Referrals from home care to emergency hospital care: basis for decisions

The Swedish government implemented a reform, the Adel reform, in the care of older citizens in 1992, so that the communities where older people live became responsible for their care and housing. Nurses were appointed to make sure that older people were given accurate care and to act as supervisors for nurses' aides. In this study, 10 Registered Nurses from community home care services and four consultant head physicians in primary care were interviewed in order to illuminate what they thought influenced nurses' decisions to refer patients for emergency treatment and what support they requested to facilitate the decision. Content analysis showed the necessity of feeling secure in one's role as a community nurse. The categories that developed were: own competence, knowledge about the patient and a supportive working environment. The main theme was To feel safe in one's role - a basis for decision-making. High demands were put on the nurses' competence and their burden of responsibility became too great. This influenced decision-making negatively, if nurses felt that they were lacking in their own personal competence. Training in documentation for the nurses was required, as well as the need for organizations to provide staff with sufficient time for accurate documentation. A greater input of nursing and medical care was required to make it possible for patients to be cared for at home if they so wished. Respondents described considerable deficiencies in their working environment and in co-workers' competence, and nurses' professional roles within the community were not made clear. If these problems were remedied, this would improve working conditions, increase understanding, and reduce feelings of uncertainty among decision-makers.     

Emotional intelligence in mental health nurses talking about practice

The aim of this study was to explore mental health nurses' experiences of emotional intelligence (EI) in their nursing practice by means of qualitative interviews. The interview questions where developed from the literature on EI. This study used a hermeneutic analysis. Four main themes emerged: relationship with the patient; the substance of supervision; motivation; and responsibility. It was concluded that EI stimulates the search for a deeper understanding of a professional mental health nursing identity. Emotional learning and maturation processes are central to professional competence, that is, personal growth and development. In addition, the moral character of the mental health nurse in relation to clinical practice is of importance. The findings imply multiple types of intelligence related to nursing science as well as further research possibilities within the area of EI.     

职业化培训对提升护士人文素养的效果研究

目的 将护士人文素质培养融入护理职业化培训中,从而提高护士的人文素养和护理质量.方法 选择2009年5月至2010年5月我院工作年限在6年以内的护士进行职业培训.通过开展非职业性阅读、指定教材阅读、多媒体讲座等系列活动,尤其通过读书报告会的提炼和精华,在强化培训和潜移默化中将人文知识和人文关怀意识内化为个人品德、言行、修养、气质.分别于护士职业化培训前后选择其护理的患者进行满意度调查.结果 培训后患者满意度显著提高.护士对读书报告会的评价满意度显著上升.结论 将护士人文素质培养融入护理职业化培训,可以提高护士的人文素养和护理质量.使护士的职业形象日渐规范,整体素质和服务质量得到提升,全心全意为患者服务的思想也越来越牢固.     

Nurses' moral strength: a hermeneutic inquiry in nursing practice

Title.  Nurses' moral strength: a hermeneutic inquiry in nursing practice.
Aim.  This paper is a report of a study to interpret nurses' experiences of moral strength in practice.
Background.  Moral strength is said to be beneficial in providing nursing care for patients, thereby contributing to high qualitative care. However, few studies focus on the meaning of nurses' moral strength.
Methods.  This study included eight Registered Nurses working in different aspects of health care in southern Sweden. Individual interviews were conducted in 2006 and 2007. We recorded, transcribed verbatim, and interpreted the interviews by a method grounded in hermeneutics.
Findings.  Three themes were interpreted on three different levels: the action level as 'having courage to act on one's convictions', the relational level as 'being attentive and recognizing vulnerability', and the existential level as 'facing the unpredictable' . Overall, moral strength was understood as a driving force to be someone special in the care of patients, i.e. someone who makes a difference.
Conclusion.  The value of nurses' moral strength in patient care should be recognized. Attention must be given to aspects outside the individual, e.g. professional and institutional processes that influence the work environment. Clinical team supervision can help make such processes visible and supportive.     

Caring for abused women: impact on nurses' professional and personal life experiences

Title.  Caring for abused women: impact on nurses' professional and personal lifeexperiences.
Aim.  This article is a report of a study of the impact of caring for abused women on nurses' professional and personal life experiences.
Background.  Encountering abused women can have emotional, cognitive and behavioural influences on nurses, known as vicarious traumatization. They may feel incompetent to deal with such an overwhelming problem and may avoid screening survivors of abuse. Thus, nurses treating these survivors need to be aware of their attitudes, emotions and differential responses during these interactions.
Method.  A phenomenological study was carried out in 2005 in Israel. The data were collected using in-depth, interviews with 22 female Israeli nurses in hospitals and community healthcare clinics.
Findings.  Data analysis revealed one main theme, 'Struggling on work and home fronts', based on two subthemes: 'Encounter with domestic violence: a challenge to nurses' professional role perception' and 'Between work and home'. Nurses experience perplexity regarding abused women and their professional care. Encounters with these women challenge nurses' personal and professional attitudes, as well as influencing their personal lives (intimate relationships, parenthood and gender attitudes). These encounters induce empathy and compassion, but also anger and criticism towards abused women, creating emotional labour for the nurses.
Conclusion.  The dissonance between personal values, attitudes and emotions and the desirable professional intervention procedures might impede nurses' performance in caring for abused women. Implementing training programmes for screening and intervening with abused women might reduce the emotional labour required, enhance nurses' responses to domestic violence, and enable personal growth.     

Swedish mental health nurses' responsibility in supervised community care of persons with long-term mental illness

The aim of the present study was to describe psychiatric nurses' experience of how the changing focus of mental health care in Sweden, from in-patient treatment to community-based care, has influenced their professional autonomy. Eleven psychiatric nurses were interviewed and a qualitative content analysis was used to identify major themes in the data. Three main themes were found: pattern of responsibility, pattern of clinical judgement, and pattern of control through support and supervision. All themes were related to the nurse's identity, moral responsibility and the feelings of loneliness and independence in his/her daily work. Together, the three themes were found to constitute a process. This study shows the complexity involved in nursing care provided in the patient's home. Achieving control over the patient's everyday life through support and supervision does not imply taking over the patient's autonomy, but rather reducing the stigma attached to mental illness and facilitating the process of rehabilitation.     

Nurses' beliefs about their abilities to delegate within changing models of care

Changing models of nursing care have resulted in a more diverse work force composition. Nurses (RNs and licensed practical and vocational nurses) have greater responsibilities for delegation and supervision of unlicensed assistive personnel providing direct nursing care. This study describes nurses' beliefs about their abilities to delegate and supervise direct nursing activities and explores differences based on professional and job-related factors. A national sample of 148 licensed nurses working in three practice settings was surveyed. In general, nurses reported a high level of comfort, frequency, preparedness, confidence, competence, and control. Differences found in nurses' beliefs were based on education, practice setting, and type of work responsibilities.     

精神科护理纠纷发生的原因分析及对策

目的分析精神科护理纠纷发生的原因，并提出相应的护理对策。方法回顾性分析和总结9起精神科护理纠纷发生的原因。结果护理纠纷发生的原因主要为主客观因素，主观因素为责任心不强（33％）、未严格执行护理操作规程（11％）、护理管理不严（11％）、精神科意外事件（33％）和护士专业思想不稳定（11％）；客观因素包括病人法律意识不断增强、护理工作性质与护理人员因素。结论实施安全管理，提高护士的综合素质及责任心对预防护理隐患、减少护理差错和避免护理纠纷的发生具有重要作用。     

"Leaving the Comfort of the Familiar": Fostering Workplace Cultural Awareness Through Short-Term Global Experiences

PROBLEM.  Facilitating the development of student nurses' cultural competence and translating these experiences into the clinical setting.
METHODS.  Qualitative methods.
FINDINGS.  A short-term global immersion experience informs student nurses' cultural awareness, education, and future clinical practice.
CONCLUSIONS.  Participation in a short-term global health experience contributes to students' personal growth and broadens their insight into multicultural care.     

Competence of newly-graduated nurses--a comparison of the perceptions of qualified nurses and students

AIM: This paper reports a study that compares opinions of final year nursing students, rating their own competence, with the opinions of experienced nurses on the competence of newly-graduated nurses. BACKGROUND: The transition of nursing preparation into higher education is regarded as positive, although it has led to differences in opinion about the competence of newly-graduated nurses and their readiness to enter the nursing profession. There are studies showing that newly-graduated nurses perceive themselves as holistically focused, professional practitioners, while other nurses are concerned that newly-graduated nurses do not have necessary skills. METHODS: A convenience sample of 106 nursing students in the final week of their course and 136 nurses who had experience of supervising nursing students completed a questionnaire. The data were collected in 2002. RESULTS: Own competence, in the form of ability to perform nursing care, was rated by nursing students to be good or strongly developed in most of the investigated areas of nursing care. Experienced nurses also estimated newly-graduated nurses' competence to be good or strongly developed, although to a lesser extent. Nurses qualified within the previous 5 years rated newly-graduated nurses' competence to be higher in comparison with those with less recent education. CONCLUSIONS: Further studies are needed to broaden our understanding of why some areas of nursing care, such as ethical awareness, were rated very highly, while others, like informing and teaching of co-workers and planning and prioritizing interventions had the lowest rating.     

Operating theatre nurses' perceptions of competence: a focus group study

Title.  Operating theatre nurses' perceptions of competence: a focus group study.
Aim.  This paper is a report of a study exploring nurses' perceptions of the components of competence in the operating theatre.
Background.  Competency Standards for operating theatre practice are used in some countries to guide clinical and professional behaviours. The need for competence assessment has been enshrined, but the conceptualization and agreement about what signifies competence in Operating Theatre has been lacking.
Methods.  Three focus groups were conducted with 27 operating theatre nurses in three major metropolitan hospitals in Queensland, Australia. Interviews were audio taped and field notes were taken. Data were collected during 2008. Thematic analysis was performed.
Findings.  From the analysis of the textual data, three themes were identified: 'coalescence of theoretical, practical, situational and aesthetic knowledge within a technocratic environment'; 'the importance of highly developed communication skills among teams of divergent personalities and situations'; and 'managing and coordinating the flow of the list'.
Conclusion.  These findings have identified that competence in respect to components of knowledge, teamwork and communication, and the ability to coordinate and manage are important and should be incorporated in operating theatre Competency Standards. Additionally, findings may assist in the development of an instrument to measure operating nurses' perceived competence.     

Reasons why Dutch novice nurses leave nursing: A qualitative approach

Shortages in the nursing profession are increasing. It is, therefore, imperative to understand why novice nurses are leaving the profession. This qualitative study explores Dutch novice nurses’ motives for leaving the profession. Individual semi-structured interviews were held with seventeen former novice nurses who had decided to leave nursing within two years after graduation. Data was collected and analysed following the principles of Thematic Analysis, leading to six themes; 1) Lack of challenge; ambitious to progress further in management or research roles. 2) Lack of passion; no feeling of passion for patient care. 3) Lack of perceived competence; not feeling “up to the challenge”. 4) Lack of job satisfaction due to heavy workload; work-life imbalance and inability to deliver high-quality care. 5) Lack of work capacity due to non-work-related health conditions; unmet requirements for job or work environment adjustment. 6) Lack of feeling of belonging; suffering from a negative attitude of colleagues to one another. To prevent novice nurse professional turnover, measures such as capacity building, supervisor support and a tailored personal development plan could be taken. To make novice nurses feel safe and reassured, support from colleagues and supervisors is important. Such measures require thoughtful implementation and evaluation.     

The study of nursing documentation complexities

This study aimed to explore complexities in nursing documentation and related factors. Nursing documentation has been one of the most important functions of nurses since the time of Florence Nightingale because it serves multiple and diverse purposes. Current health-care systems require that documentation ensures continuity of care, furnishes legal evidence of the process of care and supports evaluation of quality of patient care. However, nursing documentation has not served such objectives because of its complexities. This study explores nursing documentation complexities and related factors through both qualitative and quantitative methodologies. The study used multiple methods of inquiry: in-depth interviewing; participant observation; nominal group processing; focus group meetings; time and motion study of nursing activities; and auditing of completeness of nursing documentation. Complexities in nursing documentation include three aspects: disruption, incompleteness and inappropriate charting. Related factors that influenced documentation comprised: limited nurses' competence, motivation and confidence; ineffective nursing procedures; and inadequate nursing audit, supervision and staff development. These findings suggest that complexities in nursing documentation require extensive resolution and implicitly dictate strategies for nurse managers and nurses to take part in solving these complicated obstacles.     

The development of community psychiatric nursing: a professional project?

In this paper the author argues that the development of community psychiatric nursing can be understood as a professional project However, the case of community psychiatric nursing cannot be adequately understood from mainstream literature on the subject of professionalization within the health care division of labour The inadequacy of such literature is that it either concentrates upon the pre-eminent case of medicine or regards nursing's professionalization as being unitary The author posits that the professional projects of general nursing and community psychiatric nursing have different and even opposing interests To contextualize community psychiatric nurses'(CPNs') professional project the author examines the history of mental nursing, from which community psychiatric nursing evolved, the development of community mental health care, which allowed for the inception of community psychiatric nursing, CPNs'relationships with both psychiatrists, whose patronage assisted CPNs'initial growth as para-professionals, and general practitioners, who later assisted a more functionally autonomous role for CPNs in primary care, and social policy towards community care that enhanced CPNs'growth In conclusion the author argues that recent government-led changes in the management of community mental health care now impel CPNs to change the direction of their strategy for occupational survival and advancement     

Group supervision as a means of developing professional competence within pre-hospital care

BackgroundAmbulance care has its foundations in experience-based knowledge relating to the care provider’s flexibility and humility in the encounter with patients. The group supervision model used in this study is retrospective and experience orientated and it is designed to promote and develop the group’s overall competence by facilitating the group process, as well as extending and improving levels of professional knowledge.AimThe aim was to evaluate the experience of group supervision and to explore its impact on the participants’ personal and professional development.MethodThis study uses an inductive qualitative approach where data collection was performed in the form of a focus group interview and analysed by a model of content analysis.ConclusionGroup supervision appears to have had a positive impact on the participants’ personal and professional development. The structure of the model appears to make it easier for the inexperienced co-worker more rapidly to develop expertise within his/her working area, which can be seen as an important tool in today’s financially focused and time-pressurised health-care service. It is to be hoped that the results of this study will interest health managers and encourage them to consider group supervision as a tool for professional development not only within the area of the ambulance service.