Perioperative Nurses' Encounter with Value Conflicts

The aim of the study was to gain a better insight into perioperative nurses' experience in a value conflict that has arisen in the perioperative caring environment and how they deal with it. In order to obtain as full and objective a picture as possible the critical incident technique was chosen. Perioperative nurses were asked to write down stories about value conflicts which they have experienced in the perioperative caring environment. When interpreting the textual content of the stories the aim has been to understand the meaning of nurses' experiences and how the nurses act in a value conflict situation. A value conflict is something that nurses have become part of against their own will. They are prevented from giving the good care they want to give, they are in conflict with themselves and have a bad conscience, and they feel guilt and shame for not having prevented the value conflict. The nurse who is involved in a value conflict aims, for the sake of the patient, to be a professional caring nurse. The nurse chooses to be the patient's neighbour, the one who suffers along with the patient and represents the patient's cry for help.     

The knowledgeable practice of critical care nurses: a poststructural inquiry

BACKGROUND: Contemporary nursing literature emphasises the desirability of clinical nurses being "knowledgeable". However, the need for nurses constantly to acquire more knowledge is reiterated. Lack of knowledge is seen to underlie an array of professional problems. Little is known of how nurses themselves understand what it means to practise knowledgeably. OBJECTIVE: To explore critical care nurses' understandings of knowledgeable practice and its relationship to being a "good nurse". METHODOLOGY: A poststructuralist framework informed the study. The study participants were 12 critical care nurses. Data were generated through three individual focused interviews with each participant. Data analysis involved deconstruction of the interview texts to reveal participants' discourses of knowledgeable practice and the implications of these discourses for their subjectivity and for their work. FINDINGS: A discourse of knowledgeable practice was revealed as central to participants' sense of identity as "good nurses". Participants believed their knowledge resided in their heads ("knowing why") and in their hands ("knowing how"). Fluency of action, which was achieved and maintained by frequent repetition of activities, contributed to their sense of being knowledgeable. Participants described being excluded from knowledge in some instances. In general, however, "actual" knowledge was of less importance than was being positioned, by themselves and others, as knowledgeable. This positioning was frequently undermined by other staff, both medical and nursing. Analysis revealed that the discourse of knowledgeable practice was underpinned by a dichotomy of ignorant/knowledgeable, in which "ignorant" was the dominant category; hence, nurses were assumed to be ignorant until they could "prove" otherwise. CONCLUSIONS: The findings contest the notion, espoused in nursing literature, that acquisition of knowledge can "empower" nurses, thus providing the solution to problems they may experience. Rather, strategies are required that challenge and disrupt relations of power that construct nurses as "ignorant".     

Challenges of Nurses' Professional Behaviour Change Process

The aim of the study was to complement a project consisting of a planned modification of nurses' professional activities, which showed that nurses did not adopt a problem-solving approach to care after a specific in-service training. The aim of the study was to gain a better understanding of the ‘meanings’ that a group of nurses assigned to daily work, and how they perceived the changed situation. The main findings were that the nurses felt they had a limited degree of control over nursing care, a dependence on physicians, and consequently, used defensive strategies. The meaning assigned to nursing care was thus a series of pre-determined routines, though the nurses wished to increase the extent of interaction with patients. The study highlights the conflict between professional values and work values, as well as the gap between ‘espoused theories’ and ‘theories in use’. It is suggested that the process of change with regard to the nurses' professional behaviour, at unit level, is mediated by intrapersonal as well as by interpersonal factors such as the nurse's role and the nurse-physician relationship.     

The conflict management style of intensive care nurses

Much has been written about the causes of conflict in hospitals, however, little is known of how nurses deal with this conflict in the workplace. Few studies have examined the conflict management strategies used by nurse although such knowledge may suggest says to avoid this potentially disruptive phenomenon. In this research, 64 full-time female intensive care nurses were studied to determine the most commonly used conflict management stuyle in the workplace. An attempt was made to predict the predominant sample conflict management style from a knowledge of a nurse age, years qualified as a nurse, ethnicity and educational background. Also, the same variables were used to determine an individual's conflict management style. The conflict management style most commonly encountered in the sample was avoidance. This suggests that staff are unlikely to be assertive, and will try to distance themselves from the source of dispute. The predominant conflict management style of the sample (avoidance) could not however be accurately predicted from a knowledge of the above variables, nor could they be used to determine an individual's predominant conflict management style.     

Missed nursing care as an ‘art form’: The contradictions of nurses as carers

This article draws on the free‐text commentaries from trans‐Tasman studies that used the MISSCARE questionnaire to explore the reasons why nurses miss care. In this paper, we examine the idea that nurses perpetuate a self‐effacing approach to care, at the expense of patient care and professional accountability, using what they describe as the art of nursing to frame their claims of both nursing care and missed nursing care. We use historical dialogue alongside a paradigmatic analysis to examine why nurses allow themselves to continue working within settings that put their professional/personal selves aside in an attempt to deliver care within constraints that make completing care an impossible task. The findings suggest an ambivalence and conflict confront nurses attempting to provide care within the New Public Management environment. This can be seen in the tensions that draw a line between care as an art, and care as a financial target, juxtaposed with the inherent clash of values arising from the way nursing care is conceptualised within two contradictory paradigms.     

Spanish primary health care nurses who are smokers: this influence on the therapeutic relationship

Aim:  To identify the perception of Primary Health Care (PHC) female nurses in the Balearic Islands in Spain who are smokers, regarding the suitability of their anti-smoking therapeutic relationships with their clients. Also, to identify what factors they consider may determine why nurses smoke less in PHC than in specialized care (SC).
Background:  Backed by the signing of the WHO Framework Convention on Tobacco Control (WHO FCTC), a new Anti-Smoking law has been in force in Spain since 2006. This legislation limits the places where tobacco may be consumed. PHC nurses, because of their professional abilities, their number and their direct contact with society on all accounts – both health- and illness-wise – and also because of the proven efficacy of their interventions in the fight against the smoking habit, are called upon to play an important role against the smoking habit in the 21st century.
Method:  A qualitative study using a semi-structured interview with 15 PHC female nurses who are smokers.
Findings:  Regarding the therapeutic relationship, basically two attitudes are adopted: first, blaming themselves and feeling uncomfortable and inadequate to be able to help someone to give up smoking or, second, considering themselves to be in an optimum situation in which to be able to help by sharing their addiction and thereby understanding and empathizing much more with clients. PHC nurses believe they smoke less than SC nurses as a result of a greater degree of awareness.
Conclusion:  We would suggest that SC nurses should acquire a more relevant role in the fight against the smoking habit. In light of their capacity, commitment and efficacy, we believe there is a case for total autonomy as far as their role as therapists in breaking smoking habits is concerned.     

Being professional and being human: one nurse's relationship with a psychiatric patient

BACKGROUND: The theoretical foundations and professional ideals of psychiatric nursing contain built-in contradictions. One central ideal is that nurses should use themselves as therapeutic instruments. The expectation that nurses should have both a professional and a human function is examined in this study. PURPOSE: The purpose of this study was to find out how nurses experience and interpret the contradictory demands of being both fellow human being and health professional in their work with patients. METHODS: An ethnographic research design including participant observation and narrative interviews with nurses working on an acute ward of a psychiatric hospital was used. The case of one nurse is analysed and discussed. FINDINGS: The study shows that when nurses themselves are 'therapeutic instruments', tensions are created. Contradictory demands produce difficult role conflicts. Nurses vary in the ways in which they interact with patients. The study shows how the nurse's own vulnerability can be a constructive element in patient care. It also shows that although the nurse is aware of this, she is also critical of her performance, feeling that it falls short of accepted professional standards. Her colleagues reinforce these standards. CONCLUSION: The ideal that psychiatric nursing should be a balancing act between intimacy and distance, between human and professional ways of acting, appears to be too harmonious and narrow a one. The study suggests that there is potential for professional development if nurses are able to recognize their own vulnerability. Critical examination and discussion of conventionally accepted ideals can help develop our knowledge of the profession.     

Nurses and requests for female genital mutilation: cultural rights versus human rights

In this article we focus on female genital mutilation. We analyse this problem as one of the most important issues of multiculturalism, which is also coming to the attention of the public in Italy as a consequence of the growing number of immigrants from African countries. The fundamental problem is about the acceptability of this practice: can female genital mutilation be permitted and, if so, on what basis? We will try to cope with this as a genuine conflict between culture-relative values and universal values, such as human rights. Some attention will be drawn to Italian law. Finally, the impact on nurses of requests for genital mutilation will be described.     

The professional self-concept of nurses: a review of the literature from 1992-2006.

OBJECTIVE: This paper will discuss some recent concerns about research in the area of the professional self-concept of nurses, and trace the development of the literature on professional self-concept of nurses over the last 14 years. PRIMARY ARGUMENT: Professional self-concept or how nurses feel about themselves as nurses is vital in examining current and future nursing practice and education, as it affects patient care. CONCLUSION: The essence of the paper is the identification of three streams of literature: (1) which has 'emerged from the development of the Professional Self-Concept of Nurses instrument'; (2) literature which fails to consider recent or current research in the area; and (3) 'well-conducted work in the topic area'. The implications for nurses, educators and students are presented.     

Nurses' ethical conflicts: what is really known about them?

The purpose of this article is to report what can be learned about nurses' ethical conflicts by the systematic analysis of methodologically similar studies. Five studies were identified and analysed for: (1) the character of ethical conflicts experienced; (2) similarities and differences in how the conflicts were experienced and how they were resolved; and (3) ethical conflict themes underlying four specialty areas of nursing practice (diabetes education, paediatric nurse practitioner, rehabilitation and nephrology). The predominant character of the ethical conflicts was disagreement with the quality of medical care given to patients. A significant number of ethical conflicts were experienced as 'moral distress', the resolution of which was variable, depending on the specialty area of practice. Ethical conflict themes underlying the specialty areas included: differences in the definition of adequacy of care among professionals, the institution and society; differences in the philosophical orientations of nurses, physicians and other health professionals involved in patient care; a lack of respect for the knowledge and expertise of nurses in specialty practice; and difficulty in carrying out the nurse's advocacy role for patients.     

Parent or nurse? The experience of being the parent of a technology‐dependent child

AIMS: This paper reports a study exploring parents' experiences of caring for a child who is dependent on medical technology, and in particular of performing clinical procedures on their own children. BACKGROUND: A group of children with a continuing need for the support of medical technology have emerged in community settings as a result of medical advances and government policies. Caring for these children has a significant social and emotional impact on parents, because of their specialized and intensive care needs. Obtaining appropriate and coordinated home support services is problematic. METHODS: Grounded theory techniques were used, and in-depth interviews were conducted with the parents of 24 children. FINDINGS: Parents' accounts revealed that their constructions of parenting were shaped by the nature of their role in caring for their child and by the transformation of their homes by medical equipment and personnel. They described themselves as having a role that had both parenting and nursing dimensions. Parents managed this tension and defined their role and relationship to their child to be primarily one of parenting by differentiating parental care-giving and its underpinning knowledge from that of professionals, particularly nurses. CONCLUSIONS: Parenting a technology-dependent child alters the meaning of parenting. Professionals need to recognize that providing care has a substantial emotional dimension for parents, and that they need opportunities to discuss their feelings about caregiving and what it means for their parenting identity and their relationship with their child. A key professional nursing role will be giving emotional support and supporting parents' coping strategies. Parents' perceptions of nurses raise questions about whether nurses' caregiving is individualized to the needs of the child and family, and whether parental expertise is recognized.     

Patients' and nurses' experiences of perioperative dialogues

BACKGROUND: Previous research has shown that perioperative visiting can aid the planning and implementation of nursing care by giving patients an opportunity to express their expectation and to receive information. This is in turn can reduce anxiety and stress. However, patients and nurses' experiences of this process have not been studied before. AIM: The aim of the research was to describe and interpret the meaning of nursing care experienced by patients and nurse anaesthetists or operating-room nurses (referred to as perioperative nurses) through the pre-, intra- and postoperative dialogues. METHODS: A hermeneutic approach was used when interpreting text from interviews with 10 patients after the operation and 10 nurses who were asked to write down their experiences after having conducted pre-, intra- and postoperative dialogues with their patients. The interpretation of the whole was: the common quality of the pre-, intra- and postoperative dialogues was continuity and the distinguishing quality was how the patient and nurse experienced continuity. FINDINGS: Continuity in 'the perioperative dialogue' from the patients' point of view is expressed as sharing a story and the body is in safe hands. From the nurses' point of view continuity means that professional nursing care becomes visible and that continuity gives meaning to the work. CONCLUSION: If perioperative nurses used the perioperative dialogue they could create continuity for patients and for themselves in the pre-, intra- and postoperative phases. The nurse is, in this context, the continuity and continuity gives the possibility of establishing a caring relationship and caring for the patient in a dignified way.     

Identidad de género y cuidados intensivos: influencia de la masculinidad y la feminidad en la percepción de los cuidados enfermeros

IntroductionNursing has essentially been the work of women. The increase in men incorporating into nursing makes us think about whether there are different ways of expressing and practicing a profession in relationship to gender.ObjectiveTo describe if there are different ways of perceiving and assessing ICU work from a gender perspective.MethodologyA qualitative phenomenological study. Sample: 6 male nurses and 6 female nurses from the ICU of the Hospital Universitario de Bellvitge (HUB). Data collection: In-depth semi-constructed interview. Content analysis.ResultsMale nurses describe ICU work in terms of autonomy in making decisions and professional competence. They claim responsibility for their identity as nurses and stress the low social recognition of the profession. They prioritize the responsibility of decision making over the final outcome and evaluate family satisfaction in terms of prestige and competence. They are more practical. Female nurses describe the work in terms of control and follow-up of the patient's evolution. They emphasize the final care outcome and evaluate satisfaction in terms of a relationship of confidence and warm patient care. They are more meticulous.ConclusionsThere are differences in how they classify their ICU work, in the self-evaluation of professional identity, behavior in the development of the nursing care and in perception of family satisfaction. No differences are observed regarding problem solving with the technology.     

Why hospice nurses need high self-esteem

This article discusses the relationship between personal and professional qualities in hospice nurses. We examine the notion of self-esteem in personal and professional identity. The focus is on two questions: (1) what is self-esteem, and how is it related to personal identity and its moral dimension? and (2) how do self-esteem and personal identity relate to the professional identity of nurses? We demonstrate it is important that the moral and personal goals in nurses' life coincide. If nurses' personal view of the good life is compatible with their experiences and feelings as professionals, this improves their performance as nurses. We also discuss how good nursing depends on the responses that nurses receive from patients, colleagues and family; they make nurses feel valued as persons and enable them to see the value of the work they do.     

Professional nurses' perceptions of the skills required to render comprehensive primary health care services

As multidisciplinary health team members, professional nurses play a vital role in the delivery of primary health care services. They require specific knowledge and skills to function effectively in the primary health care settings. In South Africa, however, professional nurses followed various training programmes. This has made it difficult for the professional nurses to be competent in rendering the full spectrum of comprehensive primary health care services, focussing on preventive, promotive, curative as well as rehabilitative care. In a setting where professional nurses have different qualifications it is possible that they do not recognise their own limitations. The research aimed to explore and describe the perceptions of professional nurses about the skills required and their own level of skills to render comprehensive primary health care services. A further aim of the research was to formulate guidelines for the facilitation of trained professional nurses to truly render quality comprehensive primary health care services, based on the findings. A qualitative design was followed. Participants were identified by means of purposive voluntary sampling and data was collected by utilising a semi-structured interview schedule. Twenty two participants were interviewed. After each interview field notes were written. Ethical aspects and confidentiality were taken into consideration. The researcher and a co-coder analysed the transcribed interviews by means of open coding. The findings indicated that the more comprehensively the professional nurses were trained, the more competent they felt. The less comprehensively trained, the more negative they experienced their work. They viewed their skills as ranging from adequate to inadequate, depending on their training. The conclusion was drawn that professional nurses' perceptions were congruent with the skills they possessed. Recommendations for nursing research, education and practice, including guidelines to facilitate trained professional nurses to truly render comprehensive primary health care, were formulated.     

Collaboration at risk: registered nurses' experiences on orthopaedic wards

Aim. To extract meaning from registered nurses’ lived experiences in their professional collaboration with orthopaedic surgeons. Background. Interprofessional collaboration between registered nurses and orthopaedic surgeons faces challenges on many levels. The literature offers theories on collaboration, but reality seems to be in conflict with theory, especially in somatic hospitals. Little empirical research on lived experience has been conducted in these settings. Method. I conducted narrative interviews with five registered nurses who work on orthopaedic wards in two different hospitals in Norway. I analysed the data using a phenomenological hermeneutical method inspired by Ricoeur’s theory of interpretation. Results. The registered nurses emphasised disparate expectations and priorities when they described collaboration. They felt their performance was hindered and had difficulty in being assertive about their own area of work. Collaboration was perceived from the perspective of relations with orthopaedic surgeons, which were perceived as difficult as indicated by the themes identified: disparate expectations and priorities; feeling emotionally burdened; keeping a distance; accepting difficult relations; and being confident in difficult relations. Conclusions. Registered nurses seem to focus on relations in work settings where chaos and unpredictability set the background for collaboration. They perceived relations through their focus on behaving responsibly. This highlights their resources and their ability to see and to meet others, as well as difficulties they experience in asserting the importance of their own professional sphere. Acknowledging strengths and weaknesses could help to strengthen nursing identity and make it more explicit. Relevance to clinical practice. Both resources and weaknesses are revealed that could be used by all healthcare workers to improve collaboration with colleagues, thereby enhancing patient care.     

Registered nurses’ perceptions of their professional work in nursing homes and home-based care: A focus group study

Background

In Sweden, as well as in most industrialised countries, an increasing older population is expected to create a growing demand for health care staff. Previous studies have pointed to lack of proficient medical and nursing staff specialised in geriatric care, which poses serious threats to the care of a vulnerable population. At the same time, there are studies describing elderly care as a low-status career choice, attracting neither nurses nor student nurses. Judging from previous research it was deemed important to explore how nurses in elderly care perceive their work, thus possibly provide vital knowledge that can guide nurse educators and unit managers as a means to promote a career in elderly care.

Objective

The aim of the present study was to illuminate how nurses, working in nursing homes and home-based care, perceived their professional work.

Method

This was a qualitative study using focus groups. 30 registered nurses in seven focus groups were interviewed. The participants worked in nursing homes and home-based care for the elderly in rural areas and in a larger city in southern Sweden. The interviews were analysed in line with the tradition of naturalistic inquiry.

Results

Our findings illustrate how nurses working in elderly care perceived their professional work as holistic and respectful nursing. Three categories of professional work emerged during analysis: (1) establishing long-term relationships, (2) nursing beyond technical skills, and (3) balancing independence and a sense of loneliness.

Conclusions

The findings are important as they represent positive alternatives to the somewhat prevailing view on elderly care as depressing and undemanding. Nurse educators might use the key aspects as good examples, thus influencing student nurses’ attitudes towards elderly care in a positive way. Elderly care agencies might find them helpful when recruiting and retaining nurses to a much needed area.