Professional uncertainty: nurses in the technologically intense arena

The implementation of medical technology in health care continues to escalate. Using a grounded theory methodological approach, nurses were interviewed regarding their feelings about medical technology and its impact on their practice. Through the medium of participant observation nurses were observed as they worked in a technologically intense general hospital in the United States. Nurses were ambivalent regarding the benefits of medical technology to nursing practice and patient care. In particular, they questioned whether the use of techniques facilitated relationships with patients or detracted from them. Findings showed that, in the practice setting, it appeared that most of the nurses' time was spent in co-ordinating, assessing and manipulating equipment. Technology structured nurses' time and gave their role some parameters. Technology also shaped the nurse-patient relationship and limited interactions to educational instruction, physical assessments and strategies to support the technology. Nurses' ambivalence regarding the benefits of technology appeared to be symptomatic of professional uncertainty. The hospital focus on technology is contrary to the considerable appreciation of the psychosocial nurse-patient relationship with which the neophyte nurse has been imbued. This practice-educational dichotomy causes role uncertainty for the registered nurse.     

The impact of surgical ward nurses practising respiratory assessment on positive patient outcomes.

OBJECTIVE: A literature review to examine the incorporation of respiratory assessment into everyday surgical nursing practice; possible barriers to this; and the relationship to patient outcomes. PRIMARY ARGUMENT: Escalating demands on intensive care beds have led to highly dependent patients being cared for in general surgical ward areas. This change in patient demographics has meant the knowledge and skills required of registered nurses in these areas has expanded exponentially. The literature supported the notion that postoperative monitoring of vital signs should include the fundamental assessment of respiratory rate; depth and rhythm; work of breathing; use of accessory muscles and symmetrical chest movement; as well as auscultation of lung fields using a stethoscope. Early intervention in response to changes in a patient's respiratory health status impacts positively on patient health outcomes. Substantial support exists for the contention that technologically adept nurses who also possess competent respiratory assessment skills make a difference to respiratory care. CONCLUSIONS: Sub-clinical respiratory problems have been demonstrated to contribute to adverse events. There is a paucity of research knowledge as to whether respiratory education programs and associated inservice make a difference to nursing clinical practice. Similarly, the implications for associated respiratory educational needs are not well documented, nor has a research base been sufficiently developed to guide nursing practice. Further research has the potential to influence the future role and function of the registered nurse by determining the importance of respiratory education programs on post-operative patient outcomes.     

Something special: forensic psychiatric nursing

In this paper the claims that forensic psychiatric nursing has achieved the status of a specialist area of nursing are refuted. An examination of the literature demonstrates that specialist knowledge and skills have not been documented. It is suggested that three requirements are necessary if forensic psychiatric nurses wish to achieve specialty status. Forensic nurses have to consolidate their role in the containment and care of patients, they have to return to the nurse-patient relationship as the foundation of psychiatric nursing practice, then, within that relationship, nurses must expand their practice to include dealing with offence issues.     

Interactions between nurses and patients--a classical study in acute psychiatry

This is a classical contact and interaction study of psychiatric nursing in a Scottish teaching hospital in the 1960s which in the meantime has lost none of its validity and relevance for psychiatric nursing practice. Its aim was to examine interactive processes and to elucidate the meaning of a nurse-patient relationship by way of non-participant observation, protocols, and interviews with patients and nurses. Data were obtained from 113 patients and 40 nurses of four admission wards in 16 weeks of observation which totalled 152 hours. Interviews were held with 99 patients and 37 nurses. Interaction patterns of nurses and patients were correlated with diagnosis, age, length of hospital stay and social class. Twelve "pairs" were found where the patient and the nurse were conscious of a special relationship between them. Generally the analysis did not discover that nurses had a conceptual basis to examine the purpose of interactions and relationships. A significant result of this study was that 41.6% of all patients who mainly suffered from depressive illnesses had no individual contact with nurses at all. Another result showed changing interaction patterns with a very rapid decrease in interaction rates after a short stay in hospital.     

Point of care ultrasound use by Registered Nurses and Nurse Practitioners in clinical practice: An integrative review

BackgroundNurses and nurse practitioners (NPs) are utilising point of care ultrasound (PoCUS) in practice. PoCUS is a useful tool to enhance clinical assessments and improve patient care. There have been no published literature reviews on this topic.AimsThe objective of this review is to examine the literature on PoCUS and draw conclusions to determine the implications of the use of PoCUS by registered nurses and nurse practitioners to inform nursing practice.DesignIntegrative review.MethodsData bases MEDLINE, EMBASE, CINAHL and Google scholar were searched for relevant articles between 2008 and 2018. The inclusion criteria were registered nurses and nurse practitioners using PoCUS in their clinical practice. Articles retrieved were in English and with full text. Articles were assessed for quality using TREND and a PRISMA flowchart is presented.FindingsSix eligible articles were examined identifying major findings of education in PoCUS, accuracy and mastery of a skill and clinical influence.DiscussionAn evaluation of the use of PoCUS by registered nurses and nurse practitioners provides evidence of its efficacy and potential to improve patient care and inform nursing practice.ConclusionSome registered nurses and nurse practitioners are expanding their scope of practice to include PoCUS to improve patient care. PoCUS requires investment in time and education.     

Registered nurses' and student nurses' assessment of pain and distress related to specific patient and nurse characteristics

Previous studies examining the influence of patient and nurse characteristics on assessments of pain and distress are not consistent in their results. Few studies have focused on the influence of nurses' personality factors on the assessment of pain and distress. The aims of this study were to compare registered nurses' and student nurses' assessments of patients' pain and distress and to identify if the assessment relate to specific patient and nurse characteristics. Seventy-one registered nurses and 184 student nurses assessed pain and distress in three hypothetical cases and responded to personality factors scales. The assessments of pain and distress regarding the patients showed significant differences. The respondents were divided into two groups, respectively, for each patient according to whether the patient's experiences of pain and distress were assessed as more or less intense. Both the groups of registered nurses and student nurses showed significantly differences on personality factors. The groups of student nurses also differed on nursing experience. Patients' age, and type and stage of illness, personality factors, and nursing experience influenced the respondents' assessments. These findings can be used to help educators in nursing to develop strategies to improve skills and knowledge in the assessment at pain and distress.     

The nurse-patient relationship results of an examination about relationships between patients and nurses in hospitals

The nurse-patient relationship has received particular attention in the relevant literature. For patients in life threatening and existentially challenging situations, nursing activities often require a close intimacy. A good nurse-patient relationship is a precondition for effective nursing interventions, but by itself also contributes to the healing process. How such a relationship is realized in everyday nursing situations remains, however, unclear Literature predominantly details normative expectations on the nurse-patient relationship that are based on nursing theory or concepts from humanistic psychology. The operationalisation of these concepts into nursing practice is not given. In order to answer the research question "How do nurses experience their relationship with the patient?" qualitative interviews were conducted. Thus, the nurse-patient relationship was explored from the perspective of the nurses and considered in the context of their specific working situations. Nurses related their experiences, emotions and stress resulting from different kinds of nurse-patient relationships. Data were collected, organised and analysed following Giorgi's 1985 phenomenological analysis. Results show an ambivalence by nurses between closeness and distance in their relationship with patients. These relationships also show a polar vascillation between, for example, "sympathy" and "antipathy", or "being able to help" and "helplessness". The development of the relationship is often not very professional and depends on the specific situation and those individual persons participating in it. It is also apparent that those models of the humanistic psychology which have been discussed in nursing contexts cannot serve as such as a basis for the development of the nurse-patient relationship. A particular aspect of developing relationships in nursing are nursing interventions which necessitate bodily contact and physical work with patients. Concepts including these aspects of nursing can serve as valid and concrete starting points in order to find a way unique to nursing to create effective relationships with patients.     

Assessing successful entry into nurse practitioner practice: a literature review

Nurse practitioners (NPs) have been the subjects of many studies focused on role performance, cost effectiveness, and acceptance in clinical practice. As part of a study to compare successful entry of NP program graduates from various backgrounds into NP practice, a review of the literature was performed. This literature review focuses on research studies that examine successful entry into NP practice by seasoned registered nurses as well as by non-nurse college graduates who have no prior nursing experience. The topical areas that emerged from the literature were educational background and experience as a registered nurse, socialization into practice, transition into NP practice, and evaluation measures of successful NP practice. The results of the literature review revealed the need for further work on assessment of successful entry into NP practice.     

Integrating foot care into the everyday clinical practice of nurses

Foot care is an integral part of a patient's daily hygiene requirements, yet the authors have found it to be an area often neglected by nurses. Foot and toenail problems present a considerable challenge to nurses in all healthcare settings, especially for patients with diabetes. However, patients without diabetes also suffer from minor foot abnormalities or injuries that might have been preventable. One acute hospital ward has worked closely with the chiropody department to improve the nursing team's competence and confidence in foot hygiene assessment and toenail clipping and has, therefore, improved the patient experience during hospital admission. This article describes how the nursing team used education to improve the foot care services offered to patients.     

Nurse-patient interaction and decision-making in care: patient involvement in community nursing

AIM: This paper reports a study to identify the extent to which community nurses incorporate patient involvement in decision-making into their everyday clinical practice. BACKGROUND: The complexity underlying the concept of patient participation is not always recognized. It links the notions of 'passive patient' and 'active participant', hence its usage along with those of similar terms such as 'partnership', 'involvement' and 'collaboration' is often ambiguous. The literature on this subject is fairly extensive and often contradictory; it encompasses the participation of potential as well as actual patients. Hierarchical structures have been proposed to offer an understanding of the current nature of patient participation, and these have sometimes linked the level of participation to the quality of the nurse-patient relationship. Much work has been done in the area of cancer care, where it has been noted that the role of 'passive patient' may in itself be a deliberate choice. METHODS: The approach was ethnographic and data were collected during 2000 and 2001 by participant observations with 22 nurses and 107 patients; 137 interactions were observed in all. Detailed field notes were kept and then carefully interpreted. The approach to rigour was primarily concerned with ensuring credibility. FINDINGS: The extent to which nurses involved patients in making decisions about their care, and the manner in which this was achieved, varied considerably. Collectively, the behaviour of participants is presented as the 'involving-non-involving continuum', with five typologies of behaviour: 'completely involving'; 'partially involving'; 'forced involving'; 'covert non-involving' and 'overt non-involving'. The findings highlight that caring for people in their own home does not necessarily mean that patients are involved in care and treatment decisions. CONCLUSION: This observation study of the extent to which community nurses involved patients in decision-making in nursing care offers some useful insights into one aspect of nursing work. The implications of the study are far-reaching. The findings suggest that it could be important for nurses and their managers to devote more time to relationship-building in nursing practice. They also offer a perspective--the involving-non-involving continuum--that could usefully be incorporated into nurse education at both pre- and postregistration levels.     

护患角色情景模拟在护理服务质量管理中的应用

目的探讨护患角色情景模拟在护理服务质量管理中的应用效果。方法选择主题中需探究的问题进行情景构思;护士选择角色,护士长布置有针对性的观察思考任务;以点代面,在全院开展护患角色情景模拟学习讨论。结果100%的护士对护患角色情景模拟的学习交流形式感兴趣;98.4%的护士认为对自己今后的工作有指导作用;97.5%的护士认为情景模拟中的规范服务型护理在临床工作中能做到。5个情景模拟中规范服务型护理在实际工作中容易做到的依次为:白班新病人入院接待100%,皮内试验99.0%,查体温97.3%,夜班收治新病人90.0%,接待咨询者74.0%。11月份全院护理服务质量满意度为97.9%,比9月份上升2.9%。结论护患角色情景模拟在护理服务质量管理中的应用是提高护理服务质量的有效途径。     

护理风险管理新进展

本文从护士、患者、药物、医院卫生学、护理文书、告知行为、护息沟通等方面分析了产生护理风险的相关因素,并提出相应的管理对策.包括:加强风险教育,提高护士或护理管理人员对风险的识别和评估能力;提高护理技术水平和职业道德素养;健全风险管理机制;加强护患沟通,建立良好的护患关系;积极处理风险事件等,有效地推进科学化、系统化、制度化的护理质量管理工作,为患者提供更安全、有序、优质的护理服务.     

Perceiving risk in dangerous situations: risks of violence among mental health inpatients

BACKGROUND: Violence in British psychiatric hospitals appears to be escalating, with nursing staff the most frequent victims of assault. There is also public concern about violence on the part of individuals with mental health problems. In this climate, assessing a patient's risk of violent behaviour has become an important part of mental health care. However, little research has been published into how mental health nurses undertake such assessments in their day-to-day clinical practice. AIM: The study focused on how mental health nurses make assessments of risk in clinical crisis situations where there is a perceived likelihood of imminent violence. The study sought to identify skills, cognitive processes or any other mechanisms which nurses draw upon to assist in such assessments. METHOD: Ten experienced mental health nurses working in a secure mental health environment were interviewed and data generated was analysed using a grounded theory approach. An in-depth literature search was also undertaken. FINDINGS: It was found that, in their risk assessments, nurses rely extensively on their personal knowledge of their patients (in particular, previous history of violent behaviour; biographical data; and impact of the mental health problem on violent behaviour). Nurses 'tune in' to potentially violent situations by observing a scenario as a whole, as well as specific aspects of a patient's behaviour, whilst also searching for causes of the violent behaviour. In making clinical risk assessments, nurses often make rapid, intuitive judgements in which various possibilities are considered regarding the likelihood of violent behaviour (such as the capacity and capability of a patient to be violent and the potential in the situation). It was also found that the ability to intervene successfully in potentially violent situations reduced the level of risk that nurses felt exposed to, and here nurses draw on their knowledge of a particular patient. They also perceive lower levels of risk when working in a skilled team. CONCLUSION: The study indicates that the development of nurse-patient relationships and working in a supportive team are perceived as protective factors against risk. Implications of the research are discussed in relation to nurse-patient relationships, particularly in the context of the current nursing climate and the way in which violent behaviour may lead to an erosion of these relationships. The importance of 'working in a team' is discussed, as is the consequence of the findings for education and development. Methodological limitations of the study are also discussed.     

The norms and values held by three groups of nurses concerning psychosocial nursing practice

Research findings indicate that nurses often fail to provide patients with supportive psychosocial nursing care. The reasons for this and the norms and values on which nursing practice is predicated are unknown. The norms and values of three similar groups of nurses concerning psychosocial nursing care were inferred from observation and analysis of the nurses' interactions with each other, with other hospital personnel and with patients. Each group was observed for 5-7 weeks while working on one of three selected medical floors in the same hospital. Each group of nurses had norms and values which were discernable in typical behavior patterns, characteristics, explicit and implicit expectations, orientations, beliefs and attitudes. Two head nurses greatly influenced selection and enforcement of their groups' norms and values. The third group had not developed work-oriented norms and values. Nurses did not usually collaborate with other health-care professionals in the interests of their patients. The head nurses performed this function for each group. All nurses demonstrated knowledge of psychosocial nursing concepts but patient care was usually limited to physical nursing care, giving medications and meeting patients' verbally expressed requests for assistance. Nurses did not respond to or seem to notice patients' non-verbal or incoherent distress. They referred patients who exhibited disruptive behavior to other health professionals without delay. Patients who did not require physical nursing care had little opportunity for interaction with nurses. All three groups had work schedules which facilitated the typical style of nurse-patient interaction on each unit. These interactions were: cool, efficient and rushed on one unit; casual, warm and somewhat superficial on the second unit; brusque and business-like on the third unit. Nurses used social/moral assessment of patients which was facilitated by nurses telling each other anecdotes concerning patients. These anecdotes facilitated one group's typical humane, and two groups' typical dehumanizing nurse-patient interactions. The researcher concluded that group dynamics require consideration when planning nursing care delivery systems and that nurses need to develop pragmatic, supportive, psychosocial nursing interventions.     

Associations of nurse education level and nurse staffing with patient experiences of hospital care: A cross sectional study in China

Strengthening the nursing workforce is core to health system reform in China. Patient experiences of hospital care have been recognized as important in this endeavor. Studies exploring the relationships between nursing workforce and patient experiences of hospital care, however, are scarce. The aim of this cross-sectional study was to examine the associations between nurse education level, nurse staffing, and hospitalized patients’ experiences of hospital care. Participants were 1,582 nurses responsible for direct care and 1,305 hospitalized patients from 23 hospitals in Guangdong province, China in 2014. Education level of nurses was measured by the proportion of nurses holding a baccalaureate or higher degree. Nurse staffing was measured by the unit nurse-patient ratio. The Hospital Consumer Assessment of Health care Providers and Systems Scale was used to measure patient experiences of hospital care. Structural equation modeling demonstrated that a higher proportion of nurses holding a baccalaureate or higher degree was related directly to better patient perceptions of communication with nurses, responsiveness of nurses, pain management, and physical environment, and related indirectly to overall hospital ratings and recommendation of the hospital. A higher nurse-patient staffing ratio was associated directly with better patient perceptions of communication with nurses, education about new medications given in hospital, and physical environment, and indirectly with overall ratings and recommendation of the hospital. Our findings add new evidence in the Chinese societal context about the relationship between the nursing workforce and patient experiences of hospital care. Upgrading nurse education level and increasing nurse staffing could potentially improve patient experiences of hospital care.     

Physical assessment: implications for nurse educators and nursing practice

AIM: In New Zealand, the physical assessment of a patient has traditionally been the domain of the medical profession. As a country implementing advanced practice roles, with an expectation that both nurse practitioners and registered nurses will use physical assessment skills, the relevancy of physical assessment for each scope of practice has currency. The aim of this literature review was to discover what could be learnt from the experiences of Western countries that already incorporate physical assessment skills into nurses' health assessment. FINDINGS: Nurses in the USA, and more recently Canada and Australia, readily incorporate physical assessment skills into their nursing practice as a component of health assessment. The international literature identified that any change to the nurse's role in health assessment, to include physical assessment skills, requires strategies that involve the regulatory, educational and practice components of nursing. CONCLUSION: Nurses and other health professionals must perceive that this role expansion will improve health outcomes for the diverse populations accessing health care. Teaching physical assessment skills within a holistic health model will enable nurses to contribute a more comprehensive health assessment to the planning and monitoring of people's health care.