Nurses' daily life: gender relations from the time spent in hospital

Objective:

to analyze the everyday life of nurses through the sexual work division as well as through interdependence relations and the time in hospital.

Method:

quanti-qualitative study, based on the Time Use Survey and in Norbert Elias''s Configuration Theory of Interdependencies. Daily shifts distribution record, directed by 42 participants - with self-confrontation - by interviews which drew dialogues on subjective aspects of the everyday experiences related to use of time, based on a job at a university hospital. The theoretical intake that founded data analysis was based on concepts of conflicts of interest, power struggles, sexual work division and polychronic-monochronic concepts - whether the work environment demands multitasking nurses or not.

Results:

time records allowed to observe differences between the groups studied, useful to identify conflicts, tensions, power struggles and gender inequalities in interviewees'' everyday affairs that do not only affect physical and mental health, but also their way of life.

Conclusion:

the analytical path pointed out the need for public policies that promote equity in gender relations, keeping at sight the exercise of plural discourses and tolerant stances capable to respect differences between individual and collective time.     

Moral distress and Burnout syndrome: are there relationships between these phenomena in nursing workers?

Objective

to identify relationships between moral distress and Burnout in the professional performance from the perceptions of the experiences of nursing workers.

Methods

this is a survey type study with 375 nursing workers working in three different hospitals of southern Rio Grande do Sul, with the application of adaptations of the Moral Distress Scale and the Maslach Burnout Inventory, validated and standardized for use in Brazil. Data validation occurred through factor analysis and Cronbach''s alpha. For the data analysis bivariate analysis using Pearson''s correlation and multivariate analysis using multiple regression were performed.

Results

the existence of a weak correlation between moral distress and Burnout was verified. A possible positive correlation between Burnout and therapeutic obstinacy, and a negative correlation between professional fulfillment and moral distress were identified.

Conclusion

the need was identified for further studies that include mediating and moderating variables that may explain more clearly the models studied.     

Meaning of Self-Care: Lived Experiences of Iranian Diabetic Patients

Background

Diabetes continuously disrupts a patient''s well-being and quality of life. Successful self-care could potentially decrease overall costs and rates of mortality and morbidity. Patients'' experiences could be used to elucidate what they believe about illness and its management. The overall aim of this study was to illuminate the meaning of self-care among diabetic patients in Southeast of Iran.

Methods

Sixteen diabetic patients with a mean age of 34 and 10 years'' experience in self-care for their disease were interviewed. The interviews were recorded, transcribed verbatim, and analyzed with a Ricoeur''s phenomenological hermeneutic method.

Results

The meaning of self- care was comprehensively understood as being empowered. This can be divided into four themes: seeking information, being independent, being optimistic or pessimistic and trust in God.

Conclusion

The results in this study suggest that cultural and religious components could affect diabetic patients'' self-care. Nurses might use patients'' religious beliefs to relieve their stress, help them to retain a sense of control, maintain hope and sense of meaning and purpose in their life.     

The reasons of the nursing staff to notify adverse events

OBJECTIVE:

this research aimed to understand the motivation for reporting adverse events from the perspective of nursing staff in the work environment.

METHOD:

qualitative study that used the phenomenology of Alfred Schutz for reference, which offers a systematic approach to understand the social aspects of human action. Data were collected by open interviews with 17 nurses and 14 technicians/assistant nurses in a university hospital.

RESULTS:

motivation was revealed through six categories: all types of occurrences must be reported; the incident report is an auxiliary instrument to health care provision management; the culture of punishment in transition; nurses as the agents responsible for voluntary reporting; sharing problems with higher management and achieving quality in the work process.

DISCUSSION:

it was unveiled that, when reporting adverse events, team members perceived themselves to be in a collaborative relationship with the institution and trusted that they would receive administrative support and professional security, which encouraged them to continue reporting. Reporting allows health care professionals to share responsibilities with managers and encourages corrective actions.

FINAL CONSIDERATIONS:

the study revealed the nursing staff''s motivation for adverse event reporting, contributing to reflections on institutional policies aimed at patient safety in health care.     

A behavior model for blood donors and marketing strategies to retain and attract them

Objective

analyze and propose a theoretical model that describes blood donor decisions to help staff working in blood banks (nurses and others) in their efforts to capture and retain donors.

Methods

analysis of several studies on the motivations to give blood in Spain over the last six years, as well as past literature on the topic, the authors'' experiences in the last 25 years in over 15 Non Governmental Organizations with different levels of responsibilities, their experiences as blood donors and the informal interviews developed during those 25 years.

Results

a model is proposed with different internal and external factors that influence blood donation, as well as the different stages of the decision-making process.

Conclusion

the knowledge of the donation process permits the development of marketing strategies that help to increase donors and donations.     

Do Experiences with Medicare Managed Care Vary According to the Proportion of Same-Race/Ethnicity/Language Individuals Enrolled in One's Contract?

Objective

To examine whether care experiences and immunization for racial/ethnic/language minority Medicare beneficiaries vary with the proportion of same-group beneficiaries in Medicare Advantage (MA) contracts.

Data Sources/Study Setting

Exactly 492,495 Medicare beneficiaries responding to the 2008–2009 MA Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey.

Data Collection/Extraction Methods

Mixed-effect regression models predicted eight CAHPS patient experience measures from self-reported race/ethnicity/language preference at individual and contract levels, beneficiary-level case-mix adjustors, along with contract and geographic random effects.

Principal Findings

As a contract''s proportion of a given minority group increased, overall and non-Hispanic, white patient experiences were poorer on average; for the minority group in question, however, high-minority plans may score as well as low-minority plans. Spanish-preferring Hispanic beneficiaries also experience smaller disparities relative to non-Hispanic whites in plans with higher Spanish-preferring proportions.

Conclusions

The tendency for high-minority contracts to provide less positive patient experiences for others in the contract, but similar or even more positive patient experiences for concentrated minority group beneficiaries, may reflect cultural competency, particularly language services, that partially or fully counterbalance the poorer overall quality of these contracts. For some beneficiaries, experiences may be just as positive in some high-minority plans with low overall scores as in plans with higher overall scores.     

Acceptance of New Medicaid Patients by Primary Care Physicians and Experiences with Physician Availability among Children on Medicaid or the Children's Health Insurance Program

Objective

To estimate the relationship between physicians'' acceptance of new Medicaid patients and access to health care.

Data Sources

The National Ambulatory Medical Care Survey (NAMCS) Electronic Health Records Survey and the National Health Interview Survey (NHIS) 2011/2012.

Study Design

Linear probability models estimated the relationship between measures of experiences with physician availability among children on Medicaid or the Children''s Health Insurance Program (CHIP) from the NHIS and state-level estimates of the percent of primary care physicians accepting new Medicaid patients from the NAMCS, controlling for other factors.

Principal Findings

Nearly 16 percent of children with a significant health condition or development delay had a doctor''s office or clinic indicate that the child''s health insurance was not accepted in states with less than 60 percent of physicians accepting new Medicaid patients, compared to less than 4 percent in states with at least 75 percent of physicians accepting new Medicaid patients. Adjusted estimates and estimates for other measures of access to care were similar.

Conclusions

Measures of experiences with physician availability for children on Medicaid/CHIP were generally good, though better in states where more primary care physicians accepted new Medicaid patients.     

The treatment of childhood cancer: unveiling the experience of parents

Objective

to understand the experiences of parents of children and adolescents with cancer undergoing treatment.

Method

qualitative research, based on Heidegger''s existential phenomenology, in which 13 parents of eight patients under 19 years of age, assisted by a charity association, were interviewed.

Results

three topics resulted from the analysis: "Experiencing the unpleasantness of the treatment"; "Fearing the possibility of a frightening situation" and "Experiencing the carelessness of another person". It was showed that during and after the treatment, the parents experience the fear of the unknown and the uncertainty of the future of their children, especially as they witness the death of other children; they also experience the indifference of professionals working in the local healthcare units and feel helpless and insecure.

Conclusion

It is essential that the healthcare professionals, particularly the nurses, reflect about their care actions focused on the parents of children with cancer, recognizing their existential needs with the purpose of assisting them in their situation.     

Nurses' adherence to the Kangaroo Care Method: support for nursing care management

OBJECTIVE:

construct an explanatory theoretical model about nurses'' adherence to the Kangaroo Care Method at the Neonatal Intensive Care Unit, based on the meanings and interactions for care management.

METHOD:

qualitative research, based on the reference framework of the Grounded Theory. Eight nurses were interviewed at a Neonatal Intensive Care Unit in the city of Rio de Janeiro. The comparative analysis of the data comprised the phases of open, axial and selective coding. A theoretical conditional-causal model was constructed.

RESULTS:

four main categories emerged that composed the analytic paradigm: Giving one''s best to the Kangaroo Method; Working with the complexity of the Kangaroo Method; Finding (de)motivation to apply the Kangaroo Method; and Facing the challenges for the adherence to and application of the Kangaroo Method.

CONCLUSIONS:

the central phenomenon revealed that each nurse and team professional has a role of multiplying values and practices that may or may not be constructive, potentially influencing the (dis)continuity of the Kangaroo Method at the Neonatal Intensive Care Unit. The findings can be used to outline management strategies that go beyond the courses and training and guarantee the strengthening of the care model.     

Immigrant women's experiences and views on the prevention of cervical cancer: a qualitative study

Background

Many Western countries have cervical cancer screening programmes and have implemented nation‐wide human papillomavirus (HPV) vaccination programmes for preventing cervical cancer.

Objective

To explore immigrant women''s experiences and views on the prevention of cervical cancer, screening, HPV vaccination and condom use.

Design

An exploratory qualitative study. The Health Belief Model (HBM) was used as a theoretical framework.

Setting and participants

Eight focus group interviews, 5–8 women in each group (average number 6,5), were conducted with 50 women aged 18–54, who studied Swedish for immigrants. Data were analysed by latent content analysis.

Results

Four themes emerged: (i) deprioritization of women''s health in home countries, (ii) positive attitude towards the availability of women''s health care in Sweden, (iii) positive and negative attitudes towards HPV vaccination, and (iv) communication barriers limit health care access. Even though the women were positive to the prevention of cervical cancer, several barriers were identified: difficulties in contacting health care due to language problems, limited knowledge regarding the relation between sexual transmission of HPV and cervical cancer, culturally determined gender roles and the fact that many of the women were not used to regular health check‐ups.

Conclusion

The women wanted to participate in cervical cancer prevention programmes and would accept HPV vaccination for their daughters, but expressed difficulties in understanding information from health‐care providers. Therefore, information needs to be in different languages and provided through different sources. Health‐care professionals should also consider immigrant women''s difficulties concerning cultural norms and pay attention to their experiences.     

The cultural dialogue on the domestic dimension of care to immigrant caregivers in Spain

Objectives:

to determine how the immigration phenomenon influences the response to informal care in the domestic level through the caregiver activity, and to analyze the cultural dialogue established in the residential area of Murcia (Spain).

Method:

This is an ethnographic study, conducted in 26 informal immigrant caregivers. As data collection instruments, semi-structured interviews and participant observation were employed. MAXQDA-2 assisted content analysis was also applied.

Results:

the immigrant caregiver is the main consumer of traditional medicines, extending these health practices to her home group. A cultural dialogue is established on informal care, characterized by interculturalism and mutual adaptation.

Conclusions:

cultural hybridization was identified for informal caregivers, immigrants and cultural integration: new health care practices and cultural behaviors in informal systems. There is a transformation in the roles of family members attended in domestic environments, increasing quality of life and self care. They represent an alternative to medicalization, promoting self-management of health.     

Factors associated with reporting of abuse against children and adolescents by nurses within Primary Health Care

OBJECTIVE:

to analyze the factors associated with the underreporting on the part of nurses within Primary Health Care of abuse against children and adolescents.

METHOD:

cross-sectional study with 616 nurses. A questionnaire addressed socio-demographic data, profession, instrumentation and knowledge on the topic, identification and reporting of abuse cases. Bivariate and multivariate logistic regression was used.

RESULTS:

female nurses, aged between 21 and 32 years old, not married, with five or more years since graduation, with graduate studies, and working for five or more years in PHC predominated. The final regression model showed that factors such as working for five or more years, having a reporting form within the PHC unit, and believing that reporting within Primary Health Care is an advantage, facilitate reporting.

CONCLUSION:

the study''s results may, in addition to sensitizing nurses, support management professionals in establishing strategies intended to produce compliance with reporting as a legal device that ensures the rights of children and adolescents.     

Hospital Use of Agency‐Employed Supplemental Nurses and Patient Mortality and Failure to Rescue

Objective

To determine the association between the use of agency-employed supplemental registered nurses (SRNs) to staff hospitals and patient mortality and failure to rescue (FTR).

Data Sources

Primary survey data from 40,356 registered nurses in 665 hospitals in four states in 2006 were linked with American Hospital Association and inpatient mortality data from state agencies for approximately 1.3 million patients.

Study Design

Logistic regression models were used to examine the association between SRN use and 30-day in-hospital mortality and FTR, controlling for patient and hospital characteristics, nurse staffing, the proportion of nurses with bachelor''s degrees, and quality of the work environment.

Principal Findings

Before controlling for multiple nurse characteristics of hospitals, higher proportions of agency-employed SRNs in hospitals appeared to be associated with higher mortality (OR = 1.06) and FTR (OR = 1.05). Hospitals with higher proportions of SRNs have poorer work environments, however, and the significant relationships between SRNs and mortality outcomes were rendered insignificant when work environments were taken into account.

Conclusions

Higher use of SRNs does not appear to have deleterious consequences for patient mortality and may alleviate nurse staffing problems that could produce higher mortality.