Addressing the nursing shortage

Support is essential for students and new nurses to develop confidence in their practice (Oermann & Moffitt-Wolf, 1997). Caring, empowerment and team building are essential in helping affirm the choice of nursing as a profession. Students and new nurses will stay in nursing if they are supported (Meissner, 1986). The nursing community needs to nurture, encourage and inspire its members to learn and to grow; nurses need to treat each other with respect and patience. As Moccia (1990) so aptly stated. "The goal of nursing is to enable others so they might enable still others; to nurse, to teach and to learn with each other in caring ways." "What is modeled for nurses today will shape future practice" (Christensen, 1999).     

Teaching core nursing values.

Nursing is a caring profession. Caring encompasses empathy for and connection with people. Teaching and role-modeling caring is a nursing curriculum challenge. Caring is best demonstrated by a nurse's ability to embody the five core values of professional nursing. Core nursing values essential to baccalaureate education include human dignity, integrity, autonomy, altruism, and social justice. The caring professional nurse integrates these values in clinical practice. Strategies for integrating and teaching core values are outlined and outcomes of value-based nursing education are described. Carefully integrated values education ensures that the legacy of caring behavior embodied by nurses is strengthened for the future nursing workforce.     

A socratic dialogue on the question 'what is love in nursing?

It is the thesis of the authors that the caring ethic and moral state of being of nurses ideally suffuses their professional caring and is thus implicit in their ethical decision making. Socratic dialogue is a technique that allows such moral attitudes to be made explicit. This article describes a Socratic dialogue conducted with nurses on the topic: 'What is love in nursing?' The conclusions drawn were based on the belief that the current western-style health care system restricts the practice of nursing in such a way as to limit professional caring and loving possibilities. Nurses who love in the practice of caring go beyond the role definition of the duty of care; they are people who are prepared to think differently about their practice as professionals, and are identified as competent risk takers committed to the betterment of the other. From this dialogue, 'love in nursing' was understood as the willingness and commitment of the nurse to want the good of the other before the self, without reciprocity.     

The story of Rabbia, a dying person

Many nurses report that caring for the dying and the dead is the most difficult situation they face. Several factors contribute to this anxiety: inexperience, sociocultural influences, and the lack of education about death. Current nursing practice in caring for the dying is philosophically steeped in the Western medical model. From this viewpoint, death is considered an enemy, and its occurrence implies that the practitioner has failed. The article explores how nursing care of the dying and dead is influenced by multicultural dimensions: Western medicine, societal norms, and religious beliefs. The nursing care of a dying American Muslim woman is compared with the care provided by the patient's family and religious community.     

The professional development of nursing through different aspects of the caring practices of nurses: nursing the patient person in a geriatric assessment unit

The caring component of nursing practice has become an increasingly visible activity of nursing. Consequently, a growing amount of research has explored the role caring plays in nurse practice. Research often explores the activities of caring or its moral agenda, rather than motivation. This study broadens the discussion about nurses and caring practice by examining nurses approaches to different aspects of the caring practices of nurses for the aged in a Geriatric Assessment Unit (GAU). Data collection involved semi-structured interviews and participant observation within the GAU. Four categories of themes emerged as different aspects of the caring practices of nurses. Three fit within the professional development of nursing: physical caring, negotiative caring and relational caring. A fourth, motivated caring, however, provides an additional aspect of caring located within and beyond professional development.     

Caring in nursing: investigating the meaning of caring from the perspective of cancer patients in Beijing, China

Aims. The aims of the study were to develop an understanding of caring in nursing from the perspective of cancer patients and attempt to identify the concept of caring in the Chinese cultural context. Background. Caring as a concept remains elusive, the acceptable definitions of the term care have not been reached. The expressions, processes and patterns of caring vary among cultures, but there is a lack of Chinese culture‐based study about caring in nursing. Methods. A qualitative research design was used and 20 cancer patients were interviewed using a semi‐structured interview guide. A qualitative content analysis was used to identify themes in the data. Results. Three themes emerged from the data, which suggested that caring is delivering care in an holistic way: nurses’ caring attitudes and their professional responsibility for providing emotional support, nurses’ professional knowledge and their professional responsibility for providing informational support and nurses’ professional skills and their professional responsibility for providing practical support. The caring behaviour of nurses as perceived by cancer patients involved the provision of emotional, informational, and practical support and help based on patients’ needs. A model of caring in nursing was formulated. Conclusions. Caring in nursing as perceived by cancer patients involves nurses having qualified professional knowledge, attitudes and skills in oncology and providing the informational, emotional and practical supports and help required by cancer patients. Relevance to clinical practice. Caring is manifested in nursing actions through nurse–patient communication process. Patients have their inner expectation for nurses’ caring behaviour and attitudes and nurses’ performance of caring or uncaring behaviour has a direct influence on the feelings of patients. It is necessary for all nurses to continue improving their oncology professional knowledge, attitudes and skills as well as their abilities of offering informational, emotional and practical support and help for their cancer patients.     

Drawing a qualitative distinction of caring practices in a professional context: the case of Chinese nursing

How to draw a qualitative distinction between nursing work and the work of a servant has been a major concern for nurses in China. This article explains the ways in which nurses in China articulate the meaning of caring in practice situations. Seventy nurses in Beijing were invited to share their experience about what caring meant to them as nurses and examples of caring in practice situations. Van Kaam's phenomenologic method of controlled explication was used to analyze the data. The findings reveal that these Chinese nurses are able to articulate the cheng and jing versions of caring practices that emphasize flexible, pluralist, contextualized, individualized, and subjectively informed practices. To further this study, we would suggest nurses be more proactive in starting a dialogue with society so as to seek nursing's legitimate practice that can foster responsive care to patients and society on the one hand and the professional integrity of nursing on the other.     

The contribution of nurses' perceptions and actions in defining scope and stabilising professional boundaries of nursing practice

This paper reports on the findings of a naturalistic inquiry study that explored the scope and boundaries of nursing practice. Findings from interview and observation data suggest that nurses negotiate and adjust professional boundaries on an individual, case-by-case basis, thereby managing the scope of their practice as they see it in that circumstance. The strategies they used are presented in four major categories: 1) maintaining a comfort zone, 2) expanding into safe territory, 3) moving into the grey zone and 4) stepping over the line. Findings show that nurses' efforts to maintain the comfort zone serve to perpetuate the status quo and may threaten holistic care. Expanding nursing actions to include functional roles such as coordinating care, sharing information, advocating (for patients), collaborating and innovating offers the profession critical building blocks for defining the scope of nursing practice. Clarifying the grey zone (or overlapping territory) is an essential task for the profession in determining the boundaries of nursing practice. The data revealed that, partly due to the ambiguity of the grey zone, nurses may step over the line into medical decision-making and outside the legal sanctions for the professional nursing role. The implications of this study highlight the need for nursing to define its scope of practice and in so doing stabilise professional boundaries.     

Caring as the ontological and epistemological foundations of nursing: a view of caring from the perspectives of Australian nurses

In a study using unstructured interviews to explore nurses' understanding and interpretations of caring in nursing, one of the major themes emerging from the data is that through caring for patients, nurses discover the meaning and nature of nursing and what it means for them to be nurses. In the process of caring for patients, nurses further develop and understand the knowledge and skill of caring which constitutes the knowledge base of nursing. The data also show that nurses, in their practice, continue to define, develop and shape the meaning and knowledge of caring in nursing. From the evidence of this study, this paper argues that caring can be considered as the ontological and epistemological foundations of nursing.     

South African student nurses' experiences of professional nurses' role-modelling of caring

BackgroundStudent nurses are expected to implement a caring practice in order to become professional nurses. Caring has remained the art and science of nursing, which student nurses learn from professional nurses during clinical practice. The South African Nursing Council mandates professional nurses to teach and supervise student nurses to master the art of caring during clinical practice. Caring is taught through role-modelling of daily nursing activities.Research purposeThis study was performed to gain an understanding of South African student nurses' experiences of professional nurses' role-modelling of caring.MethodsPhenomenological, qualitative research. Purposive sampling of fourth-year student nurses. Data collection: focus groups, observations and field notes. The data were analysed using Giorgi's modified Husserlian five-step method. Ethical principles were respected.ResultsThree themes were identified. Theme 1: inconsistency in the clinical environment; Theme 2: effective and ineffective role-modelling of caring and Theme 3: carelessness cascading.ConclusionsThe study facilitated an understanding of student nurses' experiences of professional nurses' role-modelling of caring. Recommendations to facilitate professional nurses' role-modelling of caring in a public hospital were formulated: Mentorship training, recognition system for professional nurses, clinical support for student nurses, open channels of communication, random nurse leader rounds, employee wellness program, workshops and positive learning environment promotion.     

The role of the nurse providing therapeutic care for the suicidal patient

In this study, nurses perceived that the implementation of special supervision is the most effective preventive method in the nursing care of suicidal patients, but they also expressed the view that special supervision is non-therapeutic The results of these findings show that it is possible to provide nursing care in the prevention of further harm to the patient but that nurses may not necessarily be proficient in demonstrating the interpersonal caring skills essential for the development of a therapeutic relationship and hence patient recovery This paper demonstrates there is now (a) a need for special supervision as a preventive method when caring for the suicidal patient, (b) a need for a planned therapeutic programme of care during special supervision, (c) a need for the development of essential interpersonal and counselling skills and dimensions for effective therapeutic intervention and empathic nursing care, (d) a need to bridge the gulf between theory and practice by giving nurses the opportunity to practise those skills in the clinical setting under the supervision of an expert clinician, (e) a need for the patient to experience that nurses do care, i e experience empathy, during the complete therapeutic programme including the period of special supervision, and (f) a need for further research regarding the patient's perception of nursing care experienced following a failed suicidal attempt     

Nurses' experience in clinical encounters with children experiencing abuse and their parents

Aim and objectives. The aim of this study was to identify nurse’s experiences in the clinical care of children experiencing abuse. The objective was to assess how nurses remain professional especially when the suspected perpetrator is a parent. Background. The diagnosis of child abuse is a difficult one, yet essential because of the high morbidity and significant mortality rates. Young children may be unable to give a clear history; parents may be unwilling to be truthful, and the signs and symptoms of abuse are often not conclusive. A contributing factor to the challenges of providing nursing care to children in a context of abuse is the lack of education in this field. Nurses working in the care of paediatric patients may not be familiar with situations in which they cannot rely on histories provided by parents. Design. A qualitative study. Methods. Investigators used a qualitative design with a critical incident technique. Eleven nurses who cared for abused children and their parents at a tertiary care children’s hospital were interviewed. Results. We highlighted three areas in the analysis of the interviews: Feelings of ambivalence, nurses’ professionalism and the nurses’ care strategies. Participants expressed difficulties in maintaining a professional role in clinical encounters with the parents. The nurses were unhappy in their conflicting roles of both policing (a judging function) and nursing (a caring function). Conclusions. The nurses expressed that they had devised strategies to remain professional in the clinical encounter with abused children and their parents. To remain professional, education, counselling and experience was essential. Relevance to clinical practice. By identifying nurses’ experiences in clinical encounters with children experiencing abuse and their parents, nurses can assess what kind of specific interventions should be used to improve the caring situation.     

A caring relationship with people who have cancer

Title.  A caring relationship with people who have cancer.
Aim.  This paper is a report of a study conducted to elucidate the meaning of a caring relationship with people with cancer.
Background.  A caring relationship becomes the most important focus of caregiving when treatment of the body has reached the limits where cure is no longer expected. Caring as perceived by people with cancer involves nurses having professional attitudes and skills in order to provide good care, including emotional and practical support.
Methods.  A phenomenological hermeneutic approach influenced by Ricoeur was used. Eight nurses working in an oncology unit in Iran were interviewed in 2007 about their experiences of caring relationships with people who have cancer.
Findings.  The findings were interpreted as getting involved in a mutual/demanding close relationship. Closeness demanded nurses to be present, to listen to patients, and to be compassionate. Closeness was also mutual and characterized both caregiving and receiving new insights into values in the nurses' own lives. The close relationship was at times frustrating when they were faced with situations that they could not handle and were out of their control.
Conclusion.  Closeness is an important foundation for caring, and acquires a special dimension in the care of people with cancer and their relatives. It derives from the personal and professional experiences of nurses in their own life stories. Nursing education should include a reflective approach in order to develop caring skills in oncology nursing that are not merely attuned to medical care.     

The rhetoric of caring and the recruitment of overseas nurses: the social production of a care gap

Aims and objectives. I will argue that overseas nurse recruitment is the consequence of a care gap, which arose from several policy shifts in the 1990s and in part from the rhetoric of a normative moral discourse in the UK which claims that caring is the moral essence of nursing. I will suggest that this discourse has masked the uncoupling of caring from nursing practice and that this uncoupling places the overseas nurses in a contradictory position. Background. In an increasingly competitive global labour market, the UK is faced with a nursing shortage and has been recruiting trained nurses from abroad (NMC 1993–2002). Design and methods. This paper is based on two related, qualitative studies using semi‐structured focus groups and individual interviews. The first explored the experiences of overseas nurses in the UK and the second investigated the equal opportunities and career progression of overseas nurses in the UK. Results. The data from these studies challenge the normative UK value that caring is at the heart of nursing. These data are the lens through which we see this contradiction explicitly played out. Overseas nurses observe that caring (as undertaken by health care assistants in care homes) is not nursing yet caring is being passed down the line as a process that marginalizes the overseas nurses and at the same time devalues their skills. I do not argue that overseas nurses care at a higher standard (although this may be the case) just that they care differently, that they expected UK nurses to deliver basic care and, instead, experience UK nursing practice as less autonomous and of a lower standard than they expected. Conclusions. I argue that the overseas nurses’ views help us understand the processes by which the uncoupling of caring from nursing has come about. Relevance to clinical practice. This paper discusses a workforce issue which is directly relevant to clinical practice because it focuses on the meaning of care; what is caring, what are caring activities and how are these represented in the discourse on caring in the literature? This paper also reveals significant worries among nursing managers about how to staff the nursing workforce and what nurses should be doing in the clinical areas.     

Oncology nursing: our past is the prologue ... can we author the future?

The development of the standards of care, roles in oncology nursing, and role competencies was an opportunity for Canadian nurses to revisit their professional roots, review and validate their present roles, and revise or reaffirm their future roles. The standards of care for individuals with cancer and their families affirmed the centrality of the individual and family in any nursing interaction and gave voice to the stated needs of Canadians at risk for, or living with cancer. For the first time in Canada, a specialty nursing organization has taken the lead to clearly define contemporary nursing roles and competencies. This new vision has captured the interest of oncology nurses. CANO, the nursing profession, other health care professionals, and health care decision-makers must now also consider how this enlightened view of oncology nursing can be operationalized. The presenters have had the opportunity to "hear" the stories of Canadian oncology nurses and their experiences in striving for excellence in their practice. These stories highlight the evidence supporting the standards of oncology nursing. In addition, the challenges and facilitators for achieving excellence in oncology nursing practice are identified. Through these stories, the future for the development of oncology practice and operationalization of the new standards of care emerges.     

Toward a caring culture in professional nursing

Nursing is a profession founded on the traditional value of caring. Faced with rapid and tumultuous change in the health care system, nurses are finding the environment of practice more stressful and less supportive. The ideal of nursing as a caring community is at risk because of economic and political forces. The authors review the impact of managed care and reaffirm the notion of the caring community in the nursing profession. Specific assessment guidelines and recommendations for the caring community are set forth for practitioners working in a variety of organizational settings. Organizational culture is emphasized as the context for caring practice.     

Repeating history? Public and community health nursing in Australia

Despite the long history in Australia of public and community health nursing, it has never been regarded as important as hospital‐based nursing. Notwithstanding the establishment of nursing organisations in the very early years of the 20th century and subsequent efforts to develop the nursing workforce, public and community health nursing has been neglected in terms of policy, research into public health nursing practice and workforce development. Even in the present day, public and community health nurses are marginalised from mainstream nursing interests and there is a lack of conceptualisation about the value of nursing’s contribution to the primary health sector. This sector is experiencing a new wave of reforms driven by a combination of managerialism and systems change for improved responses to address health inequalities. Because there is not a strong institutionalised professional policy and support base for public and community health nurses, they are vulnerable in these reforms to increased domination and appropriation of their practice by stronger professional interests. There is an urgent need for professionally organised support from mainstream nursing to ensure that public and community health nurses are positioned as a unified force in efforts to advance the health of the community.     

Nurses' perceptions of caring as documented in theory and research

Caring represents an essential human need and the fundamental component of the nursing profession. A deep understanding of caring and the way it is expressed will help nurses to provide high-quality services and, more importantly, to understand nursing itself. This review of the literature indicates the importance of examining caring both conceptually and operationally. Based on theoretical and research accounts, it also presents the wide variety of ways in which caring is conceived and expressed within the professional field. Caring is examined from anthropological, philosophical and psychosocial perspectives. In this paper implications for practice and research are outlined.