Expertise among critical care nurses: A grounded theory study

ObjectivesExplore critical care nurses’ personal perceptions of expertise, expert performance and transition from novice to expert performer in clinical practice.DesignFollowing constructivist approach to grounded theory this investigation used qualitative open-ended interviews focused on the social construction of expertise in critical care nursing and the experiences of clinical practice that define that process.SettingA multi-site urban area in the southeastern United States.Participants10 certified critical care nurses, three males and seven females, with 10–30+ years of critical care experience.FindingsExperience and knowledge are the foundation of expertise and expert performance. The higher the acuity the more frequent the experience the greater the nurses’ aptitude and opportunity for learning and professional growth. It was also noted that self-actualisation was a major determinant in the development of expertise in critical care.ConclusionKey findings suggested that clinical experience and personal motivation combined with self-actualisation, the drive to maximise personal potential, determine critical care nurse’s trajectory towards professional excellence. Expert performance evolves over time. Knowledge acquisition and experience have an interdependent reciprocal relationship inferring that you cannot have one without the other. Social expectations and experiences have a direct impact on professional aptitude and development if expertise.     

An exploratory model of advance care planning clinical training for oncology nurses: A constructivist grounded theory study

AimThe purpose of this study was to explore and construct the ACP clinical training model for oncology nurses to provide the theoretical references for nursing educators to develop ACP clinical training program for oncology nurses.BackgroundOncology nurses are the primary forces of advance care planning (ACP) clinical practice. However, the systematic ACP clinical training for clinical nurses, especially oncology nurses, is still not visible in mainland China.DesignA constructivist grounded theory study.SettingsThis study included participants from three tertiary hospitals in northeastern China.ParticipantsA total of 23 oncology nurses who directly care for cancer patients.MethodsA constructivist grounded theory approach was adopted to explore the ACP clinical training model for oncology nurses. Semi-structured interviews were completed to collect qualitative data for constructing the theoretical model. A three-level coding procedure with continuous comparisons was adopted to analyze the qualitative data.ResultsAs a result of the study, a total of 32 open coding categories and 13 axial coding categories were extracted and four selective coding categories were formed, namely, external driving forces, self-development, training needs and training key elements. Based on the above categories, the demand-driven ACP clinical training model for oncology nurses was finally developed.ConclusionsOncology nurses have a strong desire for ACP clinical training and their ACP training needs are diverse. The ACP clinical training model provide the theoretical references for nursing educators to develop ACP clinical training programs for oncology nurses to promote high-quality ACP clinical practice.     

基于扎根理论探究伤口造口失禁专科护士选择互联网+延续性护理的影响因素及作用路径

目的：探究影响伤口造口失禁专科护士选择互联网+延续性护理的因素及其作用路径。方法：采用建构扎根理论方法,通过对11名有互联网+延续性护理经验的专科护士进行半结构化深度访谈收集数据,对数据进行初始编码、聚焦编码、理论编码最终形成理论框架。结果：影响伤口造口失禁专科护士选择互联网+延续性护理的因素围绕“安全”这一核心要义分为促进因素和制约因素。促进因素包括职业价值、资源优化和社区支持;制约因素包括患者安全风险、家属照顾水平、客观执业条件以及护士执业风险。其中患者安全风险受社区支持、家属照顾水平、客观执业条件的影响。结论：“安全”是影响伤口造口失禁专科护士选择互联网+延续性护理的核心要义,应从完善法律法规、加强平台建设、制定规章制度、加强社区支持等方面,促进互联网+延续性护理的安全发展。     

Student nurses' attitudes to illicit drugs: a grounded theory study

The aim of this research was to identify the factors that influence the attitudes of student nurses towards illicit drugs. This insight is important in providing a foundation for the development of educational approaches aimed at challenging what appear to be negative attitudes to illicit drug users within nursing. The absence of a testable hypothesis prior to the investigation led to the generation of theory from the data (inductive enquiry) with a constructivist approach to grounded theory (Charmaz, 2006), being employed. Data generation involved informal conversational interviews (n=12), semi-structured interviews (n=9), four focus groups and an audit of the education received by students (n=61) around substance misuse issues. The final grounded theory indicated that: Student nurses enter training with a wide range of personal experiences relating to illicit drug use. The influences of society's negative views and the image of drug use presented in the press appeared to be significant factors in developing their attitudes on the subject. In the absence of effective approaches to education, and given that many professionals in the practice environment appear to view illicit substance users in a negative way, it is likely that interventions with identified drug users will be influenced by negative attitudes.     

静脉治疗专科护士的临床培训实践

在静脉治疗专科护士临床实践培训中采用专人负责制,即经过专科理论及模拟人操作培训,考核成绩合格的学员才能进入临床实践培训;选拔优秀的护理专家担任临床教师,根据静脉治疗专科护士临床实践的培训目标、计划和量化指标的要求,进行有计划、全面、全程、及时、有效的督导,高标准完成对学员的临床培训。该次培训的13名学员均以优秀的成绩取得静脉治疗专科护士证书,且全部成为各医院静脉治疗护理小组的骨干;学员和教师对专人负责制临床带教模式的总体满意率分别为98.65%和97.70%。     

手术室专科护士核心能力现状调查

目的了解手术室专科护士核心能力现状,探讨其影响因素,为护理管理者合理安排工作岗位提供依据。方法采用方便抽样方法抽取83名手术室专科护士。采用护士一般情况调查表、中国注册护士核心能力量表进行调查。结果专科护士核心能力总分（169．77±33．86）分,专科护士的核心能力维度中法律／伦理实践均分最高（3．16±0．57）,评判性思维／科研均分最低（2．76±0．62）;多元线性逐步回归结果显示职称影响专科护士核心能力（t=2．89,P=0．01）。结论专科护士核心能力处于中等水平,护士能够胜任临床工作。护理管理者应有针对性的制定干预措施,以提高护理质量,促进护理队伍的整体发展。     

Preparing healthcare students who participate in interprofessional education for interprofessional collaboration: A constructivist grounded theory study protocol

This article presents a qualitative research protocol to explore and understand the interprofessional collaboration (IPC) preparation process implemented by clinical tutors and students of different professions involved in interprofessional education (IPE).

Many studies have shown that IPE initiatives improve students’ understanding of the roles and responsibilities of other professionals. This improves students’ attitudes towards other professions, facilitating mutual respect, and IPC. However, there is limited information about how students are prepared to work collaboratively within interprofessional teams. This is a constructivist grounded theory (GT) study, which will involve data collection through in-depth semi-structured interviews (to 9–15 students and 6–9 clinical tutors), participant observations, and the analysis of documentation. After analysing, coding, integrating, and comparing the data if necessary, a second round of interviews could be conducted to explore any particularly interesting aspects or clarify any issues. This will then be followed by focused and theoretical coding. Qualitative data analysis will be conducted with the support of NVivo 10 software (Victoria, Australia). A better conceptual understanding will help to understand if IPE experiences have contributed to the acquisition of competencies considered important for IPC, and if they have facilitated the development of teamwork attitudes.     

Playing the game: A grounded theory of the integration of international nurses

BackgroundMigration trends to Australia have seen an increase in international nurses, with twenty-nine percent of current registered nurses having received their first nursing qualification outside of Australia. The process international and local nurses navigate to enable successful integration into the Australian healthcare system is unclear.AimTo explore how international nurses and Australian nurses adapt to work together in the Australian healthcare system and to develop a theory that explains this process.MethodsGrounded theory methodology was used. Concurrent data collection/generation and analysis of online-survey data (n = 186) and in-depth interviews (n = 15) was undertaken. Storyline was used as a technique of analysis to develop, construct and present the theory. Focus groups (n = 9 + 7) were conducted to confirm the relevance of the theory.FindingsNurses work together to enable successful integration of international nurses. Four phases underpin this adaptation to the cultural norms of the workplace: (i) Joining the game; (ii) Learning the game, (iii) Playing by the rules, and (iv) The end game. These phases comprise the grounded theory Playing the game: Integration of internationally qualified registered nurses in the Australian healthcare system.DiscussionAdditional orientation programs and collegiate support for international nurses were significant factors influencing successful adaption to the cultural context of the work environment. Defining the role and scope of practice of the registered nurse in the Australian context provided challenges.ConclusionSupportive colleagues were critical to successful integration and retention of experienced nurses irrespective of where nurses obtain their nursing qualification. Additional orientation programs for international nurses could improve the experience of nurses migrating to work in Australia.     

浅谈儿科静脉治疗专科护士培养的必要性

目的 探讨儿科静脉治疗专科护士培养的必要性.方法 采取随机抽样的方法,将本院的儿科护士中随机抽取护士50名设为实验组,再从本院普通科室中随机抽取5个科室(呼吸内科、普外科、神经内科、心内科和胸外科),再分别随机各抽取10名护士(共50名)设为对照组,分别进行问卷调查.结果 患者及家属对普通科室护士的满意度比儿科高,儿科护士工作压力比普通科室大,儿科护士工作强度比普通科室大,儿科护士职业倦怠感比普通科室明显,儿科护士穿刺成功率比普通科室护士穿刺成功率低,5项存在差异(P＜0.05).专科知识掌握情况和工作效率两项无差异(P＞0.05).结论 儿科护士临床工作中存在着诸多问题,有必要培养儿科静脉治疗专科护士来弥补常规医护工作中的不足.     

外科护士术后疼痛管理的扎根理论研究

目的 了解外科护士对术后疼痛管理的认知水平及相关影响因素,以及干预措施对其的影响,为外科护士进行更为有效的术后疼痛管理提供理论依据.方法 主要运用质性研究中的扎根理论研究,以三角交叉检视法对资料进行收集,包括护士的深度访谈和观察以及护士和患者问卷调查等资料收集,共回收患者问卷98份,护士问卷25份.运用持续比较方式进行资料分析,归纳出影响护士术后疼痛管理的相关因素,并予以干预措施,交叉对比分析干预前后外科护士疼痛管理知识水平和行为的改变情况.结果 干预后外科护士术后疼痛管理的知识水平和行为均有不同程度的提高.干预后患者满意度问卷调查亦较干预前有显著的提高.外科护士自我意识提升影响术后疼痛管理水平的理论模型包括概念结构、促进因素和结果3个部分.结论 外科护士自我意识的提升可提高术后疼痛管理水平.     

广东省糖尿病专科护士工作现状调查及分析

目的 了解经培养的广东省糖尿病专科护士的工作现状.方法 采用自行设计的专科调查表,对首批糖尿病专科护士研究生班的9名学员有进行问卷调查.结果 全职从事糖尿病专科护士工作的1人,1人从事专科护士管理工作,1人已基本上没有从事糖尿病护理工作,其余6人均兼职从事糖尿病护理工作.8名专科护士们均有开展糖尿病专科护理会诊、护理查...     

Sifting,sorting and saturating data in a grounded theory study of information use by practice nurses: A worked example

The terminology used to analyse data in a grounded theory study can be confusing. Different grounded theorists use a variety of terms which all have similar meanings. In the following study, we use terms adopted by Charmaz including: initial, focused and axial coding. Initial codes are used to analyse data with an emphasis on identifying gerunds, a verb acting as a noun. If initial codes are relevant to the developing theory, they are grouped with similar codes into categories. Categories become saturated when there are no new codes identified in the data. Axial codes are used to link categories together into a grounded theory process. Memo writing accompanies this data sifting and sorting. The following article explains how one initial code became a category providing a worked example of the grounded theory method of constant comparative analysis. The interplay between coding and categorization is facilitated by the constant comparative method.     

手术室专科护士客观结构化临床考试站点设置的研究

目的：构建针对手术室专科护士的客观结构化临床考试（OSCE）站点,以对培训后手术室专科护士的综合能力进行评价。方法运用文献资料法、德尔菲法对27名专家进行两轮函询,确定手术室专科护士OSCE站点及考核内容。结果2轮函询专家的权威系数分别为0．88,0．91,积极性系数分别为92．59％,100％,共构建考核站点14个。结论本研究构建的考试站点可为今后的OSCE评价提供科学依据,促进手术室专科护士培训工作的顺利开展。