy in nursing: what is it? How do we get there?

Social justice advocacy is an expectation of all nurses as expressed in the professional codes that guide nursing practice. Nursing literature reflects this shift in the focus of nursing advocacy, providing insight into the potentials and challenges associated with nursing's evolution toward a broader social justice advocacy model. This article describes the concept of social justice advocacy as currently reflected in professional codes and nursing literature and contrasts this with the individual patient-nurse advocacy model, which continues to dominate in nursing practice today. Challenges associated with movement toward a social justice advocacy model and options for addressing these hurdles are also discussed.     

The effects of flying: processes, consequences and prevention

The dangers of flying have recently been highlighted in the media; however, the available literature is contradictory, as are current recommendations for travellers. The purpose of this article is to provide an account of the research that has been undertaken to investigate the possible consequences of air travel. It will examine the effect that flying has on the body, especially the respiratory and circulatory systems, by studying the theoretical and empirical literature. The aim is to provide nurses with a sound insight into the effects of long-distance flying on the body, and the potential adverse effects/complications, such as deep vein thrombosis and pulmonary embolism, that may occur as a result. In addition, it provides information on the treatment options available and should enable nurses to give sound prophylactic advice after discharge. By encouraging passengers to take precautions, the number of people affected by flight could be reduced.     

Nitric oxide and nursing: a review

Aims and objectives. This paper, therefore, aimed to review published literature in this area of pharmacological exploitation, to look at the therapeutic applications and clinical relevance and, by so doing, provide an accessible source for nurses to gain insight into the role of nitric oxide in the clinical setting. Background. Nitric oxide is a chemical mediator fundamental in the maintenance of adequate tissue perfusion and effective cardiovascular function; a major endogenous regulator of vascular tone. The use of nitrates are well established as pharmacological agents but it is only recently that it has been recognized that they act as a source of nitric oxide. Although widely addressed within the medical literature, there appears to be a paucity of nursing literature that explores either its physiological action, or its relevance to nursing practice. Conclusions. This literature review provides an overview of the use of nitric oxide and its implications for nursing practice and patient outcomes. Relevance to clinical practice. Knowledge of nitric oxide and its action is pertinent to nurses across diverse specialities. It helps in understanding the principles of many nitrogen‐derived medications which nurses administer to their patients on a daily basis. In terms of oral medication, this is demonstrated by greater insights into the action of nitrates, the appreciation of surprising developments in medications such as sildenafil and the development of new drug opportunities such as nitric oxide–non‐steroidal anti‐inflammatory drugs. Equally, the use of inhaled nitric oxide therapy in adult and neonatal critical care units appears to be an increasingly valuable source of treatment. A particular research challenge is found in the attempt at nitric oxide inhibition in the management of septic shock. The authors argue that understanding such esoteric areas of therapeutic developments is increasingly to be part of the repertoire of knowledge and skills for nurses in the 21st century.     

A systematic literature review of nurse shortage and the intention to leave

chan z.c.y., tam w.s., lung m.k.y., wong w.y. & chau c.w. (2013) Journal of Nursing Management  21 , 605–613 A systematic literature review of nurse shortage and the intention to leave Aim To present the findings of a literature review regarding nurses’ intention to leave their employment or the profession. Background The nursing shortage is a problem that is being experienced worldwide. It is a problem that, left unresolved, could have a serious impact on the provision of quality health care. Understanding the reasons why nurses leave their employment or the profession is imperative if efforts to increase retention are to be successful. Evaluation Electronic databases were systematically searched to identify English research reports about nurses’ intention to leave their employment or the profession. Key results concerning the issue were extracted and synthesized. Key issues The diversified measurement instruments, samples and levels of intention to leave caused difficulties in the attempt to compare or synthesize findings. The factors influencing nurses’ intention to leave were identified and categorized into organizational and individual factors. Conclusions The reasons that trigger nurses’ intention to leave are complex and are influenced by organizational and individual factors. Further studies should be conducted to investigate how external factors such as job opportunities correlate with nurses’ intention to leave. Implications for nursing management The review provides insight that can be useful in designing and implementing strategies to maintain a sustainable workforce in nursing.     

Trust and trustworthiness in nursing: an argument-based literature review

Caring requires nurses to establish trusting relationships with patients and to be trustworthy professionals. This article provides insight into the conceptual understanding of trust and trustworthiness in nursing through an argument-based literature review of 17 articles published between 1980 and 2010. Trust is characterized as an attitude relying with confidence on someone. The importance of trust relationships is considered by addressing the imbalances of power in nurse-patient relationships as they increase the vulnerability and dependency of the truster. Trust is considered as a process, and time, reliance on others, risk and fragility are identified as basic attributes of trust. However, trustworthiness is inadequately explored in the nursing ethics literature. Nurse educators have a responsibility to ensure that nurses are equipped with the attitudes and knowledge that are needed to establish trusting nurse-patient relationships.     

Personal resilience as a strategy for surviving and thriving in the face of workplace adversity: a literature review

AIM: This paper is a report of a literature review to explore the concept of personal resilience as a strategy for responding to workplace adversity and to identify strategies to enhance personal resilience in nurses. BACKGROUND: Workplace adversity in nursing is associated with excessive workloads, lack of autonomy, bullying and violence and organizational issues such as restructuring, and has been associated with problems retaining nurses in the workforce. However, despite these difficulties many nurses choose to remain in nursing, and survive and even thrive despite a climate of workplace adversity. DATA SOURCES: The literature CINAHL, EBSCO, Medline and Pubmed databases were searched from 1996 to 2006 using the keywords 'resilience', 'resilience in nursing', and 'workplace adversity' together with 'nursing'. Papers in English were included. FINDINGS: Resilience is the ability of an individual to positively adjust to adversity, and can be applied to building personal strengths in nurses through strategies such as: building positive and nurturing professional relationships; maintaining positivity; developing emotional insight; achieving life balance and spirituality; and, becoming more reflective. CONCLUSION: Our findings suggest that nurses can actively participate in the development and strengthening of their own personal resilience to reduce their vulnerability to workplace adversity and thus improve the overall healthcare setting. We recommend that resilience-building be incorporated into nursing education and that professional support should be encouraged through mentorship programmes outside nurses' immediate working environments.     

The perceived learning needs of paediatric intensive care nurses caring for children requiring haemofiltration.

This paper reports on a small exploratory phenomenological study to describe the lived experiences of paediatric intensive care nurses, who extended their roles to care for critically ill children requiring continuous veno-venous haemofiltration. In describing and understanding this learning experience, an insight into the educational and support needs of these nurses is offered. From the insight shared, five main themes were identified. These included the overwhelming need to be a competent practitioner, which was perceived within the context of knowledge for effective practice and technical dexterity.While generalizability of findings is not intended, the findings could be of value to other intensive care settings to guide the identification and implementation of strategies to meet the needs of nurses undertaking similar roles.     

Obesity in pre-school chldren: issuse and challenges for community based child health nurses

Childhood obesity is becoming a topical issue in both the health literature and the popular media and increasingly child health nurses are observing preschool children who appear to be disproportionately heavy for their height when plotted on standardized growth charts. In this paper literature related to childhood obesity in New Zealand and internationally is explored to identify current issues, and the implications of these issues for nurses in community based child health practice are discussed. Themes that emerged from the literature relate to the measurement of obesity, links between childhood and adult obesity and issues for families. A theme in the literature around maternal perception was of particular interest. Studies that investigated maternal perceptions of childhood obesity found that mothers identified their child as being overweight or obese only when it imposed limitations on physical activity or when the children were teased rather than by referring to individual growth graphs. The implications for nursing in the area of child health practice is discussed as nurses working in this area need an understanding of the complex and often emotive issues surrounding childhood obesity and an awareness of the reality of people's lives when devising health promotion strategies.     

Perioperative Nurses' Encounter with Value Conflicts

The aim of the study was to gain a better insight into perioperative nurses' experience in a value conflict that has arisen in the perioperative caring environment and how they deal with it. In order to obtain as full and objective a picture as possible the critical incident technique was chosen. Perioperative nurses were asked to write down stories about value conflicts which they have experienced in the perioperative caring environment. When interpreting the textual content of the stories the aim has been to understand the meaning of nurses' experiences and how the nurses act in a value conflict situation. A value conflict is something that nurses have become part of against their own will. They are prevented from giving the good care they want to give, they are in conflict with themselves and have a bad conscience, and they feel guilt and shame for not having prevented the value conflict. The nurse who is involved in a value conflict aims, for the sake of the patient, to be a professional caring nurse. The nurse chooses to be the patient's neighbour, the one who suffers along with the patient and represents the patient's cry for help.     

Empowerment, skills, and values: a comparative study of nurses and social workers

This article focuses on social workers and nurses who complement each other's work in providing health care services to their patients. The professional literature suggests that understanding the professional differences between social workers and nurses may lead to more collaboration between these groups. This study empirically compares empowerment, skills, and values of social workers (n = 213) and nurses (n = 152). Nurses reported higher scores in all empowerment and value variables. Nurses also claimed to use more therapeutic and communication skills, and social workers reported the use of more social action skills. The differences in empowerment, skills and values between social workers and nurses are discussed in light of their different professional roles and work environments.     

ANOSOGNOSIA IN INDIVIDUALS WITH SCHIZOPHRENIA: TOWARD RECOVERY OF INSIGHT

This paper addresses the growing evidence that lack of insight, or unawareness of illness in people with schizophrenia, may actually be a medically based condition known as anosognosia. Major explanatory models and related research findings are discussed. A case scenario is presented, as well as current perspectives regarding assessment of insight and alternative treatment approaches. Implications for further research, nursing education, and practice also are included. With better understanding of the characteristics and treatment of diminished insight in individuals with schizophrenia, nurses can better assist clients to recover helpful insight that enables them to take an active role in managing their symptoms and problems.     

Anosognosia in individuals with schizophrenia: toward recovery of insight

This paper addresses the growing evidence that lack of insight, or unawareness of illness in people with schizophrenia, may actually be a medically based condition known as anosognosia. Major explanatory models and related research findings are discussed. A case scenario is presented, as well as current perspectives regarding assessment of insight and alternative treatment approaches. Implications for further research, nursing education, and practice also are included. With better understanding of the characteristics and treatment of diminished insight in individuals with schizophrenia, nurses can better assist clients to recover helpful insight that enables them to take an active role in managing their symptoms and problems.     

Senior nursing students' and professional nurses' perceptions of effective caring behaviors: a comparative study.

Care forms the basic core of nursing actions. Traditionally nurses have described the acts of administering to patients as care behaviors. Many nurses find it difficult to define these caring behaviors. It is important that nurses have insight into the specific behaviors that patients perceive to be most important. Several studies have examined and compared nurses' and patients' perceptions of effective care behaviors. The literature supports an incongruence of what nurses perceive and what patients perceive as effective. This study identifies and compares student nurses' and professional nurses' perceptions of effective caring behaviors. The Caring Assessment Report Evaluation Q-sort (CARE-Q) was used to obtain the data. The participants included senior baccalaureate nursing students (n = 30) at Thomas Jefferson University, College of Allied Health Sciences, and professional nurses (n = 30) with 1 or more years experience. The significance of the difference between the groups was tested using the Mann Whitney U test. Results indicate agreement between the students and the nurses in all categories except trusting relationship (p = .06). The ages within the groups varied from 21 to 47 years. The difference in ages between the nurses and the students is significant (p = .0002). Findings provide a better understanding of student nurse perceptions of caring behaviors and provide implications for further research for nurse educators.     

Therapeutic activities for people with dementia — what,why… and why not?

This paper reviews the literature pertaining to the provision of therapeutic activities for elderly people suffering from dementia. It relates both the provision of such activities, and the types of activity done, to the values and beliefs held by nurses and other professional carers. The range of therapeutic activities cited in the literature is explored, and reasons why activities are sometimes not offered to patients are discussed. Finally, research findings into the effectiveness and value of therapeutic activities for this group of people are reviewed.     

Bullying: Effects on School-Aged Children,Screening Tools,and Referral Sources

Bullying is not a new concept or behavior, and is now gaining national attention as a growing public health concern. Bullying leads to short- and long-term physical and psychological damage to both the victims and the bullies. The serious implications of bullying drive a clinical mandate for teachers and school nurses to be educated and adequately trained to identify and address bullying within schools. This review of the literature describes screening tools that can be utilized to identify both victims and bullies. In addition, referral services utilizing collaborative intervention measures are discussed. This literature review will help school nurses and teachers to identify and expand their role in school-wide bullying prevention and intervention measures.     

The mental health of men and boys: an overview

This article provides insight and understanding into important issues of which nurses need to be aware when caring for men and boys with regard to their mental health. Inequalities in health care are discussed, and suggestions made concerning how all nurses can help redress these inequalities. The mental health of men and boys concerns all nurses; not just those working in mental health settings. The article focuses on a recent review published by the Men's Health Forum (Wilkins, 2010), and considers a number of gender-specific mental health issues that affect the health and wellbeing of men and boys. The role of the nurse is to protect and promote the health of people in their care and this article makes clear that this extends to and includes the mental health of men and boys. Labelling people and categorizing them into homogenous groups is not often helpful or strategically wise; this article does not wish to categorize, but merely attempts to explain.     

Discovering and affirming knowledge in nursing practice

This paper discusses how the use of care stories or stories derived from clinical nursing practice were used to elucidate the knowledge used in nursing practice. In addition, the processes used to elucidate this knowledge are described and consisted of reflective and critical reflective activity undertaken in both individual and group forms. In describing the processes used the concepts of reflection, critical reflection, narrative and story are discussed with reference to contemporary literature. It is the contention of the authors of this paper that nurses can, by verbalizing care stories with peers, identify knowledge that is either unique to nursing or highly valued by nurses. An additional value, that is concluded in this paper, is that nurses, by the verbalization of care stories, assist other nurses to see what they do, to hear what they do and also to value what they do. By using reflective conversation, as described by D.A. Schon, as a teaching-learning strategy the authors believe that this process may also enable the generalization of such knowledge and its transmission to peers as well as assisting students to record their knowledge and, in so doing, maintain it within the discipline.