The concept of communicative action: a contribution to nursing consultation

Nurses often adopt a mechanist view, perceiving the individual from a biological standpoint and giving little attention to psychological, historical and cultural aspects. This evidences the need for a more humane approach, in which the communication between nurses and health service users can be achieved with more comprehension and participation. The aim of this paper is to introduce the concepts of language and communication in nursing consultation, using as a theoretical and conceptual framework Jürgen Habermas' theory of universal pragmatism. In nurses' everyday routine, it is important to intermediate and adapt knowledge and technical skills with a view to effective performance in humanized care for individuals and the community. The dialogic practice, through reflexive and participative communicative action by nurses, is needed for more humane care.     

Why Bangladeshi nurses avoid 'nursing': social and structural factors on hospital wards in Bangladesh

In response to concerns that nurses spend less than 6% of their time on direct patient care, this study explored factors that influence nurses' behaviour in the provision of 'hands on' care in hospitals in Bangladesh. Through in-depth interviews with female nurses and patients and their co-workers in six hospitals, we identified conflicts between the inherited British model of nursing and Bangladeshi societal norms. This was most evident in the areas of night duty, contact with strangers, and involvement in 'dirty' work. The public was said to associate nursing activities with commercial sex work. As a consequence, their value on the 'bride market' decreases. To minimise the stigma associated with their profession, nurses in government hospitals distance themselves from patients, using nurse surrogates in the form of patients' relatives and hospital support workers to carry out their work. These adaptations are supported and sustained through unofficial activities developed over time within hospitals. In contrast nurses in NGO hospitals give more direct patient care themselves and do not rely on carers as much because of tight supervision and limited visitor hours. Initiatives undertaken to improve the quality of patient care, such as enlarging the nursing workforce or providing clinical instruction, which do not take into account the prevailing culture in hospitals and social conflicts faced by nurses, are unlikely to succeed. Fundamental decisions on how to care for the sick in Bangladesh are required. If the present nursing curriculum is followed, adequate supplies, supervision and accountability are prerequisites for its implementation.     

Nurses and healthcare chaplains: natural allies

The collaborative relationship between nurses and chaplains in the health care setting is well documented. The authors review research findings including survey results demonstrating the importance of religion and spirituality in the general population and the importance of the religion and faith in people suffering illnesses. Nurses and physicians show marked differences in their attention to spiritual care as evidenced by nurses' higher rates of referrals to chaplains and the greater quantity of nursing research on sprirituality in professional journals. Three factors that might account for nurses' recognition of spiritual needs are: 1) the inclusion of spiritual care in the nursing curriculum, 2) personal involvement in faith communities and, 3) the historical influences of the nursing profession. Further research of this partnership and its effect on patient care should ultimately benefit the most vulnerable individuals in the health care setting.     

The Brazilian Universal Health System and the delivery of nursing care in a Brazilian hospital]

There are few studies on the delivery of nursing services in hospitals participating in the Brazilian universal public health system (Sistema Unico de Saúde), which was put in place in 1988. This study, which examined possible changes in the delivery of these services since universal health care was implemented, was based on interviews carried out between July and September 1995 with 31 nurses working at a teaching hospital in the city of Ribeir?o Preto, in the state of S?o Paulo. The nurses had begun working at the hospital between May 1980 and May 1987. Thematic analysis was used to assess their answers. According to the nurses, patients treated after the universal system was implemented have had more complex medical needs and a higher socioeconomic status. In addition, nurses reported an increase in the complexity of patient demands and in the variety of medical specialties offered by the hospital, as well as a decrease in the length of inpatient stays. Forty-six percent of the interviewees reported a change in the work done by nursing staff (for example, nurses have less time available for each patient). Not all of the problems the nurses mentioned are related to the public health system (understaffing is one example). It is essential that nurses examine national health policy and that they engage in the (re)construction of the practice of health care delivery. Nurses ought to understand the reality of their institutions and carry out a management process geared towards the expectations of patients and of health care workers.     

Hospital nurses' perception of public health

The objective of this work was to study hospital nurses' perceptions of public health based on a pedagogical exercise. A qualitative study, lead by students of a training institute for nursing care (IFSI), was conducted using semi-directed interviews of hospital nurses from different departments of a provincial hospital. The main results show that for one-third of the nurses interviewed, the hospital is not a setting for public health practice. In terms of their definition of public health, it is closely linked to the concept of prevention, with primarily individual approaches. This definition is very close to the public health activities that they conduct at the hospital and which are centred on information and disease prevention, on education related to pathologies and the relationship between the provision of care and listening to the patients and their families. Few nurses place their public health activities within the scope of the areas of hospital cleanliness, the welcoming of the patients, the organisation of services, and the improvement of the quality of care. The potential tracks which have emerged from this work lead to the need for the strengthening of training in patient education, in the hospital's work networking with external partners, and in better development of public health activities undertaken in the hospital setting.     

Environmental Florence Nightingales: nursing's new front line

Nurses comprise the largest health professional group in terms of number, and they can be found in almost every health care setting, including homes, schools, work sites, and hospitals. To a large extent, nurses have always been aware of environmental factors when doing their job, but the definition of environmental health nursing is being expanded. Today, in addition to considering the possibility of environmental influences when taking patient health histories, evaluating symptoms, and conducting community assessments, nurses may change environmental conditions of affected individuals or populations through direct care, teaching, advocacy, and public policy initiatives. Nurses are helping patients evaluate the relative risks of various types of environmental exposures, such as lead. And they are also playing a key role in establishing a national tracking system of environmental health as well as in conducting patient research.     

Complaints against nurses: a reflection of 'the new managerialism' and consumerism in health care?

This paper discusses the effects of restructuring on nursing as a profession through an examination of the issue of complaints in Ontario. It argues that new managerialist techniques and associated changes in the nature of work are reducing the autonomy of nurses and making it difficult for them to meet the standards of their profession. Simultaneously, the Ontario government has increased the power of the public in the disciplinary process and the College of Nurses of Ontario is encouraging patients to register their complaints. The growth of consumerism in health care, coupled with the disciplinary process, individualizes complaints and deemphasizes their relationship to restructuring. Moreover, in response to the increasing number of complaints - complaints which more often come from the public - nursing organizations have encouraged the legalization of the disciplinary process, thus fostering the individualization of the issues.     

Rural generalist nurses' perceptions of the effectiveness of their therapeutic interventions for patients with mental illness

OBJECTIVE: To explore generalist nurses' perceptions of their efficacy in caring for mentally ill clients in rural and remote settings, and their educational needs in the area of mental health care. DESIGN: A self-administered questionnaire adapted from the Mental Health Problems Perception Questionnaire; a Likert scale used to rate the perceptions of nursing staff of their own ability to adequately treat and care for patients experiencing mental illness. Setting: The Roma and Charleville Health Service Districts, Queensland, Australia. SUBJECTS: Nurses (Registered Nurses, Assistants in Nursing and Enrolled Nurses) in the Roma and Charleville health service districts (n = 163). MAIN OUTCOME MEASURES: Generalist nurses' perceptions regarding their therapeutic commitment, role competency and role support. Results: Seventy per cent of respondents indicated that limited knowledge of mental health problems was an issue preventing nursing staff in rural and remote settings from providing optimum care to patients with mental illness. Twenty-nine per cent of respondents indicated that they had never received or undertaken training or education in relation to the care, treatment or assessment of patients with mental illness. CONCLUSION: Rural nurses do not feel competent, nor adequately supported, to deal with patients with mental health problems. In addition, the nurses' education and ongoing training do not adequately prepare them for this sphere.     

Early career RNs' perceptions of quality care in the hospital setting

The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.     

Stress in nursing

The general purpose of this exploratory research was to understand the stress in different nursing occupations, aiming at determining the meaning of stress to nurses, identifying the stressors regarding different nursing occupational activities and investigating if the nurses' occupational activity is perceived as stressful. The sample consisted of three groups of Nurses (clinical, managers and professors) working in the public service of the city of Brasília and data were collected through semi-structured interviews. Although the concept of stress is not clear among nurses, they do experience diverse stressors; related to intrinsic job factors, to relationships at work, to their roles and to the organizational structure.     

The impact of barriers to providing high-quality care on nurses' intentions to leave London hospitals

OBJECTIVES: Previous research on nurse retention has focused mainly on its relationship with employment conditions. This study aimed to include an examination of the impact of nurses' perceived barriers to delivering high-quality patient-centred care on their intentions to leave their current employers. METHODS: An American employee questionnaire was adapted for use with British nurses. The questionnaire was mailed to 6160 nurses directly employed by 20 London hospitals. Up to two reminders were sent to non-responders. The questionnaire asked nurses to report on experiences in their working lives and to state their intentions to leave or stay with their current employer. Demographic and employment history information was also elicited. RESULTS: Responses were received from 2880 (47%). Nurses report that the care they are able to provide often falls short of recognised standards. Factor analysis combined 82 questions on nurses' experiences into four patient-centred and four nurse-centred dimensions. Nurses who report more problems in both nurse-centred and patient-centred dimensions are more likely to intend to leave their current employers. Satisfaction with pay and the cleanliness of work areas are also important factors. CONCLUSIONS: Standards of care are often perceived by nurses to be unacceptably poor. Furthermore, their experience of barriers to care has a demonstrable impact on their decision to leave or stay with their current employer. Nurse managers need to address the perceived barriers to providing high-quality care when considering nurse retention strategies.     

The paradoxical impact of health care restructuring in Canada on nursing as a profession.

This article draws on the concept of "countervailing powers" to explore some of the contradictory effects of Canadian health care restructuring on nursing. The main focus is on key institutional powers in the nursing field, the major individual and collective strategies nurses have adopted in response to restructuring, and the ways in which the interaction between global and national market forces and the aggregate responses of nurses has created a severe shortage of nurses. The global shortage has led to a global competition for nurses' labor. This, along with government budget surpluses, has increased nurses' bargaining power, forcing governments and hospital managers to reverse nursing spending cuts; to offer more secure professional jobs, as opposed to casual work; to engage in aggressive, bonuses-laden recruitment of nurses, both within Canada and abroad; and, more generally, to rethink some of their restructuring strategies. However, since the bargaining power of nurses is largely market dependent and, as such, highly variable, there does not seem to be much potential for a sustained increase in the institutionalized power of the nursing profession.     

Considering the employee point of view: perceptions of job satisfaction and stress among nursing staff in nursing homes

OBJECTIVE: To document job satisfaction and sources of stress among nursing staff working in nursing homes and to evaluate the extent to which the reasons of stress differ by type of nursing staff. DESIGN: Cross-sectional study. SETTING: Twenty-five nursing homes in North Carolina participating in a demonstration project of a new model of long-term care pharmacy. PARTICIPANTS: Nurses and nursing assistants employed at the time of the survey in the spring and summer of 2002 (n = 1283). MEASUREMENTS: Health Professional Stress Inventory modified for use in the nursing home setting and ratings of job satisfaction. RESULTS: The situations most stressful for nurses were not having enough staff, having too much work to do, interruptions, having non-health professionals determine how to do their job, poor pay, and ultimately being responsible for patient outcomes. The top most stressful situations for nursing assistants included poor pay, not enough staff, and too much work to do. Nursing assistants were more likely than nurses to report stress because they do not have adequate information regarding a patient's condition. Nurses were more likely than nursing assistants to report stress because non-health professionals (eg, surveyors) determine how they must do their job. CONCLUSIONS: The findings of this study support the need to improve recognition for nursing, improve staffing, and provide competitive compensation in nursing homes.     

Nurses' perceptions of hospice palliative care volunteers

A total of 50 nurses (hospital and home care) responded to a survey designed to measure: (1) their attitudes toward, and knowledge of, hospice palliative care volunteers; (2) the types of tasks they felt it was appropriate for volunteers to perform; and (3) how valuable they felt different members of the hospice palliative care team are. In addition, they were asked to respond to some open-ended questions (eg, "Do you feel that it is appropriate for hospice palliative care volunteers to know patient medical information?"). The nurses' responses to the "Attitude/Knowledge" part of the survey revealed that they generally held positive attitudes toward volunteers. The majority of the nurses felt that it was appropriate for volunteers to perform most of the tasks listed, except for hands-on patient care. Nurses rated the value of nurses, family members, doctors, and pharmacists significantly higher than volunteers. Fifty-three percent of the nurses felt that volunteers should know patient medical information, and 77% thought that volunteers should have the opportunity to provide input regarding patient care. Also, 75% of the nurses felt that volunteers made their jobs easier, and 56% felt that volunteers should be included in team meetings. When asked to list the topics covered in a hospice palliative care volunteer training program, 73% of the nurses indicated that they were not sure or did not know what topics were covered, indicating a lack of knowledge regarding volunteer training.     

Are submissive nurses ethical?: reflecting on power anorexia

We believe that the notion of power anorexia, which we define as a lack of desire to exercise power, is central to reflections about nursing ethical concerns. Questioning the assumption that nurses are powerless, we argue that nurses can and do exercise power and that their actions and inactions have consequences not only for themselves, but also for those for whom they care. We propose that a feminist ethics perspective be used both to understand and to overcome nurses' power anorexia. Feminist thinkers remind us not only of oppression's psychological impact, but that stereotypical views about women are socially constructed and, therefore, can be changed. Nurses using this framework should explore the implications of a centralized notion of caring to the way we conceive of power relations in health care. Perhaps deconstructing caring by focusing on how nurses exercise power could help us to re-conceptualize nursing and promote new agendas for health and health care.     

Smoking-cessation counseling in the home: Attitudes, beliefs, and behaviors of home healthcare nurses

BACKGROUND: Despite advances in smoking treatment, cessation rates remain stagnant, possibly a function of the lack of new channels to reach heavily addicted smokers. This cross-sectional study examined home care nurses' attitudes, beliefs, and counseling behaviors regarding counseling their home care patients who smoke. METHODS: Home healthcare nurses (N=98) from the Visiting Nurse Association of Rhode Island were randomly selected to participate in a study helping home-bound medically ill smokers to quit. At baseline, nurses completed a questionnaire that assessed a constellation of cognitive factors (self-efficacy, outcome expectations, perceived effectiveness, risk perception, motivation, and perceived patient adherence) as correlates of self-reported nurse counseling behaviors. RESULTS: Nurses with higher outcome expectations spent more time counseling their patients about quitting (p<0.04). Nurses' self-efficacy was the only variable associated with consistent counseling (p<0.05). While the majority of nurses "asked and advised" their patients, a minority of nurses "assisted or arranged" follow-up. Perceived importance of counseling was associated with a greater likelihood of asking, advising and assisting (p<0.05). None of the nurses who currently smoked (n=13) provided follow-up to their patients. Nurses who reported higher levels of both risk perception (regarding the harmful effects of smoking) and perceived effectiveness were more likely to recommend the nicotine patch. CONCLUSIONS: Attitudes and beliefs about smoking are significantly associated with nurse counseling behaviors. Helping nurses to overcome their barriers to smoking counseling may open up new channels for smoking intervention.     

Occupational health nursing in the United States

This article is a summary of information about occupational health nurses and occupational health nursing in the United States. The article provides demographic, education, credentialing, role, and other data based on secondary analysis of occupational health nurses' responses to the 2008 National Sample Survey of Registered Nurses. Current issues affecting the U.S. work force and businesses are addressed and high-risk business and industrial sectors are noted. Occupational health nurse practice opportunities are highlighted and practice areas where occupational health nursing research is currently focused are discussed. The article also examines the challenges facing the next generation of occupational health nurses.     

Redesigning the nursing care delivery system at Fairfax Hospital

The redesign of the nursing delivery process at Fairfax Hospital is occurring from the top down and the bottom up. Nursing leaders have identified improvement opportunities that all units are addressing, such as reevaluating skill mix. At the same time, each inpatient nursing unit is redesigning its own processes to meet customer requirements. For example, the postpartum unit shifted to a "wellness" approach. Nurses reduced the amount of time spent in reassessing patients and are focusing instead on those things their patients are concerned about, such as teaching new mothers how to care for their babies. Results: Customer research revealed that patients, physicians, and nurses wanted family-centered care from competent, caring clinicians. Flow charts identified many improvement opportunities that were common across all nursing units, such as reducing the time nurses spend reporting between shifts. Nurses are more empowered to make local decisions. Additional quantitative results are being tracked for this relatively recent effort.     

Nurses' assessment of pediatric physicians: are hospitalists different?

The interaction between physicians and nurses represents a critical aspect of patient care. The numbers and influence of hospitalists-physicians who provide care to hospitalized patients-continue to increase. However, studies of interactions between nurses and hospitalists are limited. As a bridge to that gap, we studied pediatric nurses' assessment of pediatric hospitalists along with other categories of pediatric physicians (e.g., residents, surgeons) in terms of these physicians' interactions with nurses and patients and the quality of care they provide. Pediatric nurses at a tertiary children's hospital were invited to complete an anonymous online survey. They were asked to rate different categories of physicians according to various qualities of the nurse-physician relationship and patient care. Nurses were also given an opportunity to provide feedback regarding pediatric hospitalists' role in comanaging medically complex surgical patients. Our findings indicate that nurses ranked pediatric hospitalists and residents at the top in terms of nurse-physician interaction. In addition, nurses rated pediatric hospitalists highest for patient care qualities and indicated their overwhelming preference for hospitalists to comanage medically complex surgical patients. As our findings suggest, nurses may interact differently with hospitalists than with other types of physicians. As hospitalists become more influential in U.S. hospitals, it is important that positive relationships are carefully developed between nurses and hospitalists. Hospitalist programs may be key to improving the nursing practice environment and may lead to the retention of nurses.