‘We are nurses,they are doctors’: Barriers to nurses' roles in pain management following surgery in Jordan

This study explored barriers to nurses' roles in pain management following surgery in Jordan. A qualitative approach using four focus group discussions (n = 4) was used. The total convenience sample of surgical wards nurses included 25 nurses. The analysis revealed two categories explaining the context and perceived barriers affecting nurses' roles in pain management. First were barriers within bedside nursing, comprising attention‐seeking patients, ‘buzzer obsession’ and family interferences. Second were barriers within nursing, comprising lack of staff and ‘nurses need pain relief before patients’, and the perception of ‘we are nurses, they are doctors.’ Nurses' roles in managing patients' pain following surgery is hindered by contextually complex barriers identified by this research. Multidisciplinary actions are therefore urgently needed to address barriers to pain management at the nursing professional, ward culture and policy levels. Failure to do so might lead to more pain sufferers following surgery, and thus poor recovery.     

A sampling study of bedside nursing activity in a cardiac surgical intensive care unit

For a selected group of 17 patients following cardiac surgery, 33 discrete elements of nursing workload have been defined. It was possible to identify 3 broad types of activity undertaken by the bedside nurse; technical nursing care (Type 1), intermittent nursing care (Type 2), and learning activities (Type 3). The latter is the balance of the nurses time which is largely concerned with observation and liaison with other staff. The 17 patients comprised 4 groups of pathologies, 2 each representative of the adult and paediatric workload. The primary bedside nurse performs virtually all of the Type 1 activities, recruiting the assistance of a secondary nurse principally to change the patients' posture (a Type 2 activity). The only practically significant period of time spent by the secondary nurse is in clinical discussion with the bedside nurse, largely at change of shift. Statistically significant differences in bedside nursing activities between age groups can be explained by the relative physical size of the patients and equipment. However the nurse maintains a higher level of awareness with shorter periods of inattention when nursing children. A greater number of significant differences between pathologies were found within the paediatric group of patients; this may indicate that a broader spectrum of such differences is to be found in this age group. An estimate was made of the impact of computer technology on the nurse's bedside workload.     

Neuman systems model used as a guide for the nursing care of an 8-year-old child with leukemia.

The Neuman Systems Model (NSM) provides a framework for holistic pediatric oncology nursing practice. In this article, an overview of NSM is given. This model is applied to an 8-year-old child with leukemia for the comprehensive assessment, planning, and evaluation of nursing care. A comprehensive list of nursing diagnoses is categorized by primary and secondary prevention.     

Bedside nurses’ roles in discharge collaboration in general internal medicine: Disconnected,disempowered and devalued?

Collaboration among nurses and other healthcare professionals is needed for effective hospital discharge planning. However, interprofessional interactions and practices related to discharge vary within and across hospitals. These interactions are influenced by the ways in which healthcare professionals’ roles are being shaped by hospital discharge priorities. This study explored the experience of bedside nurses’ interprofessional collaboration in relation to discharge in a general medicine unit. An ethnographic approach was employed to obtain an in‐depth insight into the perceptions and practices of nurses and other healthcare professionals regarding collaborative practices around discharge. Sixty‐five hours of observations was undertaken, and 23 interviews were conducted with nurses and other healthcare professionals. According to our results, bedside nurses had limited engagement in interprofessional collaboration and discharge planning. This was apparent by bedside nurses’ absence from morning rounds, one‐way flow of information from rounds to the bedside nurses following rounds, and limited opportunities for interaction with other healthcare professionals and decision‐making during the day. The disconnection, disempowerment and devaluing of bedside nurses in patient discharge planning has implications for quality of care and nursing work. Study findings are positioned within previous work on nurse–physician interactions and the current context of nursing care.     

Shifting roles in nursing – does role extension require role abdication?

Aims and objectives. To discuss findings relating to role extension and loss of nursing care to auxiliary nurses. Background. There is ongoing discussion in the literature about what nurses’ roles may be and how the extension of role affects patient care. Various models have been devised to measure outcomes and the value of nursing to patients. However, there are limited data on the views of nurses themselves in terms of what they perceive their role to be and what they feel about role change. Design. A qualitative approach was used with the help of the elements of grounded theory. Methods. Data were analysed using a constant comparative method with core categories identified. The study described in this paper was the final of three. The first two studies involved student nurses and through theoretical sampling, the third sample was chosen to expand the data gained from the students. Results. The findings from the student studies indicated concern that the nursing role was being undertaken by auxiliary nurses. The results of the final study, as discussed in this paper, confirmed this. However, one main difference was that qualified nurses were not necessarily unhappy about auxiliary nurses’ role expansion but were concerned that the role of the nurse was moving away from the bedside. Conclusions. The data suggest that nurses’ roles may be hard to define. An abdication of role, as opposed to delegation of role, seems to be occurring. Critical thinking is needed to ensure this is a decision advocated by clinical nurses. Relevance to clinical practice. Nurses need to be explicit about what their clinical roles are. This study provides data expressing the views of clinical nurses about role expansion and role abdication and corresponding feelings about it.     

The influence of nursing leadership on nurse performance: a systematic literature review

brady germain p. & cummings g.g. (2010) Journal of Nursing Management 18, 425–439
The influence of nursing leadership on nurse performance: a systematic literature review Aim The aim was to explore leadership factors that influence nurse performance and particularly, the role that nursing leadership behaviors play in nurses’ perceptions of performance motivation. Background Nurse performance is vital to quality patient care outcomes and nursing leadership behaviors have been linked to nurse performance. Evaluations A review of research articles that examined the factors that nurses perceived as influencing their motivation and performance was conducted. Eight studies were included in the final analysis. Key issues Nurses’ perceptions of factors that affect their motivation and ability to perform were grouped into five categories using content analysis: autonomy, work relationships, resource accessibility, nurse factors, and leadership practices. Nursing leadership behaviors were found to influence both nurses’ motivations directly and indirectly via other factors. Conclusion The review suggests that nurse performance may be improved by addressing nurse autonomy, relationships among nurses, their colleagues and leaders, and resource accessibility. Implications for nursing management Nursing managers and leaders may enhance their nurses’ performance by understanding and addressing the factors that affect their ability and motivation to perform.     

Exploring the potential for advanced nursing practice role development in Kenya: a qualitative study

Background

Definitions of advanced nursing practice abound, yet little has been published concerning the context for advanced nursing in sub-Saharan Africa. This study set out to explore the existence of, and potential for, advanced nursing practice in Kenya.

Methods

Ten nurses were invited to participate in semi-structured qualitative interviews. Participants were purposively selected to provide insight into the practice of experienced nurses in urban, rural, community, hospital, public and private health care settings. Interview narratives were recorded, transcribed and subsequently analysed using a thematic approach.

Results

All participants reported that they were engaged in the delivery of expert, evidence-based care. The majority also undertook administrative activities, teaching in the practice area and policy and practice advocacy. However, only the two private practice nurses interviewed during the study were working with the level of autonomy that might be expected of advanced nurse practitioners.

Conclusions

While participants were undertaking many of the activities associated with advanced nursing roles, advanced nursing practice as widely understood in the (largely western derived) international literature was not identified. The nurses practicing with the greatest autonomy were generally those with the lowest educational qualifications rather than the highest. Highly qualified nurses and midwives tend to move into management and education, and see little opportunity for advancement while remaining in clinical practice. It is notable that, although a growing number of universities offer master’s level education, no African countries have yet regulated an advanced level of practice. The existence of the physician substitute `clinical officer’ cadre in Kenya, as in other Sub-Saharan African countries, suggests that the development of the advanced nurse practitioner role is unlikely at present. However, there is a pressing need for advanced nurses and midwives who can implement evidence-based practice and exercise clinical leadership in the drive to attain the Millennium Development Goals and their post-2015 successors.While participants were undertaking many of the activities associated with advanced nursing roles, advanced nursing practice as widely understood in the (largely western derived) international literature was not identified. The nurses practicing with the greatest autonomy were generally those with the lowest educational qualifications rather than the highest. Highly qualified nurses and midwives tend to move into management and education, and see little opportunity for advancement while remaining in clinical practice. It is notable that, although a growing number of universities offer master’s level education, no African countries have yet regulated an advanced level of practice. The existence of the physician substitute `clinical officer’ cadre in Kenya, as in other Sub-Saharan African countries, suggests that the development of the advanced nurse practitioner role is unlikely at present. However, there is a pressing need for advanced nurses and midwives who can implement evidence-based practice and exercise clinical leadership in the drive to attain the Millennium Development Goals and their post-2015 successors.

     

Are nurse-led chemotherapy clinics really nurse-led? An ethnographic study

BackgroundThe number of patients requiring ambulatory chemotherapy is increasing year on year, creating problems with capacity in outpatient clinics and chemotherapy units. Although nurse-led chemotherapy clinics have been set up to address this, there is a lack of evaluation of their effectiveness. Despite a rapid expansion in the development of nursing roles and responsibilities in oncology, there is little understanding of the operational aspects of nurses’ roles in nurse-led clinics.ObjectivesTo explore nurses’ roles within nurse-led chemotherapy clinics.DesignA focused ethnographic study of nurses’ roles in nurse-led chemotherapy clinics, including semi-structured interviews with nurses.SettingsFour chemotherapy units/cancer centres in the UKParticipantsPurposive sampling was used to select four cancer centres/units in different geographical areas within the UK operating nurse-led chemotherapy clinics. Participants were 13 nurses working within nurse-led chemotherapy clinics at the chosen locations.MethodsNon-participant observation of nurse-led chemotherapy clinics, semi-structured interviews with nurse participants, review of clinic protocols and associated documentation.Results61 nurse-patient consultations were observed with 13 nurses; of these 13, interviews were conducted with 11 nurses. Despite similarities in clinical skills training and prescribing, there were great disparities between clinics run by chemotherapy nurses and those run by advanced nurse practitioners. This included the number of patients seen within each clinic, operational aspects, nurses’ autonomy, scope of practice and clinical decision-making abilities. The differences highlighted four different levels of nurse-led chemotherapy clinics, based on nurses’ autonomy and scope of clinical practice. However, this was heavily influenced by medical consultants. Several nurses perceived they were undertaking holistic assessments, however they were using medical models/consultation styles, indicating medicalization of nurses’ roles.ConclusionsFour different levels of nurse-led chemotherapy clinics were identified, illustrating disparities in nurses’ roles. Although clinics are run by nurses they are often controlled by medical consultants, which can reduce nurses’ autonomy and negatively impact on patient care.     

Joining of 2 Powerful Nursing Forces,the Clinical Nurse Specialist and Clinical Nurse Leader

Nurse executives in 2 adult, acute care hospitals support utilization of the clinical nurse specialist (CNS) and clinical nurse leader (CNL), as master’s prepared roles with specialized education, training, and content expertise in clinical care. Utilizing both roles created a dynamic structure to facilitate high quality patient care that is efficient, safe, and cost effective. As the nursing shortage continues to grow and demands of health care continue to expand, the CNS and CNL will ensure high quality care through implementation of evidence-based practice, ongoing quality improvement initiatives, and providing an added layer of clinical care and decision-making support for bedside nurses.     

Expected roles and utilization of specialist nurses in Japan: the nurse administrators’ perspective

onishi m. & kanda k. (2010) Journal of Nursing Management 18, 311–318
Expected roles and utilization of specialist nurses in Japan: the nurse administrators’ perspective Aim This study explored (1) expected roles for specialist nurses in Japan and (2) nurse administrators’ experience-based management strategies for effective implementation of these roles. Background In Japan, specialist nurses have begun to be recognized as valuable human resources. However, managerial issues in utilizing specialist nurses, including unclear roles and lack of reports on effective management strategies, remain. Method Three focus-group discussions were conducted. Nine nurse administrators participated. Data were analysed using qualitative content analysis techniques. Results The expected roles for specialist nurses were: (1) facilitating general nurses’ learning; (2) monitoring and improving the patient care standard; and (3) developing new roles for nursing. Two management strategies were: (1) enhancing specialist nurses’ influence, and (2) enhancing specialist nurses’ motivation. Conclusions Specialist nurses are important human resources able to assume responsibility for process improvement in nursing care. Effective ways to enhance specialist nurses’ influence and motivation include developing their management and communication skills, and coordinating their workload and relationships with other health care professionals. Implications for Nursing Management Process improvement indicators may be useful for evaluating specialist nurses’ work. Nurse administrators can contribute to effective implementation of specialist nurses’ roles not only by clarifying their roles but also by empowering them to keep up with changing organizational needs.     

护士对床边护理工作模式体验的质性研究

目的了解护士在床边护理工作模式实施过程中的真实体验,为规范床边护理工作模式提供参考依据。方法采用质性研究中的现象学研究方法对12名护士进行半结构式面对面深度访谈,运用Colaizzi资料分析原则进行资料整理分析,提炼主题。结果提炼出4个主题:开展床边护理工作模式,护士由被动服务转变为床边主动服务;提高了患者的满意度,融洽了护患关系;护士的职业价值感得到提升;床边护理工作模式的实施仍需要持续质量改进。结论床边护理工作模式的实施,融洽了护患关系,提高了患者的满意度,保证了护理质量,得到了护士的肯定。但是在实施过程中,护理管理者应关注护士的切身感受,并提供针对性支持,以促进床边护理工作模式的顺利开展,从而为患者提供更好的优质服务。     

Nurse shift report: who says you can't talk in front of the patient?

Bedside nurse shift report is a process where nurses provide shift-to-shift report at the patient's bedside so the patient can be more involved in his or her care. There are many benefits of bedside report, including relationship building between staff members and increased patient satisfaction, to both the patient and to the healthcare team. Concerns about the traditional methods of communication between the various shifts helped drive a nursing unit's decision to move to a more patient-involved model of shift-to-shift report. The change from the traditional taped report between healthcare providers to bedside reporting focused on patients wanting more involvement in their care, activities, and current status. Patients also wanted updates about their health status, their medical plan as well as information about their progress toward their goals. This, coupled with Banner Desert Medical Center's Care Model, embraces patient-centered care, King's Theory of Goal Attainment, and keeps the patient informed. The current nursing shift report did not meet the medical center's model of care on any of these aspects. This article will include information on the benefits of bedside nurse shift-to-shift report, how one unit implemented bedside reporting, and some of the outcomes achieved after implementing this change at a 600-bed urban medical center.     

Differentiated practice: The evolution of professional nursing

Differentiated practice identifies and uses three distinct nursing roles to create a comprehensive nursing care delivery system that meets client needs across the health care continuum. Clearly defined associate degree in nursing, bachelor's of science in nursing, and master's science in nursing competencies present career opportunities for professional nurses at the bedside providing, integrating, or managing client care as well as options in management, education, and regulation. An evolutionary paradigm shift required of all nurses is the awareness that each nurse is not the whole of nursing, but rather each nurse contributes to the whole of nursing. A nursing community comprised of differentiated roles that are mutually valued and well integrated will position nursing as a powerful force in meeting the diversity and complexity of health care needs in contemporary society.     

A model for a national clinical final examination in the Swedish bachelor programme in nursing

athlin e., larsson m. & söderhamn o. (2012) Journal of Nursing Management 20, 90–101
A model for a national clinical final examination in the Swedish bachelor programme in nursing Aim  To describe the development and evaluation of a model for a national clinical final examination in the bachelor nursing education. Background After the transfer of nursing education to the academy, concerns have been raised among nurses, nurse leaders, lecturers and researchers about the nursing students’ clinical competence at the entrance to professional life. Methods During 2003 to 2005, a collaborative project was carried out between four universities and adjunctive health-care areas supplying clinical placements in Sweden. A two-part examination was agreed upon comprising a written theoretical test and a bedside test. An assessment tool for the bedside test was created. Nursing students, nurses and clinical lecturers participated voluntarily in the evaluation. Results The model was highly appreciated, and its relevance, usability, and validity were considered quite good for the assessment of nursing students’ clinical competence at the final stage of their education. Several deficiencies were revealed, which led to further development of the model. Conclusions and implications for nursing management The development and first evaluation of the model proved encouraging for further use, but it needs further evaluation. Involvement of nursing managers is necessary in order to satisfy new demands on competence and staffing of clinical nurses.     

Nurse prescribers' experiences of prescribing

Background. Nurse prescribing has advanced rapidly over the previous decade and is clearly on the agenda for the future. Previous research considers nurse prescribing from the patient's perspective, the medical professions’ stance and the legal and ethical implications. However, there is a paucity of literature that explores the experiences of nurse prescribers’ within their current role. These experiences need investigating to ensure nurse prescribing is able to advance in ways that provide benefit to nurses and thus provides the impetus for the study. Aim. To explore and review nurse prescribers’ experiences of prescribing. Design methods. A purposeful sample of seven nurse prescribers currently prescribing within a West Midlands Community Trust underwent minimally structured interviews in this qualitative study. Transcribed interviews were analyzed using thematic analysis. Findings. Four themes were generated from analysis of the interviews, ‘patient centred care’, ‘benefits of nurse prescribing’, ‘support and role satisfaction’ and finally ‘prescribing difficulties’. Conclusions. Nurse prescribers’ perceive prescribing as a predominantly positive experience, frequently asserting the advantages that prescribing saves the patient and nurse time, is more convenient for the patient and increases the nurses’ autonomy and role satisfaction. However, negative experiences of restrictions to practice as a result of nurse prescribers’ formulary limitations and duplication of documentation were also described. Relevance to clinical practice. Nurse prescribing is a rapidly evolving area of practice with the potential to advance nursing roles. This research aims to provide an insight into the experiences of current nurse prescribers that may then be disseminated and applied to future practice.     

An empirical test of the Nursing Role Effectiveness Model

AIMS OF THE STUDY: This study investigated the propositions depicted in the Nursing Role Effectiveness Model, in which nurse and patient structural variables were expected to influence nurses' role performance, which, in turn was expected to affect patient outcome achievement. RATIONALE/BACKGROUND: Increasingly, nurses are expected to demonstrate their contribution to patient outcome achievement as a basis for evaluating practice and for monitoring improvements in practice. A model was developed that describes nursing practice in relationship to the roles nurses assume in health care, and links patient and system outcomes to nurses' role functions (Nursing Economics 1998: 16, 58-64, 87). RESEARCH METHODS: A cross-sectional design was used to collect data on the structure, process, and outcome variables. Data were collected through structured questionnaires and chart audit, involving a total of 372 patients and 254 nurses from 26 general medical-surgical units in a tertiary care hospital. Patient structural variables included medical diagnosis, age, gender and education. Nurse structural variables included educational preparation and length of hospital experience. The unit structural variables included the adequacy of time to provide care, autonomy, and role tension. The quality of nurses' independent role performance was assessed by collecting data from patients on their perception of the quality of nursing care. Nurses' interdependent role performance was assessed by collecting data from nurses on the quality of nurse communication and co-ordination of care. Patient outcomes were assessed through self-report and consisted of the patients' therapeutic self-care ability, functional status, and mood disturbance at the time of hospital discharge. Structural equation modelling was used to test the hypothesized relationships among the structural, process, and outcome variables. RESULTS: Patients viewed nurses' independent role performance more effective on units where nurses reported less autonomy but more time to provide care. The quality of nurse communication was higher on units where nurses had higher education, more autonomy, less hospital experience, and lower role tension. However, the co-ordination of care was more effective on units where nurses had higher education, greater hospital experience, less autonomy and role tension. The three role performance variables were associated with patients' therapeutic self-care ability at hospital discharge. Nurses' independent role performance was associated with better patient functional status and less mood disturbance at hospital discharge. The role performance variables fully mediated the effect of the structural variables on patient outcomes, lending support for the proposition that nurses' role performance explains the relationship between structural variables, such as nurse education and autonomy, and patient outcome achievement. DISCUSSION: The Nursing Role Effectiveness Model provides a well-defined conceptual framework to guide the evaluation of outcomes of nursing care. For the most part the hypothesized relationships among the variables were supported. However, further work is needed to develop an understanding of how nurses engage in their co-ordinating role functions and how we can measures these role activities.     

Increasing nursing research capacity: The roles and contributions of nurse scientists within healthcare systems in the Greater Philadelphia region

PhD prepared nurse scientists within healthcare systems are uniquely positioned to advance nursing science through research and evidence-based practice (EBP) initiatives due to their ability to closely collaborate with nurses and other healthcare professionals in the clinical setting. The purpose of this paper is threefold: 1) to describe the roles and contributions of Nurse Scientists, from their perspectives, in four different health care systems in the Greater Philadelphia area, three of which are Magnet® designated hospitals; 2) to highlight organizational approaches to increase nursing research and EBP capacity; and 3) to explore strategies that Nurse Scientists used to overcome barriers to build nursing research capacity. Nurse Scientists employed in these healthcare systems share many of the same essential roles and contributions focused on developing nursing research and EBP initiatives through education and mentorship of clinical nurses, conduct and oversight of independent research, and dissemination activities. With supportive executive nurse leadership, the Nurse Scientists within each healthcare system employed different strategies to overcome barriers in building nursing research and EBP capacity. Nurse scientists within healthcare settings have potentially powerful positions to generate and apply new knowledge to guide nursing practice and improve outcomes.     

Autonomy and the developing role of the clinical nurse specialist

The role of the clinical nurse specialist has developed in response to social, technological and political changes that have impacted upon the delivery of health care. Nursing has traditionally been associated with femininity and in a paternalistic health structure the concept of nursing care can be devalued because autonomous nurses may threaten the balance of power. Autonomy is a multi-faceted concept and yet, if nurses have the courage to embrace both the traditional values of nursing and the expertise that their caring role brings to health care, they will be able to develop their own competence and autonomous practice. Nurses may not need autonomy in order to enhance their roles but they do need to concentrate on the concept of care as a team phenomenon. This notion is included in the UKCC's higher level of practice initiative which may direct specialist practice in the future. A negative element to nurse specialization is that nursing care can become fragmented, thus compromising the continuity and accountability of patient care.     

Advanced practice nursing and the role of the pediatric critical care nurse practitioner

Advanced practice nursing, since its inception in the early 1960s, has constantly changed in an effort to establish standardized core graduate education, specialization of practice, and autonomy, now common in the 1990s. Nurse practitioners, nurse midwives, and certified registered nurse anesthetists have followed in the footsteps of the clinical nurse specialist by enhancing their practice through advanced education. Nurses in these advanced areas are graduating from established programs with a master's of science in nursing and a specialty in their chosen field. The pediatric critical care nurse practitioner is one such specialty. This article highlights the results of a national survey that described pediatric critical care nurse practitioner practice over a broad geographic area. With change as a constant, nurses will look to the future of advanced practice roles, which are ever changing, and continue to provide safe, quality care to patients.