Identifying emotional intelligence in professional nursing practice.

The National Center for Health Workforce Analysis projects that the shortage of registered nurses in the United States will double by 2010 and will nearly quadruple to 20% by 2015 (Bureau of Health Professionals Health Resources and Services Administration. [2002]. Projected supply, demand, and shortages of registered nurses, 2000-2020 [On-line]. Available: http:bhpr.hrsa.gov/healthworkforce/reports/rnprojects/report.htm). The purpose of this study was to use the conceptual framework of emotional intelligence to analyze nurses' stories about their practice to identify factors that could be related to improved nurse retention and patient/client outcomes. The stories reflected evidence of the competencies and domains of emotional intelligence and were related to nurse retention and improved outcomes. Nurses recognized their own strengths and limitations, displayed empathy and recognized client needs, nurtured relationships, used personal influence, and acted as change agents. Nurses were frustrated when organizational barriers conflicted with their knowledge/intuition about nursing practice, their communications were disregarded, or their attempts to create a shared vision and teamwork were ignored. Elements of professional nursing practice, such as autonomy, nurse satisfaction, respect, and the professional practice environment, were identified in the excerpts of the stories. The shortage of practicing nurses continues to be a national issue. The use of emotional intelligence concepts may provide fresh insights into ways to keep nurses engaged in practice and to improve nurse retention and patient/client outcomes.     

Toward a mid-range theory of nursing presence

BACKGROUND. Presence is widely accepted as a core relational skill within the nursing profession. Nurse educators are challenged to ensure that the humanistic aspects of client care are included in the Bachelor of Science in Nursing (BSN) curriculum. Introducing and teaching presence skills early in the BSN curriculum will ensure the essential value of relational engagement with clients. Nursing literature, however, notes presence is a challenging concept for BSN students. Articulating a mid‐range theory of nursing presence will facilitate students' conceptual understanding of presence and guide nurse educators to teach presence skills. AIMS. To propose a mid‐range theory of nursing presence. Within the theoretical model, identify development opportunities to improve student nurse use of presence as a relational skill. METHODS. An extensive literature review was conducted. Materials were synthesized and the mid‐range theory was developed. DISCUSSION. Kim's nurse‐client domain provided the perspective that guided the parameters of the theory. Professional nursing presence is dependent upon the combination of five variables: individual nurse characteristics, individual client characteristics, shared characteristics within the nurse‐client dyad, an environment conducive to relational work, and the nurse's intentional decisions within the practice domain. The variables are described and the relationships among variables depicted in the model. Specific nurse‐sensitive points during a nurse‐client interaction determine or influence the nurse presence intervention and dose. Areas designed to teach or improve relational skills are identified for the BSN educator. CONCLUSION. A mid‐range theory of presence contributes to our understanding of the relational aspects of nursing practice within the contemporary healthcare environment. Identifying strategies to teach BSN students presence skills will facilitate the incorporation of the humanistic aspects of client care in the undergraduate curriculum.     

Creating reporting and learning cultures in health-care organizations

Patient safety has emerged as an important issue in Canadian health care, as reflected in the Canadian Council on Health Services Accreditation's patient/client safety goals. Achieving these goals calls for concerted efforts within health-care organizations. To assist nurse leaders in their efforts in developing a culture of safety that is receptive to reporting and learning from adverse events and near misses, the authors explore the challenges and provide four recommendations for action. By enacting these recommendations, nurse leaders can support the analysis and actions necessary to identify improvements that will create safer health-care environments.     

Black American folk medicine health care beliefs: implication for nursing plans of care.

Even in this age of information, some African Americans equate good health with luck or success. An illness or disease, viewed as undesirable, may be equated with bad luck, chance, fate, poverty, domestic turmoil, or unemployment, and in such case, Black Americans will consult a physician only after attempts with home remedies have failed. It is important for the nurse when working with Black patients, remember that when this patient enters the traditional bio-medical health care delivery system, it is best to assume that all known and available cultural home remedies have been tried. According to Bloch (1976), some Black Americans believe that the nurse should recognize cultural medical practices and the western medical remedies based on these beliefs. It is essential that the nurse determine whether these home remedies will interact or interfere with orthodox medical approaches. If home remedies are found to be efficacious or neutral. they may be kept at the patient's bedside. However, if they are found to be harmful, the nurse should assist the patient in developing an understanding about the remedies' dangers. With an emphasis on education, the patient can be navigated toward modern medical preventive techniques and cures, and the nurse may observe and judge the variety and efficacy of age-old culturally entrenched health care practices. Future studies may just substantiate the science behind the folklore.     

Nursing law violations. A threat to competent and safe nursing practice

Nurse Practice Act violations pose threats to consumers of nursing services and lead to disciplinary actions against nurses by boards of nursing. To analyze nursing law violations, the actions and decisions of boards of nursing, and evaluate trends in negligent and unsafe nursing practice, the authors reviewed nursing law violations as well as rates of recidivism among nurses who received actions against their nursing licenses in Kentucky. The authors discuss how their findings can assist nurse administrators in investigating nurse care givers before employment and in initiating safeguards against nurse violations that affect client safety.     

Partnership in education: an example of client and educator collaboration

This article describes one education strategy designed to assist nursing staff in the process of "learning to surrender" the service providers' need to direct client decision-making. Using the health promotion principle of "client as expert," a nurse educator and a client with advanced multiple sclerosis co-present an inservice class about the importance of personal empowerment and environmental mastery for maintaining physical and psychological well-being in the face of a chronic disorder. This collaborative strategy provided the client a forum from which to share his personal experience and professional knowledge to influence attitudes and provide valuable information to nursing staff in a long-term care facility. Collaborating with the client to bring information to nursing staff is one means to foster a climate of client empowerment, influence staff perceptions and communicate the unique experiences of the client.     

Reflective practice in the Accident and Emergency setting

The object of this paper is critically to analyse the issue of reflective practice within the writer's own professional arena. The writer is a senior nurse within an Accident and Emergency (A & E) department.It has long been recognised that a gap exists between theory and practice in nursing. There has been much discussion in the nursing literature about the development of the reflective practitioner and how reflection in practice can assist in closing the theory-practice gap.Nurses have always experienced great difficulty in identifying a theory of practice.Jarvis (1992) states that reflective medicine is a frequently used but infrequently defined concept in nursing at the present time. For both qualified nurses and students alike, reflection can be utilised as a learning process to help them expand and develop their clinical knowledge and skills to directly benefit client care (Dewing 1990).Schon (1987) has identified reflection as a process of knowledge acquisition originating in practice and best suited to solving complex practice based problems. Reflection is an active process of exploration and discovery which often leads to unexpected outcomes (Boud et al 1985).Reflection that occurs in the process of an experience is referred to as reflection-in-action (Schon 1987). Nurses have the ability to think about their actions while they are carrying them out and change the actions should the professional's assessment of the situation change (Schon 1983). Reflection can lead to new understanding and appreciation which can be put to use in future experiences (Dewing 1990).This paper will commence with a brief explanation of how nurse education is developing reflection and experience to assist the student nurse to close the theory-practice gap.     

The epidemiologic basis of coronary disease prevention.

With a knowledge of the epidemiologic basis underlying the risk factors for CHD, the nurse can improve the quality of care offered to clients. By collecting information during assessment, the nurse can identify persons at increased risk for CHD. Information about the nonmodifiable risk factors can be used to assist in determining the amount of emphasis to place on borderline levels of the modifiable risk factors. As risk factor data are collected, the nurse can also explain the nature of the risk factor-CHD relationship to the client and family, thus teaching them as well as demonstrating that nursing practice is data based. When the health care team has decided on the focus of risk factor modification, the nurse will know about clinical trials that underlie the treatment plan or else will be able to explain that there are still areas of incomplete knowledge.     

King's theory as foundation for an advance directive decision-making model

This article discusses the utilization of King's conceptual system, transaction process model, and theory of goal attainment as foundations for an advance directive decision-making model. Research has shown nurses may be educationally unprepared, experience conflicts between beliefs and actions, or resist the responsibility to address advance directives and end-of-life issues. Nurses, especially nurse practitioners providing primary care, are in positions to facilitate the process. By understanding and incorporating this model into practice, both the nurse and the client may achieve mutual goal attainment resulting in both increased client autonomy and Patient Self-Determination Act compliance.     

A Framework for Family Assessment in chronic illness

Family assessment can enable the nurse to expand the internal and external resource potential of the family unit. Specifically, the nurse may be able to determine what information the client and family need to cope effectively with the illness condition. Additionally, the nurse may supply the family with consumer information regarding qualifications, cost, and appropriate points of entry for additional health and welfare services, and intervene as client advocate by documenting more specific information relevant to the agency's criteria for acceptance. With an adequate knowledge base obtained through the use of such an assessment, and with knowledge of local health-care delivery systems and community agencies, the nurse will be able to assist the family more fully. Specific information about resources, points of entry, costs, and quality of services may be offered to the family members to enable them to evaluate alternative courses of action appropriate to the specific situation and select the most beneficial solution.     

Communication as it Affects the Therapeutic Alliance

The therapeutic relationship, the working bond between the nurse practitioner and patient, is considered to be a significant factor that affects treatment outcome. Components of the therapeutic relationship viewed from the nurse practitioner's perspective and also from the patient's viewpoint are reviewed. Modes of communication the client uses directly influences the therapeutic relationship or alliance. Two communication modes are used to exemplify two case examples in which the patient's mode of perceiving his or her world is an important consideration in the working alliance.     

ORN role in an office based ASC.

This article outlines the role of an ophthalmic registered nurse (ORN) in an office based ambulatory surgical center (ASC). Advantages of this concept to both nurse and client will be outlined. In an office based ambulatory surgery center the opportunity exists for the professional nurse to follow the client throughout the preoperative, intraoperative and postoperative phases of the surgical procedure.     

Recognizing borderline personality disorder in the primary care client

The nurse practitioner is responsible for the diagnosis and treatment of a great variety of physical and psychological disorders in the ambulatory client. Frequently the diagnosis of personality disorder is missed, ignored or not even considered. This article will introduce the nurse practitioner to the various personality disorders. The main focus, borderline personality disorder, is estimated to affect 5 to 15 percent of the general population. A picture of the borderline client from etiology to treatment as well as recent research findings and suggestions for history taking and physical exam are covered. Borderline has been a difficult and confusing diagnosis to make because in the past the term has had several different meanings. This article will clarify what this diagnosis means, and will assist the nurse practitioner in the recognition, diagnosis and management of all clients with personality disorders.     

The effect of clients' family structure on nursing students' cognitive schemas and verbal behavior.

The primary purpose of this study was to investigate if nursing students stereotype clients on the basis of family status. In addition, the influence of information about the client's family status on students' predictions about the client's behavior, information sought from the client, recalled information, and verbal responses directed toward the client were examined. The participants were 83 nursing students from a large Midwestern university. They were randomly assigned to one of two groups. Brief written information about a female adult client with a vaginal discharge was provided and, after listening to an audiotaped interview between a nurse and the client, students completed a battery of questionnaires. They also responded verbally to questions asked by the audiotaped client. All information given to both groups was identical except for the client's family status. Results indicated that the client who was a married mother was perceived somewhat more positively than the unmarried mother client. Participants' perceptions were only somewhat consistent with cultural stereotypes about these family statuses. Information sought and information remembered about the client were greater when she was an unmarried mother. There were no differences in predictions of patients' behaviors and verbal responses.     

Compartment syndrome: when it is least expected

Compartment syndrome, if not identified and acted upon early, will result in irreversible damage to neuromuscular soft tissues. Therefore, orthopaedic nurses must be aware of the risks, signs and symptoms, unusual circumstances, and appropriate medical and nursing interventions with this syndrome. Usually compartment syndrome is considered to occur with fractures of the tibia, the forearm, or in vascular injuries or burns where there is significant edema. Not as common are compartment syndromes that occur after intramedullary nailing, in the thigh or upper arm, or in the presence of fracture blisters. These unexpected compartment syndromes each occurred only once in the author's many years as an orthopaedic clinical nurse specialist at a major trauma center. However, in each case, the situation and actions were significant. Compartment syndrome will be reviewed with supporting current literature. Each scenario will then be analyzed in terms of the particular considerations surrounding the diagnosis, treatment and nursing implications with the compartment syndrome.     

Pediatric assessment tool—a self-Instructional guide

This self-instructional guide is designed for the nurse who works primarily in an adult patient setting but occasionally cares for a pediatric client. Although proficient in nursing skills, this nurse might experience anxiety when assigned a pediatric client. It is hoped that having this information will replace anxiety with confidence.     

To be or not to be accountable … that is the question

The Association of Rehabilitation Nurses' Rehabilitation Nursing Institute has directed to Standards Committee to promote and implement standards in rehabilitation nursing with these actions:

• 1 . begin to identify body of knowledge
• 2 . continue to explore certification based on body of knowledge (investigate levels, specialty tracks, issues)
• 3 . begin to construct study modules (considering levels of practice)
• 4 . do research on available resources (members, their expertise, sources of funding, and published and produced materials)
• 5 . seek information on ways to influence teaching of rehabilitation nursing in basic progra.

The above actions are of major importance and should be the immediate concern of each person who expects to be identified as a credible rehabilitation nurse by the consumer. Today the consumer of the practice of rehabilitation nursing may be an individual client, an institution, a physician, a clinic, an insurance company or other employers. These potential clients/employers are asking how to tell whether or not a nurse is qualified to fill a rehabilitation nursing position. It is our responsibility as members of ARN to be able to answer these inquiries soon or we will not be asked anymore, and we will not have the opportunity to protect the consumer and ourselves from those who are content to practice rehabilitation nursing in name only. We ask that each ARN member read “To Be or Not to Be Accountable … That is the Question,” complete the Body of Knowledge and Credibility Reaction Questionnaire , and return it to Rosemarian Berni before May 30, 1978.     

Current concepts of children's perceptions of control

Beliefs about control have been identified as an important aspect of the occupational therapy evaluation process because of their potential influence over the course of action chosen. This paper reviews the current status of research and theory in this area as it relates to children. Issues addressed include the drawbacks of the downward extension of adult theoretical models and tests to children, the multidimensionality of perceived control, and the relation between cognitive development and changes in beliefs. Recent revisions in theoretical models and new measures that provide more differentiated information on children's beliefs about causality and personal efficacy are reviewed. The implications for the selection of instruments and interpretation of results for the assessment of children's perceived control in clinical practice are discussed.     

Mapping social processes at work in nursing knowledge development

In this paper, we suggest a blueprint for combining bibliometrics and critical analysis as a way to review published scientific works in nursing. This new approach is neither a systematic review nor meta‐analysis. Instead, it is a way for researchers and clinicians to understand how and why current nursing knowledge developed as it did. Our approach will enable consumers and producers of nursing knowledge to recognize and take into account the social processes involved in the development, evaluation, and utilization of new nursing knowledge. We offer a rationale and a strategy for examining the socially‐sanctioned actions by which nurse scientists signal to readers the boundaries of their thinking about a problem, the roots of their ideas, and the significance of their work. These actions – based on social processes of authority, credibility, and prestige – have bearing on the careers of nurse scientists and on the ways the knowledge they create enters into the everyday world of nurse clinicians and determines their actions at the bedside, as well as their opportunities for advancement.