'Something always comes up': nurse-patient interaction in an acute psychiatric setting

In this study, 10 nurses and 10 patients were interviewed to explore factors influencing nurse-patient interactions in an acute psychiatric inpatient facility. The six themes that emerged from the nursing interviews were; environment, something always comes up, nurses' attributes, patient factors, instrumental support and focus of nursing. The four themes from the patient interviews were; nurses' attributes, role perceptions, clinical care, and time. These findings have implications for clinical practice, the nurses' role and nursing education.     

Comparing nurses' intent to leave or stay: differences of practice environment perceptions

Few existing studies have compared nurses' perceptions of the practice environment in relation to intent to leave or stay in employment and nursing concurrently. This study compared the differences between Taiwanese nurses' intent to leave or stay in employment and nursing, as related to their perceptions of the practice environment. A cross-sectional questionnaire survey was conducted at four hospitals in southern Taiwan. Questionnaires including the Chinese Nursing Practice Environment Scale, regarding intention in employment and nursing, were distributed to 535 nurses who provided direct patient care in Taiwan hospitals. Taiwanese nurses with intent to stay perceived the practice environment as better than nurses with intent to leave employment and nursing. The influences of the nursing practice environment on nurses' intent in employment and nursing were supported preliminarily. Targeting interventions to enhance participation in hospital affairs and adequacy of staffing and resources could be beneficial for a stable nursing workforce.     

Improvement in the nursing care quality in general surgery wards: Iranian nurses' perceptions

Improving care quality is one of the duties of almost all health service providers. Although it is of much significance to identify the factors influencing nursing care quality in specific clinical settings, a few studies have been conducted to improve our knowledge in this regard. This study aimed to determine Iranian nurses' perceptions of the factors influencing quality of nursing care in general surgery wards. A qualitative approach was adopted using content analysis of semi-structured interviews carried out with 15 nurses working in general surgery wards of two educational hospitals. The following themes and subthemes emerged from the analysis: 'beyond daily routine tasks', 'cooperation and the promotion of effective relationship' and 'updating education'. The second theme consisted of two subthemes: 'relationship among care team members' and 'communication between nurses, patients and relatives'. Providing qualified nursing care in Iran is complicated contextually and is somehow controversial. The study participants believed that in this context, proper delivery of appropriate nursing care is difficult for nurses owing to the barriers mentioned. Therefore, as a primitive action health care policy makers and managers are required to bring sensible changes into health care system through legislating suitable rules to guarantee the quality of nursing cares.     

Iranian intensive care unit nurses' moral distress: a content analysis

Researchers have identified the phenomena of moral distress through many studies in Western countries. This research reports the first study of moral distress in Iran. Because of the differences in cultural values and nursing education, nurses working in intensive care units may experience moral distress differently than reported in previous studies. This research used a qualitative method involving semistructured and in-depth interviews of a purposive sample of 31 (28 clinical nurses and 3 nurse educators) individuals to identify the types of moral distress among clinical nurses and nurse educators working in 12 cities in Iran. A content analysis of the data produced four themes to describe the nurses' moral distress. The four themes were as follows: (a) institutional barriers and constraints; (b) communication problems; (c) futile actions, malpractice, and medical/care errors; (d) inappropriate responsibilities, resources, and competencies. The results demonstrate that moral distress for intensive care unit nurses is different and that the nursing leaders must reduce moral distress among nursing in intensive care.     

Registered nurses' expectations and experiences of first year students' clinical skills and knowledge

BACKGROUND: Clinical education is a fundamental component of nurse education. In theory, this aspect involves integrated input from registered nurses, clinical educators and university lecturers. Registered nurses are important contributors to this process and play a major role in influencing and shaping undergraduate nursing students' early clinical experiences. Despite this important function, their voice has been somewhat neglected. Little is known about registered nurses' expectations and experiences of first year aduate nursing students undertaking their first clinical placement. AIM: The aim of this study was to explore registered nurses' expectations and experiences of first year undergraduate students' levels of knowledge and clinical skills. METHOD: Three consecutive focus groups were conducted with a purposive sample of 16 registered nurses. Interviews were audiotaped and transcribed and thematic analysis applied to the data to identfy themes imbedded in the data sets. FINDINGS: Three main themes emerged: (1) Clinical nursing skills (2) Knowledge requirements and (3) Experiences of reality shock. The findings highlight that registered nurses' expectations of first year students' clinical skills and knowledge were not consistently met. Registered nurses placed significant emphasis upon a range of basic skills, but acknowledged that some aspects of nursing knowledge can only be learned through experience. Furthermore, they demonstrated a considerable degree of empathy surrounding the reality shock that students might experience during early clinical placement. CONCLUSION: Findings from this study suggest that registered nurses and academics differ in their perceptions surrounding the level of clinical skills first year students should have during their first clinical placement. There appears to be a two way theory practice gap between registered nurses in clinical practice and academics in tertiary institutions. Improved communication between registered nurses and providers of nurse education may assist in addressing some of the issues raised by this study and reduce the theory practice gap, which remains 'alive and well'.     

The role of stress,peer influence and education levels on the smoking behaviour of nurses

Smoking kills yet a substantial number of qualified nurses continue to smoke. Stress, peer influence and education levels have been cited as influencing prevalence levels among nurses. A self-completed questionnaire was used to survey qualified nurses' perceptions of smoking prevalence, attitudes, and reasons for smoking. The respondents were composed of a random sample (n=1074) of qualified nurses employed in Northern Ireland. Results show that 25.8% of the sample smoked. Factors influencing smoking behaviour and reasons for continuing smoking are explored. This paper discusses the implications of these findings for nursing and nurses' health promotion activities.     

Chinese nurses' ethical concerns in a neurological ward

Our aim was to describe Chinese nurses' experiences of workplace distress and ethical dilemmas on a neurological ward. Qualitative interviews were performed with 20 nurses. On using latent content analysis, themes emerged in four content areas: ethical dilemmas, workplace distress, quality of nursing and managing distress. The ethical dilemmas were: (1) conflicting views on optimal treatment and nursing; (2) treatment choice meeting with financial constraints; and (3) misalignment of nursing responsibilities, competence and available resources. The patients' relatives lacked respect for the nurses' skills. Other dilemmas could be traced to the transition from a planned to a market economy, resulting in an excessive workload and treatment withdrawal for financial reasons. Lack of resources was perceived as an obstacle to proper patient care in addition to hospital organization, decreasing the quality of nursing, and increasing moral and workplace distress. The nurses managed mainly by striving for competence, which gave them hope for the future.     

Effective communication in an intensive care setting: nurses' stories

Effective communication has been long considered an important aspect of nurse-patient interactions. However, follow up of people who have been patients in intensive care units (ICUs) indicates that nurses' communication in this setting is at times unsatisfactory. Patients have described how they were left feeling frustrated and alienated by this failure in the communication process and unconscious patients report how they were aware of nurses' attempts at communication with them while unconscious (Lawrence, 1995). Because most of the research to date has focused on patients' perceptions of nurses' communication in an intensive care unit, this study sought to explore what nurses believed constituted effective communication in an intensive care setting. Therefore, a qualitative study was undertaken to explore nurses' perceptions of effective communication with patients in an intensive care setting. The stories of four intensive care nurses were utilized as the means of data collection. The analysed data revealed the following themes: nurses' perceptions, presencing and reassurance. The findings have relevance for nurses in many settings.     

Professionalism: the major factor influencing job satisfaction among Korean and Chinese nurses

Background:  The nursing shortage has become an internationally important issue. Nurses' professionalism and job satisfaction have been recognized as strong factors influencing their turnover. As international interchanges in nursing education are growing between Korea and China, understanding the commonalities and differences in factors associated with job satisfaction is critical to improving nurses' job retention.
Aim:  To compare the factors influencing job satisfaction among Korean and Chinese nurses.
Method:  A cross-sectional survey was conducted. The participants were comprised of 693 nurses at three general hospitals in Jinan, People's Republic of China and 593 nurses at two general hospitals in Seoul, Korea. A questionnaire was designed to measure the nurses' professionalism and job satisfaction. Stepwise multiple regression analysis was performed to identify factors related to job satisfaction.
Results:  Professionalism was the common factor influencing job satisfaction in Korean and Chinese nurses. Professionalism was positively related to job satisfaction in both groups. Additional factors associated with job satisfaction were demographics and job characteristics such as age, job position and department of work, which were significant only in Korean nurses.
Conclusions:  Professionalism was the most important factor influencing job satisfaction in both Korean and Chinese nurses. Enhancing nursing professionalism is recommended as a common strategy to improve nurses' job retention across different healthcare systems.     

Uncovering the secret: giving voice to the experiences of nurses who misuse substances

AIM OF THE STUDY: The aim of this study was to gain insight into the experience of being a nurse with a substance misuse problem. RATIONALE: Several members of the research team work in a withdrawal programme specifically designed for nurses by nurses. Gaining insight into nurses' experiences will contribute to the development of appropriate guidelines to assist with prevention, identification and intervention strategies. BACKGROUND: Published research is almost exclusively from North America. Much of it represents work completed in the 1980s, with very few research-based accounts from the perspective of nurses, highlighting that this is a poorly researched and understood problem in Australia. RESEARCH METHODS: This phenomenological study used in-depth, unstructured interviews either face to face or via the telephone with a purposive sample of 12 nurses who had experienced problem substance use. FINDINGS: Five major themes were identified: nurses' justification for using substances, the fear surrounding being 'discovered', the personal meaning for nurses, the professional impact and the turning point in their road to recovery. DISCUSSION: The five themes derived from the data are inextricably linked to the nature of nursing and of the nursing workplace. Information about potential risk factors and the experiences of nurses with substance misuse problems is critical to the development of prevention and treatment strategies. CONCLUSIONS: Issues of occupational health and safety are raised due to the increasingly demanding and often traumatic nursing work environment. Fears about stigma and loss of their nursing identity highlight nurses' perceptions that treatment programmes are often punitive in nature. Guidelines for the workplace addressing issues such as confidentiality, stress reduction and strategies for handling situations where a colleague is suspected of having a problem are beginning steps that will help address the problem of substance misuse in the nursing profession.     

护理人员工作满意度、工作负荷与压力自我评价及其影响因素

目的了解医院护理人员对工作负荷、工作压力和满意度的自我认识与评价,探讨年龄、学历、工作年限等个人特征对工作负荷、工作压力和满意度的影响。方法采取整群抽样的方法,对2所三级医院10个科室260名正式在编护士进行问卷调查,内容包括护理人员年龄,学历,职称,从事护理工作年限,护理工作负荷及工作压力大小及原因,工作、收入满意度及原因等,并对调查资料进行统计学分析。结果护理人员认为工作负荷重的比例占83.7%,报告工作压力大的比例占80.5%;工作负荷重的原因主要是护理人员缺乏,工作压力大的原因主要是工作负荷重和担心人身安全;护理工作年限、学历和职称是影响护理人员对工作负荷评价的因素;护理人员对工作与收入满意度不高,且职称越高,工作满意度越低;工作满意度不高的主要原因是收入低、工作不受重视、个人才能难以发挥、职称晋升难。结论护理人员工作负荷重,工作压力大,工作满意度不高;有必要制定针对性的人力资源管理对策,合理配备与使用护理人员,减轻护理人员工作负荷与压力,提高护士的工作满意度。     

What makes nursing satisfying: a comparison of college students'' and registered nurses'' views

This paper reports a study of nurses' perceptions of the positive and negative features of the work environment and their contribution to satisfaction with nursing. The concept of a 'work space' was developed to describe nurses' mental images of the features of their work environment. Eighty-four final-year student nurses and 75 registered nurses rated questionnaire items designed to examine perceptions of opportunities for professional development, sources of satisfaction, difficulties, time constraints and problematic interactions with other hospital personnel. There was general agreement among nurses about the aspects of their work that they found satisfying, but student nurses were more pessimistic than registered nurses that nursing would give them opportunities for recognition of their worth. Students returning from practica in critical care wards reported more stressful interactions with other personnel than students returning from general ward practica. Structural equation modelling of the causal relations between sources of satisfaction with nursing revealed that recognition and self-perceptions of work as a nurse were the strongest predictors of overall satisfaction with nursing. Caring for patients contributed only indirectly through its influence on nurses' feelings about themselves. The data indicate the significance of personal and social implications of nursing careers.     

Caring for patients with terminal delirium: palliative care unit and home care nurses' experiences

AIM: To explore palliative care unit and home care nurses' experiences of caring for patients with terminal delirium. DESIGN: A qualitative exploratory design using individual interviews. SAMPLE: Participants included five nurses working in an interdisciplinary palliative care unit located in a large Canadian city hospital, and four nurses from a palliative home care nursing team located in the same city. RESULTS: Nurses in both sites experienced multiple challenges caring for delirious patients. Additional education on delirium and collaborative teamwork were viewed as key factors in enhancing their ability to care for and support this patient and family population. Four core themes reflected the participants' perceptions and experiences: experiencing distress; the importance of presence; valuing the team; and the need to know more. CONCLUSION: Findings suggest the need for interdisciplinary educational initiatives focused on the identification and management of terminal delirium, and targeted to the specific context in which nurses practise.     

Nursing to care or caring to nurse: a qualitative investigation of perceptions of new recruits

This article discusses the perceptions of nine student nurses at the commencement of a 3-year diploma programme in nursing. In particular, it focuses on new recruits' perceptions of nursing. As part of a larger longitudinal study which examines the impact of the nursing curriculum on perceptions of health, data were collected from a sample of students concerning their perceptions of nursing, health, illness and the course. Content analysis of indepth interviews identified four themes concerning perceptions of nursing. These were caring, nurture, healing and self-development. These themes are discussed in relation to the student nurses life experiences and in the context of a notion of health as a central goal for nurse education. The students' perceptions of nursing at the commencement of the course suggest that nursing may be a moral choice as an occupation underpinned by the desire to do something worthwhile, whilst the relationship between nursing and health was not explicit.     

Nurses' perceptions of parental involvement in hospital care

Parental involvement is an essential element of quality of care for children in hospital. However, there is often confusion in role perception between parents and nurses which may be affected by nurses' attitudes, their ability to provide information, their communication and interpersonal skills and willingness to relinquish control. AIM: This study examined nurses' perceptions of parental involvement and communication with parents of children in hospital and explored differences in perceptions of recent graduate nurses and more experienced nurses. METHOD: Two focus groups were carried out at a university paediatric hospital in Sweden, one with experienced paediatric nurses (n = 7) and one with recent nursing graduates (n = 6). FINDINGS: Analysis of the discussions identified five themes: clarifying roles, information, work environment, support and clinical competence. These nurses confirmed the belief that involving parents in the child's care is an important part of nursing in paediatric care and suggested that the nurses should play the role of being the communicator with the parents. CONCLUSION: Nurses need to be aware of the impact their communication has on parents and help them to clarify their role as parents in hospital.