Establishing a Therapeutic Hospital Environment: The Patient Perspective

The United States is currently in a hospital building boom, replacing aging structures built in the 1960s and 1970s, and it is estimated that $250 billion will be spent on new hospital construction within the next 10 years.^{[5] and [7]} Major drivers for hospital construction include attracting clients, incorporating new technology, cost efficiency, and meeting hospital guidelines and regulations. This is a unique opportunity for nurses to provide input into the hospital design that can improve patient safety, as well as reduce staff stress and inefficiencies and improve health care quality. What we build now will be in use for decades. More than the physical plant must be addressed. The way we organize our care, the emphasis we place on the goals of care, the need to work interdisciplinarily, and ensuring safe handoffs are as critical as the physical plant.     

The Undergraduate Research Fellows Program: A Unique Model to Promote Engagement in Research

Regardless of which research enrichment processes are endorsed by a university, enhancing undergraduate research experiences strengthens the overall quality of the educational process. In supporting the Boyer Commission on Educating Undergraduates in the Research University (1998), the UGRF program and Boston College William F. Connell School of Nursing involve undergraduate students in research projects by preparing the next generation of scholars through the creation of a quality program. These programs can be evaluated overtime and represent a tangible goal for academic institutions committed to research intensive development. This process must be viewed as a critical point in research experience continuum because realistically, a researcher may only be able to model selected aspects of the research process and unable to model the whole spectrum of scholarly behaviors (Meleis, 1992). Helping undergraduates begin to see key aspects of the researcher role through real participation is an important step in helping them advance science through individualized engaged development.     

Springboard to Research: A Service and Academic Partnership

Principles from learning organizations provide a useful guide to summarize the process of building this collaborative. According to Peter Senge, learning organizations are “organizations where people continually expand their capacity to create the results they truly desire, where new and expansive patterns of thinking are nurtured, where collective aspiration is set free, and where people are continually learning to see the whole together. These organizations are guided by a set of disciplines: systems thinking, personal mastery, mental models; building shared vision; team learning.”¹This collaboration was guided by a group of nurse leaders who shared a common approach and philosophy based in systems thinking. The partners each committed themselves to personal mastery. They approached the collaboration with independent aspirations to do research that engaged the system and nurses from the inception of the research problem to the interpretation of the data.Each partner has individually committed to ongoing improvement activities. Both researchers and administrators seek and bring resources to the table as needed. When problems or gaps are identified, tolerance for ambiguity is required, often opening the way for innovative solutions.Many issues have been resolved just through -in-time meetings, including various nursing leaders as necessary. Senge says, “Truly creative people use the gap between what they want and what is to generate energy for change. They remain true to their vision.”¹ This energy allowed the partners to push forward, uncovering potential barriers and creating structure to accomplish the goals in areas where none existed.Organizations that seek collaborative service and academic research enterprises will embark on a journey that requires building a new mindset. The mental models that carry the stereotypes from the service and academic environments can be the launching pad, but eventually must be put aside to make room for the development of new systems and working relationships.Evidence that this academic/service research partnership has solidified is evidenced by plans for future studies that build on early findings. Within the collaborative, team learning has provided a sharing of strategies to implement the research.Nursing research in both clinical and leadership arenas can and will make a difference to future patients and nurses. As this case study demonstrates, a collaborative partnership between academicians and nursing service leaders is an excellent vehicle for advancing our profession.     

On the fundamental role of anatomy in functional imaging: Reply to commentaries on “In praise of tedious anatomy”

We have highlighted the importance of methodological clarity and consistency in the context of anatomical localization, and the commentaries on our target article were largely in agreement with our arguments. Whereas the focus of our target article was on the methodological aspects of anatomical localization, several of the commentaries also highlighted the fact that anatomy is not just about location: The reason that anatomical localization is critical is that anatomy is directly related to multiple aspects of brain function (e.g., Leonard et al., 2006). As a result, accurate, informative reporting of anatomy is a fundamental, but underappreciated, element in functional neuroimaging. We hope that our target article and the associated commentaries will bring renewed attention to this important issue.     

The accidental entrepreneur: One nurse manager's story

This is an overview from one nurse's perspective and story. There are many more stories that are yet to be written by other nurse entrepreneurs. “The entrepreneurial personality contains a gamut of distinguishing traits and characteristics that support innovation and degrees of risk taking.”² I believe that all nurses have unique characteristics and gifts that support innovation and creativity because they are in roles and settings where they can see areas for improvement. Entrepreneurial nurses who step forward and think “I can do this” will create the environment for a reformed and effective health care system—who better to see how best to care for patients?I challenge readers to think critically and see their organizations and roles in a new light that seeks innovation and improvement in numerous facets of how things are done. Be the change that makes things get done differently and, more importantly, done better.     

Creating an Enhanced Triage Area Improves Emergency Department Throughput

The majority of emergency departments in the US experience overcrowding. This trend is likely to continue due to multiple economic stressors, use of the emergency department as a healthcare safety net, and other factors.Process improvements in the emergency department are best effected when resources are committed to 1 of 3 areas typically responsible for bottlenecks: triage, tests and treatments, or patient discharge/admission. We described one solution that dramatically affected the triage process, improved our ability to respond to increasing patient volume, and enabled revenue recovery through a decrease in our LWBS rate (Figure). Establishment of Unit 45 has improved satisfaction and morale on the part of the staff, the hospital, and most importantly, the patients. Because of cooperative teamwork and “out-of-the-box” thinking, we were able to create a highly acceptable solution to a frustrating situation and maintain our focus of providing the best patient care possible.     

A retrospective audit of hospital records evaluating change in respiratory function during hospitalisation for pulmonary exacerbation in a paediatric population with cystic fibrosis

The findings of this study are in agreement with those of Rosenberg and Schramm [1] that respiratory function tests provide objective data that are useful in predicting and monitoring responses to management in acute pulmonary exacerbations. A unique aspect of this study is that it demonstrated that the level of dysfunction according to FEV₁ band affects the rate of improvement in FEV₁ and FVC during hospital admission. Consideration of FEV₁ band at admission may provide valuable information about likely respiratory function changes during hospitalisation for an acute pulmonary exacerbation in young people with cystic fibrosis. In addition, the weight of sputum expectorated at the initial physiotherapy session also affected the rates of change of FEV₁ and FVC. Therefore, collection of serial respiratory function tests and recording of sputum weight expectorated at admission inform the evidence base regarding young cystic fibrosis patients during hospitalisation for an acute pulmonary exacerbation.     

Public perception of registered veterinary nurses

Veterinary nursing has dramatically advanced as a profession in its own right over the past few years (O’Dwyer, 2013 O’Dwyer, L. (2013). Veterinary nursing - the future of our profession. The Veterinary Nurse, 4(4), 195–19510.12968/vetn.2013.4.4.98767[Crossref] , [Google Scholar]). This should cause registered veterinary nurses to be treated as professional personnel, not only by colleagues but also by veterinary clients due to their professional status. The study intends to acquire the client’s perspective on what tasks a veterinary nurse can perform and what their personal opinion is of veterinary nurses. The subject chosen is designed to highlight the need for further client education and show “gaps” in current knowledge, provide more evidence for the need to protect the veterinary nurse title and in turn, increase job satisfaction among present and future veterinary nurses. The research completed is a prospective survey in the form of a questionnaire. Using SPSS as the statistical analysis tool, the association between the variables has been tested. The results showed there to be a statistical significance in the relationship between the participants’ age and their knowledge of tasks an RVN can legally perform. This indicates that age has an effect on the level of knowledge participants had about RVNs.     

Recovery-Oriented Psychiatric Nursing in South Korea: A Hybrid Concept Analysis

The purpose of this study is to examine the attributes and verify the definition of the recovery-oriented psychiatric nursing concept using the hybrid model suggested by Schwartz-Barcott and Kim (2000 Schwartz-Barcott, D., &; Kim, H. S. (2000). An expansion and elaboration of the hybrid model of concept development. In B. L. Rodgers and K. A. Knafl (Eds.). Concept development in nursing: Foundations, techniques, and applications (2nd ed., pp. 161–192). Philadelphia: W.B. Sanders. [Google Scholar]). In the theoretical analysis phase, a literature search was conducted and data were collected using the Pubmed, CINAHL, and Google Scholar databases. This study considered of 7 empirical studies, 21 guidelines, 12 instruments, 2 related theories, 3 practical models, and 2 intervention programs. In the fieldwork phase, this study performed in-depth interviews with nine psychiatric nurses. After comprehensively analyzing the attributes of recovery-oriented psychiatric nursing through a literature review and the fieldwork phase, this study rearranged the final attributes and definition of recovery-oriented psychiatric nursing in the final analytic phase as follows: “Placing consumers in the center of nursing as human beings”; “Expecting with hope”; “Encouraging them to lead a satisfactory life”; “Guiding them to live along with their peers, family and the community”; “Becoming a companion”; “Growing together”; and “Establishing a nursing organizational culture and system.” The results of this study will be used as the basic data for developing educational contents and practice guidelines for the quick resolution and activation of recovery-oriented psychiatric nursing.     

Expanding NP Students’ Skills: Learning Minor Procedures

Minor procedure skills stations are immensely popular with students. Many express a sense of accomplishment in knowing that they have carried out a specific procedure at least once before having to do so in the clinical setting. Students who complete the skills have a good foundation in minor procedures and are knowledgeable about indications, contraindications, and techniques to perform the procedure before facing that first patient in the clinical setting. They will also have accumulated a set of procedures, patient discharge instructions, and a bibliography that can be reviewed before carrying out a procedure for the first time in the clinical setting. Combining clinical hands-on skills with the experience of writing a step-by-step procedure reinforces learning and is a valuable skill that can be used in clinical practice after graduation.Although many of the students will only apply a portion of the skills they learn in these exercises, they expressed a significant boost in self-confidence, a decrease in anxiety level, and a sense of accomplishment in their skills, before being confronted with the procedures in their clinical practice. Additionally, many expressed increased confidence in their ability to carry out these skills before entering into clinical rotations and a competitive health care marketplace.⁸     

“From resistance to challenge”: child health service nurses experiences of how a course in group leadership affected their management of parental groups

Background

All parents in Sweden are invited to child health service (CHS) parental groups, however only 49% of the families participate. The way the parental groups are managed has been shown to be of importance for how parents experience the support and CHS nurses describe feeling insecure when running the groups. Lack of facilitation, structure and leadership might jeopardise the potential benefit of such support groups. This study describes CHS nurses’ experiences of how a course in group leadership affected the way they ran their parental groups.

Methods

A course in group leadership given to 56 CHS nurses was evaluated in focus group interviews 5–8 months after the course.

Results

The nurses felt strengthened in their group leader role and changed their leadership methods. The management of parental groups was after the course perceived as an important work task and the nurses included time for planning, preparation and evaluation, which they felt improved their parental groups. Parental participation in the activities in the group had become a key issue and they used their new exercises and tools to increase this. They expressed feeling more confident and relaxed in their role as group leaders and felt that they could adapt their leadership to the needs of the parents.

Conclusions

Specific training might strengthen the CHS nurses in their group leader role and give them new motivation to fulfil their work with parental groups.

Trial registration

 Clinical Trials.gov ID: NCT02494128.

     

Effects of Behavior Problems,Family Functioning,and Family Coping on Parent Stress in Families with a Child with Smith-Magenis Syndrome

Smith Magenis Syndrome (SMS) is a rare genetic syndrome most commonly caused by a microdeletion on chromosome 17 p11.2. It is associated with a pattern of physical, developmental, and behavioral characteristics including intellectual disability, sleep disturbance, and a variety of behavior problems. The purpose was to examine the relationship between maladaptive behaviors in children with SMS and parent stress, and to determine whether family functioning and effective parent coping strategies may alleviate the impact of child maladaptive behaviors on parent stress. Data were collected on 25 individuals with SMS ages 1.4 to 19.4 years old. Parents were interviewed using the Vineland Adaptive Behavior Scale (VABS; Sparrow et al. 1984), the Achenbach Child Behavior Checklist (CBCL; Achenbach 1991), the Family Assessment Device-General Functioning Scale (Epstein et al. 1983), the Family Crisis Oriented Personal Evaluation Scales (McCubin et al. 1991), the Parental Stress Index-3rd edition (Abidin 1995), and the Stress Index for Parents of Adolescents (Abidin 1995). Using multiple hierarchical regression analyses we found that maladaptive behaviors (CBCL internalizing and externalizing behaviors) affected parent stress; however, we also saw that parent stress was alleviated in well-functioning families. Maladaptive behaviors did not have a significant negative impact on life stress.     

Nurses’ experiences of caring for patients with intellectual developmental disorders: a systematic review using a meta-ethnographic approach

Background

Research suggests that registered nurses (RNs) do not feel adequately prepared to support patients with intellectual disability disorder (IDD). This is unsurprising, as few European health sciences curricula include undergraduate and graduate training courses in IDD. As RNs are often in the front line of care, eliciting in-depth knowledge about how they experience nursing this group of patients is vital. Our aim in this study was to develop a conceptual understanding about RNs’ experiences of nursing patients with IDD.

Method

We undertook a systematic review and meta-ethnography to synthesise qualitative research studies found in PubMed, CINAHL, PsycINFO, ERIC databases and by manual searching to identify additional studies. We condensed translatable second-order constructs, and developed an idiomatic translation. Finally, we formulated line of argument (LOA) syntheses to capture the core of the idiomatic translations.

Results

We included eighteen published studies from eight countries involving 190 RNs. The RNs’ experience of nursing patients with IDD were reflected in 14 LOAs. Six of these reflected a tentatively more distinctive and at times unique conceptualisation of RNs’ experience of nursing this group of patients. The remaining eight LOAs represented a conceptualisation of nursing per se, a conceptualisation of nursing that was interpreted as a universal experience regardless of context and patient group.

Conclusion

Lack of awareness and knowledge are likely breeding grounds for the ‘otherness’ that still surrounds this group of patients. In encounters between patients and RNs, focusing on the person behind the disability label could be one way to secure relevant nursing care for patients with IDD. Undertaking appropriate under- and postgraduate education alongside the implementation of nursing models focusing on patient-centred care would help RNs in reducing the health and care inequalities this group of patients still face.

Trial registration

PROSPERO 2017: CRD42017077703.

     

Duty,professionalisation and nursing knowledge

ABSTRACT

The history of human nursing demonstrates that the nature of nursing knowledge is closely tied to the development of the vocation and its subsequent redefinition as a profession (Johnson 1974 JOHNSON, D. E. (1974). Development of theory: a requisite for nursing as a primary health profession. Nursing Research. 23(5) pp. 372–377.[Crossref] , [Google Scholar]). This article discusses the context in which nursing knowledge has evolved and its intimate relationship with the nurse's duties and obligations. It concludes with a short discussion of possible next steps in the development of veterinary nursing practice.