The nursing technician: profile developed by professionals of the area

The purpose of the present investigation is to recognize the basis of qualification and the nuances that permeate the performance of the nursing technicians, at the present time, in the district of Uberlandia. Qualitative research, having as reference the analysis of discourse, was the methodology chosen, and semi-structured interviews were used for data collection. The analysis was based on four categories: education-work, curriculum, professional identity and expectations. Starting from a detailed study of these categories, it was possible to evaluate education-work relationship in nursing technical courses, aspects related to the regulation and exercise of nursing work in Brazil, the importance of the curriculum in the organization of knowledge experiences; the meaning and influences of this work on the construction of professional identity. Finally, this research has also as its objective draw a profile of the nurse technician based on the analysis of their performance at work and the way this professional relates to his/her work.     

Judith Butler's theories: reflections for nursing research and practice

Judith Butler is one of the most influential late 20th and early 21st century philosophers in regard to left wing politics, as well as an active campaigner for social justice within the United States and worldwide. Her academic work has been foundational to the academic discipline of queer theory and has been extensively critiqued and applied across a hugely wide range of disciplines. In addition, Butler's work itself is extensive covering topics such as gender, sexuality, race, literary theory, and warfare. This article can only serve as a taster for the potential application of her work in relation to nursing, which is in its infancy. This introduction covers three of the potentially most productive themes in Butler's work, namely power, performativity, and ethics. Each of these themes are critically explored in turn, sometimes in relation to their actual application in nursing literature, but also in relation to their potential for producing novel critiques of nursing practice. Suggestions are made about how Butler's work can develop nursing research and practice. The article concludes with a short summary of Butler's key works as well as suggested reading for people interested in examining how her theories have been applied across different academic settings.     

乡镇卫生院护理人员工作现状及离职意愿研究

目的:描述乡镇卫生院护理人员工作现状和离职意愿,并分析工作量和工作内容对离职意愿的影响,为改善基层护理工作提出建议。方法:采用多阶段分层整群随机抽样,对我国三个省45家乡镇卫生院的167名护理人员进行问卷调查,并深度访谈44名护理人员。结果:深化医改以来,农村基层护理人员工作量增加,62%认为自己的工作量大。护理工作占护理人员平均工作时间的60%;公共卫生服务工作占平均工作时间的21%。30%的被调查者具有离职意愿。在控制省份、工作量、婚姻状况、编制、文化程度和从医年限等混杂因素后,公共卫生服务参与情况与护理人员离职意愿显著相关(P0.05)。结论:医改后乡镇卫生院护理人员工作内容扩展、工作量增加,工作内容的扩展降低了护理人员的离职意愿。     

Time, human being and mental health care: an introduction to Gilles Deleuze

Abstract  The French philosopher, Gilles Deleuze, is emerging as one of the most important and influential philosophers of the 20th century, having published widely on philosophy, literature, language, psychoanalysis, art, politics, and cinema. However, because of the 'experimental' nature of certain works, combined with the manner in which he draws upon a variety of sources from various disciplines, his work can seem difficult, obscure, and even 'willfully obstructive'. In an attempt to resist such impressions, this paper will seek to provide an accessible introduction to Deleuze's work, and to begin to discuss how it can be employed to provide a significant critique and reconceptualization of the theoretical foundations and therapeutic practices of psychiatry, psychotherapy, and mental health nursing. In order to do this, the paper will focus upon Deleuze's masterwork, and the cornerstone to his philosophy as a whole, Difference and Repetition ; in particular, it will discuss how his innovative and challenging account of time can be employed to provide a conception of human life as a 'continuity', rather than as a series of distinct 'moments' or 'events'. As well as discussing the manner in which his work can provide us with an understanding of how life is different and significant for each human being, this paper will also highlight the potential importance of Deleuze's work for logotherapy, for the recent 'turn' to 'narrative' as a psychotherapeutic approach and for contemporary mental health care's growing interest in 'social constructionism'. As such, this paper also seeks to stimulate further discussion and research into the importance and the relevance of Deleuze's work for the theory and practice of psychiatry, psychotherapy, and mental health nursing.     

实施整体护理后健康教育中的问题与对策

目的为了提高护理人员开展健康教育的质量。方法采用问卷对４所三级医院的４００名护理人员进行调查。结果９６４％的认为健康教育很重要；８３０％的认为健康教育是医生和护士的共同责任；８８３％的人选择病人与家属进行健康教育；８４１％的选病人入院至出院间开展健康教育；５９５％的人未接受开展健康教育的培训；４９４％的人的健康教育知识是通过阅读专业图书获得；８５２％的感到健康教育知识缺乏。结论护理人员在健康教育中做了大量工作，但多数人缺乏系统和规范的健康教育知识及对教育效果缺乏评价指标等。因此，应从３个方面采取措施。     

开展“营造安全文化防范护理差错”活动的体会

目的剖析护理安全隐患,有效回避护理风险,降低护理缺陷,确保护理安全,提升护理质量。方法将安全文化视为一种安全管理思路运用到护理质量管理中,首先让护士明确服务对象,感悟工作责任,然后对护理工作中存在的安全隐患进行识别和评估,提出相应的护理措施进行风险控制,及时发现问题,及时进行整改落实,达到回避护理风险,保证护理质量的目的。结果通过营造护理安全文化活动,明确了护士对待安全问题态度,提高了安全意识,使护理缺陷发生率大大降低。结论将安全文化视为管理思路运用到护理质量管理中,可以降低护理缺陷,提高护理质量,和谐护患关系。     

Husserl's theory of wholes and parts and the methodology of nursing research

Abstract  Whenever the name Edmund Husserl appears in the context of nursing research, what correctly comes to mind is the phenomenological approach to qualitative methodology. Husserl is not only considered the founder of phenomenology, but his broad concept development also contributed to the demise of positivism and inspired fruitful approaches to the social sciences. In this spirit of inspiration, it must be expressed that Husserl's theory of wholes and parts, and particularly his differentiation of parts into 'pieces' and 'moments', is very helpful in guiding the selection of research methods across the board in nursing science. The purpose of this paper is to highlight a frame of reference for nursing researchers to use in examining the essential nature of that which is being studied. This frame of reference is the Husserlian philosophy of 'pieces' and 'moments' in relation to the whole. 'Pieces' are independent parts of the whole that are subject to isolability in study, whereas 'moments' are nonindependent parts, which cannot be detached, presented, or studied apart from the whole. The intent is to propose this frame of reference as a philosophical base from which nursing researchers may better select among paradigms and methodological approaches in regard to the essential nature ('pieces' or 'moments') of that which they are researching.     

Relaxation: a strategy in the context of nursing care

This work has evaluated the application of relaxation as a strategy of nursing care; it has also sought for a theoretical framework that could base this technique application to assist the needs of a client facing his illness status, as well as a resource to be used by nurses in dealing with stressing situations, regarding to their professional praxis. We have worked upon conceptual aspects, the etymology, the aims, relaxation application and its implication in nursing care. We have concluded that relaxation technique is an ability that needs to be learned and pratice in order to improve well-being. It is a therapeutic modality, not pharmacologic, can be associated to traditional therapeutics and is of preventive value. It increases the options of efficient therapy for nurses. It is a coping technique in relation to stress. For inserting it into nursing praxis it is demanding that the nurse perceive the client and himself as a whole for both are benefitted by this strategy use.     

Sources of career disadvantage in nursing. A study of NHS Wales

Despite the numerical predominance of women in nursing there is a marked concentration of women, especially those working part-time, in the lower echelons of the profession. The paper presents survey data and interview material from a study of qualified nurses in NHS Wales. By controlling for differences in education and experience in nursing work, it was found that comparable groups of female nurses received unequal employment opportunities. Women with dependent children were primarily located in the lower nurse grades irrespective of their qualifications and experience. Much of this was associated with inflexible working practices, and the low status of part-time work. Occupational downgrading for female returners was also a significant barrier to career advancement. However, these problems were not recognised by management. Management failed to evaluate the mechanics of their human resource policies in terms which matter to many nurses, in particular with regard to the management of diversity.     

刍议护理项目成本核算

目的 探讨护理项目成本核算对医院护理工作的影响.方法 调查本院2015年10月-2016年3月部分护理项目所需耗材、工作量、临床技能,以及成本核算情况,发现护理效益低下的因素,分析护理项目成本核算对医院护理工作的影响.结果 对成人及小儿静脉治疗、新生儿暖箱及蓝光治疗、基础护理、尸体料理进行现状调查,发现现行的护理项目成本核算标准中的定价偏低;对生命体征测量、翻身叩背、备皮、PICC穿刺进行现状调查,发现现行的护理项目成本核算标准中无收费标准.结论 现行核算机制中,对成人及小儿静脉治疗、新生儿暖箱及蓝光治疗、基础护理、尸体料理等项目定价较低,对生命体征测量、翻身叩背、备皮、新技术、新业务等项目没有定价,与所付出的的工作量、临床技能等不匹配,造成护理低效益,间接限制护理学科的建设与发展.     

Pierre Bourdieu: Expanding the scope of nursing research and practice

Bourdieu is an important thinker within the sociological tradition and has a philosophically sophisticated approach to theoretical knowledge and research practice. In this paper, we examine the implication of his work for nursing and the health sciences more broadly. We argue that his work is best described as a reflexive realist who provides a space for a nonpositivist approach to knowledge that does not fall into the trap of idealism or relativism. We emphasize that Bourdieu was not an abstract theorist, but only utilized theories to understand and explain the social world in all its empirical complexity. Theory is emphasized over method without denying the importance of method. We then provide a brief overview of some of his key concepts: habitus, field and capital. His work is a scientifically astute practice that has an emancipatory purpose, with particular resonance to the problems of nursing as a social practice. Some have criticized Bourdieu for undermining agency and we briefly address this issue, but argue that his conceptual framework helps us to understand what endures in social practice and why change is often problematic. In short, this paper argues that Bourdieu's work is a fruitful resource for critiquing existing nursing approaches that are preoccupied with agency over structure.     

Immersed subjectivity and engaged narratives: clinical epistemology and normative intricacy

Gadow's understanding of nursing as a relational narrative anchored in a dialectic between the fundamental subjectivity of the individual client and the objectification of his illness poses some interesting questions for nursing ethics and care. For Gadow, nursing is an encounter with the immediate vulnerability of the client and also lends it responsibilities to the medical objectification of illness aiming at disease treatment and control. Hence, nursing agency is divided between its responsibilities induced by the personal vulnerability of the patient and the more impersonal, but benevolent intention shaped by medical knowledge. Medical knowledge is impersonal in the sense that it is knowledge detached from the subjectivity of the patient. But how is nursing able to reconcile the interests derived from personal and experienced vulnerability with the more impersonal and often conflicting demands of medical knowledge? This question is even more intriguing because there seems to be an objective dimension within a patient's subjectivity itself: an autonomous person can critically evaluate his own subjectivity as a basis for informed self‐interest. The sick person is thus confronted with objectivity on two important levels: the objective facts of his disease and his detachment from his own experiential vulnerability when engaged in the critical evaluation of his self‐interest. This paper will discuss the normative dimensions of these complex and, frequently, conflicting perspectives from the theoretical perspectives of Thomas Nagel's normative responsibility and Sally Gadow's clinical epistemology and relational narratives. The empirical basis for the discussion will be an ongoing study of the ethical dimensions of pain relief and sedation in an intensive care unit.     

NURSING OUTSIDE HOSPITALS: THE WORKING EXPERIENCE OF COMMUNITY NURSES. EDUCATIONAL CHARACTERISTICS AND JOB PERCEPTIONS

The community nursing practice research project reports the results of a mailed questionnaire survey of nurses employed outside hospitals and nursing homes in Victoria in 1985. Two 10 per cent random samples stratified across practice areas were selected from listings of community nurses providing detailed employment information to the Victorian Nursing Council. An 84 per cent response rate was obtained from these listings yielding 689 responses. This paper reports that part of the study relevant to job entry, job satisfaction, job mobility and perceived career options as well as educational preparation. One half of community nurses entered community nursing after five years of hospital experience. The major reasons for choosing employment in community health nursing were its conditions of work, its autonomy and a dissatisfaction with hospital nursing, rather than a specific orientation to community nursing. These can be appreciated in terms of competing demands by the nurse's family life and her sense of growing professional maturity. Job satisfaction was high, with 87 per cent of nurses in the study population being satisfied or very satisfied. Only one quarter considered opportunities for career advancement to exist in their practice area. In the event only one fifth of nurses regarded promotion as important. The high levels of job satisfaction and the low importance attached to promotion are explicable given the nature of female employment and dissatisfaction with hospital nursing. Despite this high level of job satisfaction, one third of nurses believed they would not be nursing in five years time. Less than one third of nurses felt there was adequate opportunity for advancement in their practice area. Fifty per cent of community nurses were aged over 40 (the majority of these are in the maternal and child health and medical clinic groups) and some had the non-nursing educational standards that would be expected given this age composition. Overall 61 per cent of nurses believed that their basic nursing education was an adequate preparation for community nursing at least at a beginning level. However, a perceived need for preparation beyond a beginning level existed given that 83 per cent perceived regular ongoing in-service education to be essential. No more than 29 per cent however supported either a post-basic in-service course, a Diploma in Community Health Nursing, or a Bachelor degree in Applied Science with a major in Community Health Nursing or other college program as being essential. It was considered that the non-academic nature of the educational background of the majority of nurses was the principal reason for these findings. It was concluded that planning for future development in community nursing, especially with regard to the appropriate educational preparation and career structure, should recognise the current experiences and expectations of nurses. These, however, are likely to change with the introduction of college-based nursing. They may also be affected by the current absence of an adequate career structure in most community nursing practice areas.     

Does missed nursing care predict job satisfaction?

This study explores the impact of missed nursing care (required patient care that is omitted) on job satisfaction of nursing personnel. Data from 3,135 registered nurses (RNs) and 939 nursing assistants (NAs) on 110 patient care units in ten midwestern hospitals revealed that nursing staff who perceived less missed nursing care on the patient care unit where they work are more satisfied in their current position and occupation. Perceptions of staffing adequacy also significantly predicted both satisfaction variables. Focused interventions aimed at decreasing missed care and ensuring staffing adequacy are needed to improve job satisfaction and patient care.     

Practical nursing training in the University School of Nursing of the Community of Madrid. Opinion of students and health professionals. Qualitative study with discussion groups

BACKGROUND: In the nursing schools, the contrast between what is taught in the classrooms and what is practiced at the health care centers usually creates a great deal of confusion on the part of the students. The objective of this research is to ascertain the opinion of the students and of the professionals at the health care centers where they are doing their training with regard thereto in order to detect their problems and see what differences exist between primary and specialized care. METHODS: This research was conducted throughout the first half of 2000 employing qualitative methodology, by means of four discussion groups comprised of students, former students, primary care training advisors and nursing professionals at the hospitals where the students of the school in question are doing their nursing training. The initial involvement employed was indirect. RESULTS: The comments of the nursing students and of their training advisors with regard to the practice nursing during the diploma studies reveal dissatisfaction on the part of both of these groups. In all of the groups point out anxiety as the leading factor involved in their teaching as well as learning activities and during professional training. The lack of identification as a group of professionals seems to be related to the lack of recognition on the part of the others, the demand for a degree being granted for their college studies and for the setting up of specialities would contribute to their social recognition and, as a result thereof, to their identification as a professional group. CONCLUSIONS: Until a solution is provided to the anxiety which the nursing professionals feel with regard to their professional practice, which they pass on to their students during nursing training, it will not be possible to achieve a higher degree of satisfaction with nursing training experiences either on the part of the training advisors or on the part of the students.     

Children's regard for nurses and nursing: a mosaic of children's views on community nursing

In the past decade there has been both an increase in the number of children who receive nursing care in their communities rather than in hospitals, and an increasing willingness to listen to children. This qualitative study used Clark's Mosaic approach to elicit children's views of community children's nursing. Twenty-one children took part in total, with seven children making up a core group who participated in a number of activities for over a year. A non-core group of 14 children were observed receiving care from six community children's nurses. The children had diverse medical conditions, were aged from 11 months to 17 years old and came from diverse social, ethnic and cultural backgrounds. Some children expressed a positive regard for nurses and nursing. Some children a negative regard, others were ambiguous. From these data it is proposed that there is a continuum of regard for nurses. How children regarded nurses did not seem to be related to the nurse's actions, but to the child's understanding of their illness and their involvement in care. Further study is required to clarify the concept and should focus on what effect children's regard for nurses and nursing has on health outcomes.     

Subjectivity and vulnerability: reflections on the foundation of ethical sensibility

This paper investigates the possibility of understanding the rudimentary elements of clinical sensitivity by investigating the works of Edmund Husserl and Emmanuel Levinas on sensibility. Husserl's theory of intentionality offers significant reflections on the role of pre‐reflective and affective intuition as a condition for intentionality and reflective consciousness. These early works of Husserl, in particular his works on the constitution of phenomenological time and subjective time‐consciousness, prove to be an important basis for Levinas’ works on an ethics of alterity and infinite responsibility for the other person. In fact, it is difficult to understand the core of Levinasian ethics, of vulnerability as proximity, of ethical sensitivity as passivity and a suffering for the suffering of another, without understanding the influence from Husserl's work. Crucially, the paper will, on the basis of Levinasian ethics, establish an understanding of sensibility as vulnerability and receptivity that is fundamental also for understanding significant intuitions in clinical nursing. Clinical sensitivity and carefulness in nursing are shaped by the concrete and also bodily expressions of vulnerabilities in a receptivity that is pre‐reflective and pre‐ontological.     

Self-transcendence: Lonergan's key to integration of nursing theory, research, and practice

Abstract This paper proposes that the philosophy of Bernard Lonergan can provide insight into the challenge of integrating nursing theory, research and practice. The author discusses Lonergan's work in regard to reflective understanding, authenticity and the human person as a subject of consciously developing unity. This is followed by a discussion of two key elements in Lonergan's work that relate to nursing: the subject–object challenge of nursing inquiry and common sense vs. scientific knowledge. The author suggests that integration of nursing theory, science and practice may be achieved through self‐transcendence.