How nurses manage time and work in long-term care

AIMS OF THE STUDY: The aim of this study was to better understand the ways in which conditions of work, including staffing, affect how nurses in long-term care (LTC) facilities do their jobs and the quality of care they provide. BACKGROUND: The research reported here was performed in the context of public policy debates about the relationship between staffing levels and quality in LTC. METHODS: In 1995 and 1996, interviews and participant observation were used to examine how 18 licensed nurses employed in two LTC facilities in the midwestern United States experience their day-to-day work. RESULTS: Time was an extremely salient work condition for the nurses interviewed. Under conditions of too little time and many interruptions, nurses compensated by developing strategies to keep up or catch up. These strategies included minimizing the time spent doing required tasks, creating new time and redefining work responsibilities. Although these strategies allowed nurses to complete the tasks for which they were accountable, there were adverse consequences for nurses and residents. Nurses realized that time demands often made it impossible to provide care of high quality. They expressed their ideas about quality care as the notion of 'should do' work. In effect, time pressures forced them to forego the 'should do' work to complete the 'must do' work. CONCLUSION: Increased staffing could improve the quality of care in LTC facilities.     

护士长如何适应护理改革发展的需要

随着医疗卫生改革的不断深化 ,护理学科的发展亦有更广泛的前景 ,人们主动参与意识、创新能力增强 ,求知欲望增大 ,勇于实践探索和接受新事物的能力增强 ,更加注重效果、效率和效益。护士长如何适应护理改革发展的需要 ,在健康服务中扮演好自己的角色 ,是每一个护理管理者应认真思考和亟待解决的问题。文章重点阐述的问题为 :(1)充分认识变革时期护理工作的特点 ;(2 )护理改革需要转变观念 ;(3)护士长如何树立管理者的新形象 ;(4)如何提高护士长的管理能力 ;(5 )做好培训工作 ;(6 )开展以病人为中心、以健康为中心的护理等。     

Coronary care nurses' clinical decision making

Increasing acuity of hospitalized persons with cardiac disease places great demands on nurses’ decision-making abilities. Yet nursing lags in knowledge-based system development because of limited understanding about how nurses use knowledge to make decisions. The two research questions for this study were: how do the lines of reasoning used by experienced coronary care nurses compare with those used by new coronary care nurses in a representative sample of hypothetical patient cases, and are the predominant lines of reasoning used by coronary care nurses in hypothetical situations similar to those used for comparable situations in clinical practice? Line of reasoning was defined as a set of arguments in which knowledge is embedded within decision-making processes that lead to a conclusion. Sixteen subjects (eight experienced and eight new nurses) from coronary care and coronary step-down units in a large, private, teaching hospital in Minnesota, USA, were asked to think aloud while making clinical decisions about six hypothetical cases and comparable actual case. One finding was that most subjects in both groups used multiple lines of reasoning per case; but they used only one predominantly. This finding highlighted the non-linear nature of clinical decision making. Subjects used 25 predominant lines of reasoning, with intergroup differences on six of them. Where there were differences, experienced nurses used lines of reasoning of lower quality than did new subjects. The type variability in lines of reasoning suggested that multiple pathways should be in-corporated into knowledge-system design. One implication of the variability in subjects’ line of reasoning quality is that nurses at all levels of expertise are fallible and could benefit from decision support. The finding that subjects tended to use similar lines of reasoning for comparable hypothetical and actual cases was modest validation of subjects’ performance on hypothetical cases as representing their decision making in practice. Consequently, there was support for using simulations and case studies in teaching and studying clinical decision making.     

Uncertain terms of sedation in ICU. How nurses and physicians manage and describe sedation for mechanically ventilated patients

? Sedation which is used for intubated patients may prolong mechanical ventilation by increasing the risk of complications. The aim of the study was to illuminate the specific terminology and unrecognized contextual factors which may influence nurses' and physicians' sedation practices. ? The main research questions were: How do nurses and physicians describe sedation? and How does the level of nursing skill relate to the level of sedation? The hypotheses were that sedation practices are inconsistent and that experienced nurses provide a better quality of sedation than less experienced nurses. The hypotheses were supported by the study. ? The research strategy was case study research with triangulation of sources and methods and a multicentre multiple‐case design. Four university hospitals in Copenhagen, Denmark, and 14 cases were included in the study. The findings were based on secondary analysis of observation, interviews and chart review. ? The theoretical framework for the study was the problem‐solving model, in which sedation was assumed to be provided according to indication (clinical problem), intervention (clinical decision) and expected outcome (clinical end‐point). Indications could be patient‐related, ventilator‐related, or patient–ventilator related. Interventions could be related to the choice of agent, dose or administration method and the outcome was the level of sedation. ? Sedative therapy was prescribed by physicians and administered by nurses. The four sites in the study did not use guidelines for sedation and did not use sedation level assessment tools. The study shows that when the terminology is unclear, the indications, interventions and outcomes become unclear.     

A whatsapp community of practice to support new graduate nurses in South Africa

Internationally, transition from student to registered nurse is a challenging and stressful period. This study investigated the use of an Instant Messaging application (WhatsApp) community of practice to support graduate nurses in their first year of practice in the Western Cape, South Africa.A preliminary survey was conducted to determine the technology readiness of 64 participants. Following the enrolment of a further 8 participants, 76 new graduate nurses were enrolled in the WhatsApp Community of Practice which ran over an 8-week period. A quantitative one-group pre and post study evaluation via Survey Face was conducted comparing socio-professional outcome measures.The analysis of the readiness survey showed high WhatsApp use and perceived ease of use and usefulness. Though only 9 males in the survey, age and gender had no impact on the reported use. Interactions with alumni, bridging and bonding social capital, professional integration and a sense of belonging to a community of practice significantly improved. For graduate nurses in non-urban settings, bonding, professional identity and theory practice integrations were significantly higher compared to urban graduates.The findings highlight the value of a WhatsApp community of practice for isolated graduated nurses, especially in critical phases of transition and their professional development.     

New graduate nurses and dementia care in acute care: A qualitative study

With the increasing older adult population, new graduate nurses will be providing care for patients with dementia more frequently. The purpose of this qualitative study was to explore the experiences of new graduate nurses when providing care for patients with dementia in acute care environments. We conducted semi-structured interviews with eleven new graduate nurses in Ontario, Canada. Three themes emerged from the thematic analysis: (1) building of vision and values; (2) clashing of vision and values; and (3) making do with what you have. Barriers to providing dementia care in acute care were similar to barriers experienced by non- new graduate nurses reported in the literature, such as challenges with responsive behaviours, maintaining safety and providing psychosocial care. Facilitators identified were supportive colleagues and early exposure to dementia care.     

Critical care nurses' decision-making activities in the natural clinical setting

This article reports on observation of 18 nurses in urban and rural based critical care settings. The purpose of the study was to observe and describe the decision-making activities of critical care nurses within natural clinical settings. During the 2-hour observation, the researcher dictated a detailed commentary on to audio-tape of each nurse's actions. Tapes were transcribed and subjected to content analysis. Findings indicated three main categories of decisions. Decision frequencies were linked to nurses' critical care experience, appointment level, and location, as well as nursing shifts. The findings are discussed in relation to previous empirical evidence and the implications for practice. The author concludes that future research should be directed towards measuring the contextual influences on nurses' decision-making on the outcome of patient care.     

Documentation of medication management by graduate nurses in patient progress notes: a way forward for patient safety

Nursing documentation provides evidence of nurses' management, the patient response, and evaluation of care. The aim of the study was to examine how graduate nurses document their medication management in the progress notes. A prospective clinical audit of patient medication charts and the progress notes made by 12 graduate nurses was undertaken. Graduate nurses were also individually interviewed and asked clarifying questions about their medication management. Documentation was examined based on four areas: assessment, planning care, administration of medications, and evaluating outcomes of medications. Recorded information about assessment focused on cues of a biomedical rather than a psychosocial nature. Planning care involved non-specific documentation of discharge planning needs, and little information about communication with doctors, pharmacists, nurses, patients and next of kin. Administration of medications included details about the names of medications given to patients, but no information about medication education provided to patients during this time. Evaluation of outcomes of medication administration was poorly documented. Graduate nurses tended to focus on assessing medications before their administration without considering how the patient responded to treatment. Recommendations are proposed for improving the quality of graduate nurses' progress notes. These recommendations include implementing and evaluating protocols that link nurses' decision-making to documentation processes. Adopting a supportive multidisciplinary approach to quality improvement and providing education that emphasises written documentation of verbal communication are also recommended.     

Factors influencing clinical decision making used by mental health nurses to provide provisional diagnosis: A scoping review

Medical diagnosis has traditionally been the role of medical officers. However, mental health nurses working in crisis/emergency settings within Australia are expected to provide a provisional diagnosis postassessment of a consumer. There is limited literature and understanding how mental health nurses develop a provisional diagnosis. In this scoping review, we aimed to first identify and describe the clinical decision‐making processes used by mental health nurses across a variety of clinical settings. Second, we sought to explore the factors influencing mental health nurse's diagnostic practice in a variety of settings. Literature was searched using CINAHL (EBSCOhost), PubMed, and ProQuest. Peer‐reviewed literature published between 2007 and 2017 was used for this scoping review. Two major themes were identified: clinical decision making (CDM) in mental health nursing and diagnostic practice in nursing. A combination of clinician, environmental, and patient factors were found to have influenced CDM. Furthermore, mental health nurses rely heavily on tacit knowledge when making clinical decisions. Little is known about the use of diagnostic practice in mental health nursing in Australia; however, the limited literature revealed an overlap between the factors which influence CDM and diagnostic practice, respectively. Further research is needed into the use of diagnostic practice in mental health nursing to develop frameworks to assist with CDM pertaining to application of provisional diagnosis by mental health nurses working in assessment environments.