心理授权对护士行为目标达成度的影响

目的调查护士心理授权和行为目标达成度现状,分析心理授权对护士行为目标达成度的影响。方法采用心理授权量表和护士行为目标达成度评价量表对432名护士进行问卷调查。结果护士心理授权总分为(42.45±4.72)分;护士行为目标达成度总分为(153.62±15.23)分,其中62.96%行为目标达成度较低,21.99%行为目标达成度中等,15.05%行为目标达成度较高;工作年限、职称、工作意义、工作影响、自我效能和工作自主性均为护士行为目标达成度的影响因素(P0.05)。结论护士心理授权处于中等水平,行为目标达成度较低,心理授权是护士行为目标达成度的影响因素,可通过改善护士心理授权来提高其行为目标达成度。     

The Prince Edward Island Conceptual Model for Nursing: a nursing perspective of primary health care.

The philosophy of primary health care (PHC) recognizes that health is a product of individual, social, economic, and political factors and that people have a right and a duty, individually and collectively, to participate in the course of their own health. The majority of nursing models cast the client in a dependent role and do not conceptualize health in a social, economic, and political context. The Prince Edward Island Conceptual Model for Nursing is congruent with the international move towards PHC. It guides the nurse in practising in the social and political environment in which nursing and health care take place. This model features a nurse/client partnership, the goal being to encourage clients to act on their own behalf. The conceptualization of the environment as the collective influence of the determinants of health gives both nurse and client a prominent position in the sociopolitical arena of health and health care.     

The impact of self-care practices on treatment of interstitial cystitis

Self-care, as a theoretical base of practice in caring for patients with interstitial cystitis (IC), has been suggested as a model of holistic health. Those living with IC look to the nurse/health care practitioner for intervention and care. Nurses operating from the self-care nursing framework may find this model useful in caring for patients with IC. These patients are educated by the nurse regarding preventative measures, interventions, and advanced treatments and therefore may be in a better position to participate in achieving the goal of optimal health. Self-care nursing helps the client to care for themselves through education, resource acquisition, and role-modeling positive behavioral outcomes.     

Cultural negotiation: a constructivist-based model for nursing practice.

Combining abstract concepts from grand theories with the pragmatics of nursing practice presents a dilemma for nursing that is being addressed with the emphasis on middle-range theory. The philosophical perspective of constructivism is the foundation for a middle-range theory that links the nursing process to holism through the respective worlds and knowledge of the nurse and client. The nursing process is situated in the context of the cultural worlds of the nurse, client, and health care system and in the greater social context. This model allows the nursing process to be recast in new language that captures the interdependence of the client-nurse interaction. This model accommodates the social values and beliefs of both the health care system and the social context.     

The client as educator: learning about mental illness through the eyes of the expert

Increasingly, educators are asking clients who have a mental illness to make a contribution to nursing students' learning as a way of informing their attitudes towards persons experiencing mental illness and thus enhancing care delivery. The nature of clients' involvement in the classroom and the quality of learning by students through this approach has rarely been questioned. This paper discusses a model of client/nurse educator collaboration in a mental health course with undergraduate nursing students. It draws on the nursing education experiences of the first author, and the personal views of the second author, a user of mental health services. Specifically, it addresses positive features of collaboration as perceived by students, client, and nurse educator and analyzes some of the challenges/issues for the nurse educator. In addition, it outlines helpful aspects of the collaborative process for both nurse educator and client, in particular, its impact on the client's personal well being. This kind of analysis is essential if we are to develop education models of such collaboration that are beneficial for all partners in the learning process.     

Health Care Delivery in Faith Communities: The Parish Nurse Model

Abstract Religious institutions and nurses have a common bond—both are committed to empowering individuals to achieve their full potential and believe in the self-care capacity of individuals. The purpose of this study was to examine parish nursing as an evolving model of care within faith communities. Annualization of monthly reports and parish nurse interviews revealed that parish nurse activities contributed to the empowerment process and to the attainment of Healthy People 2000 objectives.     

Holistic symptom management: modelling the interaction phase

AIM: This article details an interaction model that links the way a nurse participates in a client's effort to describe the symptom experience and the eventual symptom management outcome. RATIONALE: Symptoms represent more than clues to an underlying disease process. Within a nursing perspective, managing symptoms requires an understanding of the person's experience and the meaning associated with each symptom. All nurses engage in symptom work with clients, but the extent of their accountability varies within their scope of practice. In the United States of America (USA) model of advanced practice nursing, the scope expands to include all aspects of symptom management such as eliciting an accurate understanding, using a symptom cluster to determine underlying causes, and involving the client in management decisions. A holistic nursing approach to symptom management is particularly well suited to the increasing numbers of people with chronic illness. METHOD: The discussion herein details the interaction phase of the evolving model of Negotiated Symptom Management in chronic illness. Analysis of the participants, process, and context governing this encounter reveal the complexities of the interaction. FINDINGS: It is argued that variables within the interaction have the potential to compromise desired nurse and client outcomes. Although symptom acknowledgement and relief is a primary goal, the emphasis for the nurse clinician remains on the person, not the symptom. Effective symptom management is dependent on hearing and attending to the lifeworld of the client. CONCLUSION: Attending to key areas of influence in the interaction process facilitates the achievement of desired outcomes in symptom management--accurate diagnosis, symptom relief, and agreement on a course of action. The dominance of chronic illness in health care, and the centrality of the symptom experience underscores the value of sensitizing nurses to these issues.     

Interstitial cystitis and self-care: bearing the burden

The purpose of this case study article is to place a personal twist on a frightening disease process known as interstitial cystitis (IC). As nurses, the goal of our interventions is to promote the independence of the client in his/her own self-care. One nursing theory, Modeling and Role-Modeling (Erickson, Tomlin, & Swain, 1983), has assisted me not only as a nurse but also as a client to overcome the IC dilemma through the practice of self-care nursing.     

Effective ergonomic teaching for positive client outcomes. Implications for practice.

Teaching and intervention are integral aspects of professional nursing practice. Numerous publications encourage the use of specific teaching intervention techniques, but few are validated by studies conducted to assess actual teaching behaviors of nurses who administer successful teaching intervention programs. This is a case study of one occupational health nurse who administers a highly effective ergonomic program for employees in a large urban hospital. Themes identified during observation of nurse and client interactions include mindfulness on the part of the nurse, respect for client autonomy, nurse effort, nurse accessibility, and professional distance. A consistent teaching process identified during observation consists of six steps: inquiry, invitation, assessment, synthesis, validation, and progression. This six step process is embedded within identified themes. Teaching and intervention methods identified in the study are a synthesis of caring behaviors and nursing process. This integrated method is entitled "Effective Teaching Through Unified Process and Caring Interpersonal Behavior." It may represent a valid teaching and intervention method supporting compliance and positive client outcome when interacting with clients requiring ergonomic teaching and intervention.     

Undermining self-efficacy: the consequence of nurse unfriendliness on client wellbeing

Although unfriendly nurse behaviours are noted in research findings, no study names these behaviours as such, nor investigates the impact of nurse unfriendliness on clients. Because the present findings reveal the phenomenon of nurse unfriendliness, they allow both the phenomenon and its consequences to be understood. These findings were developed through secondary data analysis of a text where participants discussed their encounters, during hospitalisation/s in 2002-2003, with friendly and unfriendly nurses. Findings reveal nurse unfriendliness is characterised by frostiness, officiousness and apathy. It results in thoughtless and inept nursing and in a hostile environment where clients feel unsafe, unwelcome and unaided. Unfriendly nurses create barriers--they are disrespectful, cheerless, unresponsive and domineering so clients feel belittled, disheartened, unprotected and distressed. When clients are placed in this position, their self-efficacy is undermined. By revealing the consequences of nurse unfriendliness on client wellbeing, findings from this study advance nursing knowledge.     

A concept analysis of empowerment

In this paper, an objective concept analysis was undertaken to examine the attributes, characteristics and uses of the concept of empowerment. A review of the literature and selected empirical referents indicated that empowerment is a complex and multi-dimensional concept. Within a nursing context, empowerment can be conceptualized as a composite of (a) attributes that relate to the client, (b) attributes that relate to the nurse, and (c) attributes that belong to both the client and the nurse. In a broad sense, empowerment is a process of helping people to assert control over the factors which affect their lives. This process encompasses both the individual responsibility in health care and the broader institutional, organizational or societal responsibilities in enabling people to assume responsibility for their own health. Antecedents to and consequences of empowerment, from a nursing perspective, are presented. To adopt truly an empowerment model in nursing, a radical paradigm shift is needed. The final conclusion is that this concept has great utility for nursing practice, education, administration and research.     

The development of the Intersystem Model

A nursing model has been developed which guides curriculum development and nursing practice at Azusa Pacific University School of Nursing; the Intersystem Model. It is a model which focuses on the interaction between nurse and patient/client and requires that the nurse assess the knowledge base, the values and the behaviours that are brought to a specific patient situation by both the nurse and the patient/client. Using the system concepts of supra and subsystems, person can be defined as the individual, the family or the community. An intrasystem assessment of the biological, psychosocial and spiritual subsystems of the person is carried out, as well as an assessment of the developmental environment. The developmental environment consists of all the events, factors and influences which have made the person what he is at the time he enters a specific encounter requesting nursing action for an illness situation he is unable to resolve independently. Positive and negative variables are identified and a score on sense of coherence is assigned. Sense of coherence is a construct which includes three components: comprehensibility, meaningfulness and manageability. In using the model, each component is scored from low to high. Through a collaborative process, a joint plan of care is developed in order to increase the sense of coherence the patient/client experiences about the health problem and the plan is evaluated by rescoring on sense of coherence. An example of how the Intersystem Model has been used with a diabetic patient in the community is presented, as well as diagrams illustrating the way the nursing process is carried out in intersystem interaction.     

Assessing the educational needs of post-myocardial infarction patients

Nurses involved in cardiac rehabilitation have a responsibility and an opportunity to promote positive changes in lifestyle through patient education programs. Assessing patients' needs and setting goals with the patient are essential for attainment of the maximum benefit from the educational program. The problem of dwindling resources and pressures to control health care costs have complicated the delivery of this care in some institutions. The educational strategy chosen by the nurse will depend on the resources available. Nevertheless, whichever strategy is chosen, the nurse, by virtue of his or her role in the health care delivery system and specialized knowledge, can still significantly impact on the successful goal attainment of goals for increasing numbers of post-myocardial infarction patients.     

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.     

Goal setting as an outcome measure: A systematic review

BACKGROUND: Goal achievement has been considered to be an important measure of outcome by clinicians working with patients in physical and neurological rehabilitation settings. This systematic review was undertaken to examine the reliability, validity and sensitivity of goal setting and goal attainment scaling approaches when used with working age and older people. AIMS AND OBJECTIVES: To review the reliability, validity and sensitivity of both goal setting and goal attainment scaling when employed as an outcome measure within a physical and neurological working age and older person rehabilitation environment, by examining the research literature covering the 36 years since goal-setting theory was proposed. METHODS: Data sources included a computer-aided literature search of published studies examining the reliability, validity and sensitivity of goal setting/goal attainment scaling, with further references sourced from articles obtained through this process. MAIN FINDINGS: There is strong evidence for the reliability, validity and sensitivity of goal attainment scaling. Empirical support was found for the validity of goal setting but research demonstrating its reliability and sensitivity is limited. CONCLUSIONS: Goal attainment scaling appears to be a sound measure for use in physical rehabilitation settings with working age and older people. Further work needs to be carried out with goal setting to establish its reliability and sensitivity as a measurement tool.     

Luck: what the nurse should know about it and how it affects nursing situations

Luck permeates every aspect of human behaviour. Thus, luck is an aspect of nursing care and client belief of which the nurse should be aware. Beliefs about luck will influence client compliance with recommendations for actions as well as influence actions the client selects in relation to health. Beliefs about luck will also influence actions the nurse may take when responding to clients.     

Client and family learning in the rehabilitation setting

Learning in the rehabilitation setting, whether it be inpatient or community based, is a vital part of the client and family's role as consumers of rehabilitation care. Educational programs foster client participation in selecting appropriate modes of learning activities as they relate to the recovery process and help the client and family make a smooth transition into community living. Varied modes of instruction may be used, including practice sessions, group learning activities, computerized programs, use of videos as well as printed resources. The role of the nurse as educator coupled with a broad range of teaching strategies provides the client and family effective tools to make ongoing changes related to their functional abilities. The role of the rehabilitation nurse as an educator is an evolving one. No longer is the nurse practicing in a rehabilitative setting, whether it be inpatient or community based, guaranteed what appeared to be unending time to conduct educational programs. Past constraints, shortened stays, the client assuming an earlier role as a self-care agent, the focus on wellness, disabled individuals mainstreaming into community life, greater family involvement in rehabilitation efforts, and increased use of paraprofessionals force the nurse to strengthen and clarify her role as educator. Nurses need to value their teaching role as an integral part of the team effort. Strategies include scheduling teaching time with clients and families, recording activities and outcomes, discussing educational issues with other disciplines, and designing and promoting an environment that is conducive to learning.     

Professional nurse autonomy: concept analysis and application to nursing education

Professional nurse autonomy, an essential attribute of a discipline striving for full professional status, is often confused with personal autonomy, work autonomy or aggregate professional autonomy. Using Walker & Avant's (1995) model for concept analysis, this paper presents an analysis of professional nurse autonomy. Professional nurse autonomy is defined as belief in the centrality of the client when making responsible discretionary decisions, both independently and interdependently, that reflect advocacy for the client. Critical attributes include caring, affiliative relationships with clients, responsible discretionary decision making, collegial interdependence, and proactive advocacy for clients. Antecedents include educational and personal qualities that promote professional nurse autonomy. Accountability is the primary consequence of professional nurse autonomy. Associated feelings of empowerment link work autonomy and professional autonomy and lead to job satisfaction, commitment to the profession, and the professionalization of nursing. A student-centred, process-orientated curricular design provides an environment for learning professional nurse autonomy. To support the development of professional nurse autonomy, the curriculum must emphasize knowledge development, understanding, and clinical decision making.     

The Role of the Nurse Practitioner in the Diagnosis and Management of Bulimia Nervosa, Part 3: Psychosocial Management

Psychological problems associated with bulimia nervosa affect both the client and the family. The nurse practitioner is often in a position to refer the client to a therapist who has experience in treating clients with eating disorders. The nurse practitioner and the therapist, along with the nutritionist, if available, need to work from the beginning as a team. Each team member must have a distinct role regarding management of specific aspects of client care in order to avoid confusion and attempted manipulation by the client.     

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.