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.     

SARS (severe acute respiratory syndrome): reflective practice of a nurse manager

Aims and objectives. This paper describes the reflective practice of a nurse manager in Hong Kong in supporting frontline nurses to overcome the crisis of SARS. Background. SARS infection was a crisis for everyone in endemic areas because of its threat to physical and emotional health. Hong Kong was the second leading endemic area in the world. Inadequate supplies of protective devices and the death of a nurse infected with SARS triggered nurses’ negative emotions. Methods. A model of structured reflection was adopted to examine one's practice. A problem‐solving model for crisis intervention was integrated into the reflective stage of structured reflection. Results. Promotion of nurses’ safety and emotional stability were the major goals in handling the crisis. Strategies were employed including self‐awareness, empowerment and team building, information sharing, provision of personal protective equipment and emotional support for frontline nurses. Conclusions. SARS infection threatens the physical and emotional health of nurses. From a positive perspective, such a crisis created an opportunity to learn and grow in terms of ethical, personal and aesthetic arenas. Relevance to clinical practice. SARS epidemic raised worldwide attention and challenged the Hong Kong's health care system. Reflective practice is useful to guide and examine nurses’ professional action during the crisis, and to put the experience into a learning perspective.     

Severe acute respiratory syndrome (SARS) prevention in Taiwan.

Severe Acute Respiratory Syndrome (SARS) is a newly identified respiratory disease that threatened Taiwan between April 14 and July 5, 2003. Chang Gung University experienced various SARS-related episodes, such as the postponement of classes for 7 days, the reporting of probable SARS cases, and the isolation of students under Level A and B quarantines. Ninety-eight percent of the students at the university live in dormitories; thus the prevention of SARS became an important issue. Preventive strategies are classified into primary, secondary, and tertiary prevention, with a different focus and strategy for each level of prevention. The university emphasized personal hygiene and a healthy lifestyle as the key to SARS prevention. Our experiences as school nurses during this crisis can help other school nurses to prevent the spread of SARS during similar situations.     

SARS: caring for patients in Hong Kong

Aim and objective. To explore in depth the experiences of nurses' caring for SARS patients in Hong Kong. Background. Severe Acute Respiratory Syndrome (SARS) dramatically demonstrates the global havoc that can be wreaked by a newly emerging infectious disease. The current literature either has a predominantly biomedical focus or deals with the psychological impact on healthcare workers. Published studies on the lived experience of nurses caring for SARS patients are currently lacking. Design. A phenomenological design. Methods. Using methods consistent with Husserl's philosophy, eight Registered Nurses working in three regional hospitals in Hong Kong were invited to participate in sharing their lived experience of caring for SARS patients and data were analysed using Colaizzi's approach. Results. The three major themes explicated were: the various emotions experienced in caring for SARS patients, the concept of uncertainty and revisiting the ‘taken for granted’ features of nursing. Conclusion. These themes, when taken together, describe the essence of the voyage undertaken by nurses who cared for SARS patients during the outbreak. The findings of this study indicate that extensive and ongoing support is needed to prepare and enable nurses to care for SARS patients during a crisis and make it easier for nurses to deal with the various uncertainties. Relevance to clinical practice. The essence of caring for SARS patients is highlighted in this study. The experience of caring for SARS patients prompts nurses to find meaning in their experience(s), and to develop knowledge and attitudes on how best to care for patients and prepare for a new crisis in the future. This paper considers a more in‐depth understanding of the lived experience of nurses during the crisis and the relevance of this perspective for education and support of nurses.     

Nurses' motivations for studying third level post-registration nursing programmes and the effects of studying on their personal and work lives

Internationally nurses' motivations for post-registration education and the effects of studying are important concerns for the profession. This paper describes Irish nurses' motivations for studying post-registration nursing programmes and the effects of studying on their personal and work lives. Eighteen nurses participated in this qualitative study. Data were collected using three focus groups and a one-to-one interview. Data were analysed using the qualitative data analysis method Framework [Ritchie, J., Spencer, L., 1994. Qualitative data analysis for applied policy research. In: Bryman, A., Burgess, R. (Eds.), Analyzing Qualitative Data. Routledge, London, pp. 173-194]. Three themes were identified: "I want to keep up and I want to keep in there," "It's about juggling and getting the balance" and "I'm looking at things differently." Findings revealed that nurses studied to aid their professional development. Contextual factors influenced their motivations including a free fees initiative and Irish nursing developing into an all graduate profession. The impact of studying on their personal and work lives was broader in scope than their motivations.     

The Greek goddesses speak to nurses

The Greek goddess myths are a uniquely creative medium to teach affirming feminine images to nurses learning about the impact of gender in their personal and professional lives. The author briefly reviews the stories of the goddesses and strategies for integrating goddess literature into nursing courses.     

Risky business: Lived experience mental health practice,nurses as potential allies

Mental health policy includes a clear expectation that consumers will participate in all aspects of the design and delivery of mental health services. This edict has led to employment roles for people with lived experience of significant mental health challenges and service use. Despite the proliferation of these roles, research into factors impacting their success or otherwise is limited. This paper presents findings from a grounded theory study investigating the experiences of Lived Experience Practitioners in the context of their employment. In‐depth interviews were conducted with 13 Lived Experience Practitioners. Risk was identified as a core category, and included sub‐categories: vulnerability, ‘out and proud’, fear to disclose, and self‐care. Essentially participants described the unique vulnerabilities of their mental health challenges being known, and while there were many positives about disclosing there was also apprehension about personal information being so publically known. Self‐care techniques were important mediators against these identified risks. The success of lived experience roles requires support and nurses can play an important role, given the size of the nursing workforce in mental health, the close relationships nurses enjoy with consumers and the contribution they have made to the development of lived experience roles within academia.     

The Lived Experience of Women Military Nurses in Vietnam During the Vietnam War

The lived experience of 24 military nurses during the Vietnam war is described in addition to common elements of their lives after returning from Vietnam. In-depth interviews generated data about personal and professional aspects of the lives of women nurses in the war zone. Data analysis incorporated the qualitative methods of Colaizzi, Lincoln and Guba, and Van Manen. Findings revealed that the nurses struggled with moral and ethical dilemmas of wartime nursing, felt out-of-place, and lacked privacy. The nurses described a deep and special bonding, and many found serving in Vietnam to be the most rewarding experience in their careers. The Vietnam War continues to have an effect on the lives of the nurses who served there. They balance their personal andprofessionalgrowth gleaned from this experience with the physical and emotional stresses experienced during the war and since the war. The findings of this study have implications for further research about nurses in Vietnam and nurses who have served in other wars.     

Seven years on: distance learning courses for first level registered nurses and midwives

There is a recognized need to increase the accessibility and flexibility of post-registration course provision for first level registered nurses and midwives. Distance learning courses were developed and implemented at the University of Dundee in response to this need. The courses provide a range of learning opportunities from single module certificate courses to Bachelor, Honours and Masters level studies. The courses are well received by nurses and midwives and experience, over the last 7 years, has highlighted important aspects for distance learning education for both professional groups. Different educational strategies such as Work-based Learning and Problem-based Learning are incorporated into distance learning course design to facilitate the integration of theory and practice and develop cognitive and meta-cognitive skills. The relationship between course assessment and clinical environment is also a key feature of course design, with assessment methods built around work-based learning opportunities in clinical practice. Experience has shown that students require support throughout the learning process. This is achieved through text-based study guides and a range of other support strategies. It is concluded that distance learning can be individualized to meet the professional and personal needs of students and provide quality, flexible learning opportunities for nurses and midwives, facilitating practice development and benefiting patient care.     

Becoming a community matron: the transition from acute to primary care

Community matrons are an important part of the policy of community-based management of long-term conditions. In contrast to some early conceptions of the role, community matrons can come from all areas of nursing. This article draws together two personal accounts by nurses from one primary care trust who have made the transition from acute care to community matron, and highlights the learning process they and their colleagues have undergone.     

Predictors of hospital-based registered nurses' engagement in on-the-job policy activities

Nurses have been urged to participate in public policy-formulation processes as an integral part of their professional role through collective and personal policy activities. However, there is only limited empirical data on this participation. This cross-sectional study examined the level and the predictors of the personal policy activities of 200 Israeli hospital-based registered nurses undertaken in their work setting and aimed at furthering hospital, local or national policies. The nurses completed questionnaires that examined policy activities, policy skills, political interest, political efficacy, political and professional network involvement, and organizational support for policy activities. The overall engagement of nurses in on-the-job policy activities was limited and focused primarily on their immediate surroundings, their departments and their hospitals, and much less on local or national policies. The most common policy activities were internal and indirect and included receiving feedback from patients to improve nursing care policy and calling colleagues' attention to policy issues. Positive significant correlations emerged between motivational and organizational factors and personal policy activities, and these contributed 55% to the explained variance. The findings enhance the relevance of integrating motivational and organizational factors in understanding the policy activity of nurses. As such, increasing personal involvement of hospital nurses in policy formulation processes requires professional training that seeks to improve nurses' policy skills, to enhance their political interest and efficacy, and to encourage their involvement in political and professional networks. In addition, hospitals need to cultivate an organizational culture that supports personal policy activities by nurses.     

Exploring the fear of contracting HIV/AIDS among trauma nurses in the province of Kwazulu-Natal

A qualitative study, using phenomenology as an approach was conducted. The title of the study was "Exploring the fear of contracting HIV/AIDS among trauma nurses in the province of Kwazulu-Natal". Participants were selected on the basis of category (registered nurses), workplace (level one trauma units), and work experience (six months experience in a trauma unit). Twelve nurses participated in the study, six from the state institutions and six from the private institutions. The objectives of the study were to explore the fear of contracting HIV/AIDS, its effect on their personal/working lives and how they coped with it. The findings of the study revealed that trauma nurses perceived themselves to be at risk of acquiring HIV/AIDS from their working environment despite the available precautionary measures. Needlestick injuries appeared to be the main source of fear. They used different coping and defence mechanisms effectively to cope with this fear of contracting HIV and none were in any emotional crisis. Education at different levels and development of support networks has been recommended as the key strategies to decrease these fears. Other recommendations include improving the quality and availability of protective materials and equipment, making HIV/AIDS a notifiable disease as well as improving general and specific beliefs that increase coping.     

Professional development: Iranian and Swedish nurses' experiences of caring for dying people

Our world is rapidly becoming a global community. This creates a need for us to further understand the universal phenomena of death and professional care for dying persons. A transcultural study was undertaken using a phenomenological approach to illuminate the meaning of nurses' experiences of professional development in the contexts of Iran and Sweden. Eight registered nurses working in oncology units in Tehran, Iran, and eight working in the context of a hospital and private homes in northern Sweden were interviewed. The interviews were analyzed using the principles of phenomenological hermeneutics inspired by Paul Ricoeur. A naive reading guided a structural analysis, which yielded four main themes: coping with existential, organizational, and cultural contexts; sharing knowledge, experiences, and responsibilities; using embodied knowledge; and developing personal competence. The interpreted comprehensive understanding revealed that the meaning of professional development is that it actualizes other-oriented values and self-oriented values. Caring professionally for dying people was a learning process that could help nurses to develop their personal and professional lives when they were supported by teamwork, reflective practice, and counselling.     

The relationship between caregiving and employment. A study of stress in employed and unemployed caregivers of elderly persons

The need for persons to provide care on an informal basis to frail and dependent elderly persons has generated a "caregiving crisis" in this country. Middle age women, the traditional caregivers for most generations, are no longer readily available to provide informal care. Instead, they are likely to be struggling to cope with the dual demands of paid employment and family responsibilities. Significant differences exist between employed and unemployed caregivers in relation to age, marital status, gender, personal health status, and caregiver-care recipient relationships. However, no differences exist in relation to the amount of stress experienced as a consequence of caregiving responsibilities. Occupational health nurses have an ideal opportunity to help employed caregivers cope with their caregiving responsibilities both at the worksite and in their personal lives.     

Advancing health policy in nursing education through service learning

Knowledge of health policy is an increasingly important aspect of nursing practice and education, especially as nurses strive to improve the rapidly changing health care delivery system. At the same time, many educators, researchers, foundations, and government officials are touting the benefits of service learning. In particular, service learning offers ways to enhance partnerships between academia and community agencies and to extend learning beyond the traditional classroom. We present a model for educating nurses as advanced practice nurses in health policy that links service learning with a framework for the political development of nurses. Under the rubric of service learning, the curriculum is based on the overlap among health policy, the role of the nurse as consultant, and community-based care. After discussing the importance of health policy for graduate nursing education and reviewing the essentials of service learning, we describe a three-semester graduate sequence in health policy service learning. The focus is on the clinical and classroom components of both individual and group practica and their relationship to stages of nursing's political development. The article concludes with evaluation considerations and the implications of our work for nursing theory, research, practice, and education.     

Interwoven histories: Mental health nurses with experience of mental illness,qualitative findings from a mixed methods study

The effects of mental health nurses’ own experience of mental illness or being a carer have rarely been researched beyond the workplace setting. This study aimed to explore how the experience of mental illness affects mental health nurses’ lives outside of and inside work. A sample of 26 mental health nurses with personal experience of mental illness took part in semistructured interviews. Data were analysed thematically using a six‐phase approach. The analysis revealed the broad context of nurses’ experiences of mental illness according to three interwoven themes: mental illness as part of family life; experience of accessing services; and life interwoven with mental illness. Participants typically described personal and familial experience of mental illness across their life course, with multiple causes and consequences. The findings suggest that nurses’ lives outside of work should be taken into account when considering the impact of their personal experience of mental illness. Similarly being a nurse influences how mental illness is experienced. Treatment of nurses with mental illness should account for their nursing expertise whilst recognizing that the context for nurses’ mental illness could be much broader than the effect of workplace stress.     

Perspectives of people with learning difficulties on relocation and community care

Steady progress is being made in the UK in the deinstitutionalisation of services for people with learning difficulties. Growing numbers are moving out of long-stay hospitals and hostels into less restrictive settings. But so far little is know about how they respond to the way these policies are changing their lives. This paper presents the views of movers who were interviewed using an innovative 'visual game' technique as they went through the process of relocation. Based on findings from a longitudinal research evaluation of a local community care programme, the paper describes the methods used and discusses the choices and preferences of the movers. The implications for policymakers are clear. People with learning difficulties can make perfectly sensible, consistent and illuminating comments on their experiences, and favour options and environments that maximise their independence. The evidence from this study suggests that the policy of relocating people from hospitals and developing community alternatives to institutional living is entirely in keeping with the wishes of the users themselves.     

An active learning experience in health policy for baccalaureate nursing students

Nurses have the potential to promote the public's health through active involvement in shaping health and social policy. Preparing nursing students to influence public policy is a major component of the curriculum in public/community health nursing. A series of learning experiences was designed to engage students in this process. First, students participate in information sessions at the State Health Department and the State House. This provides them with opportunities to engage in dialogue with public health leaders as well as advocates from both professional organizations and community groups. Next, students identify the legislators who represent them in the community and write a narrative that describes the legislators' interest and commitment to health-related legislation. Lastly, students work in clinical groups to analyze a public health problem that can be addressed through public policy interventions. This has led to the students testifying at legislative hearings and working with community groups involved with the issue. The students present their findings to their peers and to the wider college community. Through these learning experiences, students gain practical experience in understanding the political process that leads to important policy change. This in turn prepares them for their roles as professional nurses and involved citizens.     

Motivational forces affecting participation in post-registration degree courses and effects on home and work life: a qualitative study

Motivational forces affecting participation in post-registration degree courses and effects on home and work life: a qualitative study ¶ Over the past decade, pre- and post-registration education for nurses and midwives in the United Kingdom has undergone major change, creating an atmosphere where continuing professional development is a matter of priority for individual health care staff. Against this context of change, and as part of a larger study of continuing education and training in the National Health Service, a cohort of participants in a part-time health studies degree course were interviewed using a semi-structured schedule. Twenty-nine nurses, midwives and allied professional staff described their motives for participation in the course and its effects on their professional and personal lives. Data collected in interviews were analysed using qualitative methods and revealed that participation was encouraged by both professional and personal factors. For many staff participation was prompted by negative feelings about themselves and their professional status. Participation in the course was associated with (largely negative) changes in home and family life and most participants faced additional financial burdens. The findings of the study have implications for policy relating to the funding of continual professional education for nurses and other health care staff. Health care staff are receiving mixed messages about continuing education from policy makers and employers. Dependence on willingness and ability to pay for post-registration degree-level studies is unlikely to be an efficient or equitable means of ensuring lifelong learning for healthcare staff.