伦理敏感性与工作嵌入在护士感知的管理关怀与工作满意度间的链式中介效应

目的 探讨伦理敏感性、工作嵌入在护士感知的管理关怀对工作满意度影响机制中的多重中介作用。方法 采用便利抽样法,于2020年7-8月选取湖南省5所医院的护士作为调查对象。采用一般资料问卷、管理关怀性量表、伦理敏感性量表、工作嵌入量表、工作满意度量表对773名研究对象进行调查,构建并检验链式中介模型。结果 本组773名护士感知的管理关怀总分为152.00（134.50,165.00）,伦理敏感性总分为39.00（36.00,44.00）,工作嵌入总分为26.00（22.00,28.00）分,工作满意度总分为74.00（67.00,80.00）分。护士感知的管理关怀对工作满意度的间接效应成立,总的间接效应为0.284;伦理敏感性的特定中介效应占总间接效应的20.8%;工作嵌入的特定中介效应占总间接效应的70.4%;伦理敏感性和工作嵌入在护士感知的管理关怀和工作满意度间的链式中介效应占总间接效应的8.8%。结论 伦理敏感性、工作嵌入在护士感知的管理关怀和工作满意度间的多重中介效应成立。建议管理者重视对护士实施的关怀举措,制定不同培训计划,提升其伦理敏感性,提高对组织的认同感和依赖性,进而提高工作满意度水平。     

出现生命危急值肿瘤患者的护理

目的探讨出现生命危急值肿瘤患者的护理方法。方法回顾性分析2012年1-9月在军事医学科学院附属医院肺部肿瘤内科治疗的出现生命危急值的87名肿瘤患者的临床资料,总结其护理方法。结果所有患者经对症治疗,病情好转。结论积极配合医生采取有效地治疗措施,进行行之有效的预防及护理,能够有效地减轻患者的临床症状。     

Building the Information Infrastructure Required for Managed Care

Purpose: To describe the information used by health care purchasers, policymakers, and administrators when making the decisions required in a managed-care environment and what the profession must do to develop an information infrastructure to demonstrate its contribution to patient outcomes.
Scope: Managed care has created a competitive environment for all health care organizations in which they must offer the best value for their dollar. The purchasing processes germane to managed care rely heavily on information for the selection of cost-effective providers and the provision of efficient care. lnformation used in these processes is derived from transaction systems that largely describe physician and other health care worker's services, but not nursing care. Data analysis by computers requires that data be obtained using a standardized language. Currently, nursing lacks a unified approach to the use of a standardized nursing language.
Conclusions: Individual nurses, nurse managers, executives, and educators should strive to develop an information infrastructure that will overcome barriers. Nurses should both adopt a unified approach to a standardized language, and develop a nationwide information infrastructure that will demonstrate nursing's contribution to patient outcomes.     

Nurses' responses to ethical dilemmas in nursing practice: meta-analysis

Title. Nurses’ responses to ethical dilemmas in nursing practice: meta‐analysis. Aim. This paper is a report of a study to explore nurses’ responses to ethical dilemmas in daily nursing practice. Background. Concern about nurses’ ethical competence is growing. Most nurses perceived that there were barriers in their work environment to ethical practice, compromising their ability to perform ethically. Since most research focuses on contextual barriers to nurses’ ethical practice, little is known about how nurses involve themselves in ethical decision‐making and action in daily care. Method. A meta‐analysis of nurses’ ethical behaviour was conducted using data from nine studies in four countries (n = 1592 registered nurses). In all studies, the Ethical Behaviour Test was used to measure nurses’ ethical responses, based on an adapted version of Kohlberg’s theory of moral development. Data were analysed using random‐intercept regression analysis. Findings. All groups, except the expert group, displayed a uniform pattern of conventional ethical reasoning and practice. When nurses were faced with ethical dilemmas, they tended to use conventions as their predominant decision‐guiding criteria rather than patients’ personal needs and well‐being. Conclusion. Conformist practice (following conventions rather than pursuing good for the patient) constitutes a major barrier for nurses to take the appropriate ethical actions, as creativity and critical reflection are absent. There is an urgent need to find ways to promote nurses’ ethical development from conventional to postconventional ethical practice. More research is needed to strengthen existing empirical evidence.     

Nurses' Perceptions of Safety Culture in Long-Term Care Settings

Purpose: To describe perceptions of workplace safety culture among nurses employed in long-term care (LTC) settings.
Design: A cross-sectional survey. Respondents were licensed nurses ( N =550) with membership in gerontological nursing professional organizations in the United States ( n =296), Canada ( n =251), and other ( n =3).
Methods: An anonymous, self-administered, mail-in questionnaire, which included the Hospital Survey on Patient Safety Culture as well as questions about individual and institutional characteristics. The survey included key aspects of safety culture, such as work setting, supervisor support, communication about errors, and frequency of events reported.
Findings: Nurse-managers reported significantly more positive safety culture perceptions compared with licensed staff nurses. Additionally, licensed nurses employed in government-run facilities had significantly less positive safety culture perceptions compared with those working in nonprofit organizations.
Conclusions: Interventions designed to improve safety culture in LTC settings should be focused on the concerns of licensed staff nurses and the improvement of communication between these nurses and their managers.
Clinical Relevance: Enhancing safety culture in long-term care settings may facilitate improvements in resident safety. Assessment of workplace safety culture is the first step in identifying barriers that nurses face to provide safe resident care.     

Influence of Managed Care on Professional Nursing Practice

To explore how nurses in one U.S. state perceived that managed care influenced professional nursing in that state. The nursing community is challenged to move with haste in demonstrating, through research, the clinical and economic value that nurses add to cost-effective outcomes.

Design:

A Delphi survey in 1996 of a convenience sample of 84 clinical nurse specialists (CNSs) and nurse practitioners (NPs) in California.

Methods:

CNSs and NPs contributed to the list of managed care influences on nursing practice. Fifty-seven (68%) completed the third and final round.

Findings:

Panelist agreement was the highest for (a) exploring new approaches to providing quality care more cost-effectively, (b) expanding nurse practitioners' rote in primary care, and (c) more effectively partnering with clients in helping them assume greater self-responsibility for their health. Greatest threats were perceived to be hassles involved in seeking authorization for care and responding to payment denials; the tenuous job market for nurses; and encroachment on nursing practice by others.

Conclusions:

The findings can assist nurses in states with low managed-care concentration to create their preferred future within health care delivery. A more highly educated nurse workforce will be needed for 21st century health systems in which more care is likely to be delivered outside hospitals.     

Assisted Dying and Nursing Practice

Nurses' views are often solicited about physician-assisted dying, a concept that incorporates both assisted suicide and active euthanasia. Yet nurses are rarely asked about their own clinical experience of assisted dying. The literature indicates that many nurses experience difficulty distinguishing professionally sanctioned end-of-life interventions from those that are not. In this article the investigator explores the social, legal, and political roots of assistance in dying, and critically examines the profession's position on nurse participation in assisted dying and the research regarding nurse-assisted dying.

Scope:

The bioethics and nursing literature was reviewed from 1990 to 1999. The databases used were the Cumulative Index to Nursing and Allied Health Literature and Medline.

Conclusions:

The complex nature of caring for highly symptomatic dying patients, and the difficulty some nurses experience in distinguishing a moral difference between hastening and assisting death, strongly indicate a need for additional nursing research that does not use a forced answer.     

Nurses' views on ethical codes: a focus group study

AIM: This paper reports a study exploring nurses' views on the 'potential' content and functions of an ethical code for nurses in Belgium. The term 'potential' is used, because Belgian nurses do not have experience with an ethical code. BACKGROUND: Ethical codes have been developed to guide nurses' practice and to improve their professional status. Little empirical research, however, has been undertaken to determine nurses' views on the content and functions of these codes. The available quantitative studies merely give some information on nurses' (lack of) knowledge and use of their ethical code. No nursing ethical code currently exists in Belgium. Qualitative research exploring nurses' views, therefore, was needed in order to find out which functions an ethical code could fulfil and what the code's content could be. METHOD: Eight focus groups were conducted with 50 nurses in different healthcare settings in Belgium. Data were generated during 2003. FINDINGS: According to participants, an ethical code could fulfil several functions, including supporting their professional nursing identity (external function) and giving guidelines for nursing practice (internal function). In addition, some aspects of content were mentioned, including nurses' responsibilities in a relational context: particular attention should be paid to the personality of the nurse and to the specificity of nursing as a relational activity. Most agreement was reached on the 'ethical' function of the code, namely guiding nurses' professional moral practice. Regarding disciplinary use and the need for legalization of the ethical code, on the contrary, opinions were divergent. CONCLUSIONS: It is of utmost importance to take into account nurses' views when developing an ethical code for their profession. This study gave a first picture of the views of nurses themselves. These initial findings should be completed with nurses' views on the formulation, dissemination and promotion of the ethical code. Such evidence-based development of an ethical code will probably give more guarantees that the code will meet nurses' expectations and will function optimally.     

老年失智症住院患者的伦理关怀

目的探讨对临床老年失智症患者的伦理关怀照护模式,以期提升护理服务内涵,培育护士的人文素养。方法便利抽样法选择精神科二个老年病区患者48例,以患者所在病区的不同将其分为试验组和对照组,各24例。试验组给予物质、精神和护理道德三个维度的伦理关怀,对照组常规护理,干预6个月后评估两组患者生活质量的差异。同时选取护士23名为护士组研究对象,同步作护士伦理关怀知晓度访谈、护理人员关爱行为量表评估,比较其在实施过程中认知、态度、心理和行为的变化。结果护士评价项目干预前后有明显差异;患者生命质量指标干预前后总体比较未显差异,但情绪得到明显改善,互动能力增强,促进了整体生活质量的提高。结论伦理关怀模式督导护士遵从护理道德;给予失智症患者更多的关爱,提升了他们的生活质量;倡导伦理关怀理念已成为患者、社会及护理学科发展的需要。     

Primary Health Care Nurses' conceptions of involuntarily migrated families' health

BACKGROUND: Involuntary migration and adaptation to a new cultural environment is known to be a factor of psychological stress. Primary Health Care Nurses (PHCNs) frequently interact with refugee families as migrant health needs are mainly managed within Primary Health Care. AIM: To describe the health of the involuntary migrated family in transition as conceptualized by Swedish PHCNs. METHOD: Thirty-four PHCNs from two municipalities in Sweden were interviewed and phenomenographical contextual analysis was used in analysing the data. FINDINGS: Four family profiles were created, each epitomizing the health characteristics of a migrated family in transition: (1) a mentally distressed family wedged in the asylum-seeking process, (2) an insecure family with immigrant status, (3) a family with internal instability and segregated from society, and (4) a stable and well-functioning family integrated in society. Contextual socio-environmental stressors such as living in uncertainty awaiting asylum, having unprocessed traumas, change of family roles, attitudes of the host country and social segregation within society were found to be detrimental to the well-being of the family. CONCLUSION: Acceptance and a clear place in society as well as clearly defined family roles are crucial in facilitating a healthy transition for refugee families. Primary Health Care Nursing can facilitate this by adopting a family system perspective in strengthening the identity of the families and reducing the effects of socio-environmental stressors.