ENA's Delphi study on national research priorities for emergency nurses in the United States.

INTRODUCTION: This study identified and prioritized research questions with greatest value to emergency nurses and of highest importance for health care consumers. METHODS: Three hundred twenty emergency nursing leaders were invited to participate in 3 rounds of mailed surveys aimed at developing consensus. During round I, 147 nurses submitted 456 research problems. These problems were synthesized into 154 researchable questions, encompassing 17 themes. The round II questionnaire listed these questions in random order. Respondents used a 7-point Likert scale to rate each question's value for practicing nurses and importance for health care consumers. One hundred one nurses rated 106 questions >5.0. The round III questionnaire was individualized to provide each respondent's round II score and each item's median group score. Reflecting on these data, subjects again rated the 106 questions. RESULTS: Seventy-nine nurses rated 16 questions 6.0 or greater for value for practicing nurses; 3 questions were rated 6.0 or greater for importance to consumers. Optimum staff to patient ratios, effects of mandatory overtime, holding admitted patients, and ED overcrowding, as well as effective strategies for educating and ensuring competence of nurses, were highest priority research problems for practicing nurses. Pain relief, impact of and methods of decreasing holding/lengthy ED stay, and effective strategies for patient teaching were judged most important for consumers. DISCUSSION: Nurses' concerns with staff shortages and overcrowding of emergency departments and their effects on patients are paramount. Pain management and patient education were chief clinical issues requiring research.The mission of ENA is "to provide visionary leadership for emergency nursing and emergency care." This mission encompasses a number of values, including the following: "The discipline of emergency nursing includes a defined and evolving body of knowledge based on research."(1) In 1998, the ENA appointed vision councils to develop futuristic ideas to advance ENA's mission. The Research Vision Council proposed that ENA develop a center for emergency nursing research to provide leadership and focus for scientific approaches to the many issues that concern emergency nurses and their patients. The Board of Directors supported this idea by formulating a work group to develop the National Institute for Emergency Nursing Research. In 1999, the work group proposed that a study be conducted to determine national priorities for emergency nursing research. This article reports on the methods and results of a Delphi study conducted for that purpose.     

School staff's satisfaction with school health services.

The School Nurse Impact Committee of the Columbus Public Schools in Columbus, Ohio, initiated a survey to determine staff satisfaction with the delivery of health services. School nurses need the cooperation and support of the staff to successfully deliver school health services, therefore, the staff's satisfaction with school health services is crucial to the school nurses' ability to fulfill their role. The objectives of the survey were to (a) determine staff satisfaction with school nurse interventions, (b) determine staff satisfaction with the effectiveness of interventions, (c) identify areas of health service delivery which may need improvement, and (d) determine areas of school health services where school nurses may need to more effectively communicate their involvement. Critical elements of school nurse practice included staff health, safety and environment, classroom education, medication, school system collaboration, and program management. Several key issues were identified through the survey. School system collaboration issues need more school nurse involvement. School nurses also need to improve their visibility regarding school system collaboration, and in classroom and individual pupil education. Traditional school nurse functions were adequately covered. Results indicate that staff would be more satisfied if they had more nursing support in the classroom and more nurse time in their building.     

Caring for maltreated children: a challenge for health care education

AIM OF THE STUDY: The aim of this study was to establish whether paediatric nurses and doctors in a university hospital need supplementary training in the identification of child physical abuse and whether there is a need to develop health care education on child abuse issues. BACKGROUND: Child physical abuse was defined as actions of a parent or a primary caregiver of a child under 18 years of age, which have caused physical injuries to the child. METHODS: The sample consisted of paediatric staff (n=513) in a university hospital. Data were collected with a questionnaire, and the response rate was 62%. The data were analysed using statistical methods and quantitative content analysis. FINDINGS: Sixty per cent of respondents needed supplementary training in the identification of child abuse. Those having experience in caring for abused children considered the identification most difficult (P < 0.001) and needed training more often (P < 0.005) than the others. The need for training was explained by stating that their basic education had not addressed child abuse issues, and by the complexity of the issue. CONCLUSIONS: The findings indicate that research-based knowledge of the identification and treatment of child abuse should be incorporated into health care education. Supplementary education should address the management of complex and sensitive issues with customers, legislation, division of labour and multiprofessional collaboration in which nurses and doctors have an important, family wellbeing promoting role.     

Using a Delphi approach to develop a strategy for A&E in defence nursing

The Armed Forces has seen an increase in the number of operational deployments overseas and a greater demand for Accident and Emergency (A&E) trained nurses. This article describes a modified Delphi study used to contribute to the development of a strategy for emergency nursing in the Defence Nursing Services. Twenty-eight A&E specialists took part and the key issues raised were recruitment and retention, staff development, new roles, research priorities, increased internal recruitment of A&E nurses to meet operational demands, and the need for a structured career pathway to help retention. The most pressing areas requiring research were evaluation of the nurse practitioner role, clinical competencies and managing heat injuries in the operational setting. The modified Delphi study provided a valuable and detailed insight into the challenges and aspirations of the military A&E nursing cadre and has assisted in developing a strategy for emergency nursing.     

Views of health professionals on discussing sexual issues with patients

PURPOSE: This survey was carried out to study the views of multidisciplinary health professionals about discussing sexual issues with patients. METHODS: A questionnaire was sent to professionals (nurses, doctors, physiotherapists and occupational therapists) to return by post. A duplicate questionnaire was sent 4 weeks later to a random sample of respondents. RESULTS: A total of 813 replies were analysed (61% response rate). Mean age+(SD) of respondents was 37+10. Most were female (85%). Test-retest reliability of the questions showed moderate to very good agreement. Most respondents (90%) agreed that addressing sexual issues ought to be part of the holistic care of patients. However, most staff (86%) were found to be poorly trained and most (94%) were unlikely to discuss sexual issues with their patients. The gender and age of respondents was not significantly related to their participation in such discussion. Therapists had less training, lower comfort level, and less willingness to discuss sexual issues than doctors and nurses while doctors discussed sexual issues significantly often more than others (p< or =0.001). Respondents from rehabilitation wards were equivalent to those from medical or surgical wards in their training and comfort. However, they participated in discussing sexuality with patients less often than those from medical wards. CONCLUSION: Health professionals agreed that patients' sexual issues needed to be addressed and discussed in health services. However, they were poorly trained, ill prepared and rarely participated in such discussion. This suggests that training in sexuality and sexual issues should be implemented as part of the training of health care professionals.     

An investigation of the developmental influences on nurses'' motivation for their continuing education

This author investigated these influences by use of a questionnaire. It was distributed to 90 second-year students and 89 staff nurses, working in three London hospitals. The tool was developed from a literature search, which looked at motivational theories, research into nurse retention and attitudes and interest in continuing education. No similar studies were found. An assumption was made that students are idealistic about their continuing education and staff nurses pragmatic. That is, the role change from student to staff nurse alters the perspective on career and continuing education needs. Eighty-one per cent of the questionnaires were returned. Results indicated that students decided their future training needs on how much they enjoyed a particular experience, and on their expectation of furthering their skills in that area; whereas staff nurses wanted management training and skills and knowledge in looking after critically ill patients. A number of respondents were considering leaving nursing, because of poor staffing and salary; this dissatisfaction was greatest amongst the staff nurse respondents. The investigation identified the need for commitment from both service and education to the concept of continuing education for nurses as crucial to improving patient care, and support and help for staff and students to assess their needs and be informed of choices and resources.     

Factors contributing to contemporary nursing shortage in Macao

leong c.s.u . (2012) Journal of Nursing Management  20, 491–501 Factors contributing to contemporary nursing shortage in Macao Aim The purpose of the study was to examine the reasons for a shortage of nurses in Macao, a Special Administrative Region (SAR) of the People’s Republic of China. Background Macao is facing a problem that is confronting many other cities or countries in the developed world, namely a shortage of nursing professionals. Increasing shortages are affecting the quality of patient care as well as patient outcomes. Methods This research study used a qualitative approach to explore and understand the experiences of nurses affected by the manpower shortage. All interviews were transcribed verbatim to convey the interviewees’ intended messages as accurately as possible. Results and conclusions The two principal themes that emerged from the study were (1) concerns about the inadequate number of nursing staff and (2) increasing demands on the staff for service. Unless addressed successfully, these two issues can compromise optimal patient care and add to the cost of health care. Implications for nursing management There is an urgent need to improve the management of nurses’ workloads and to communicate better with frontline nursing staff on issues such as payment and employee benefits, the number of staff on duty and continuing nursing education.     

Human resource management strategies for the retention of nurses in acute care settings in hospitals in Australia

It is paramount that there is an adequate nursing workforce supply for now and in the future, to achieve equitable and quality health outcomes and consumer access to healthcare, regardless of geographic location. Nursing forms the largest body of employees in the health care system, spanning all segments of care. A shortage of nurses, particularly in the acute care settings in hospitals, jeopardizes the provision of quality health care to consumers. This article provides a literature review of Australian State and Federal Government reports into nurse retention. All reports discuss staff turnover rates; the average age of nurses; enrolment numbers in nursing courses; workloads; nursing workforce shortfalls and the effect on the work environment; leadership and management styles; organizational culture; change management; the mobility of nursing qualifications both locally and internationally and the critical need to value nurses. Then why has the situation of nurse retention not improved? Possible reasons for the continued nurse shortage and the promise of strategic HRM in addressing nurse retention are discussed.     

Why is pain management suboptimal on surgical wards?

BACKGROUND: During a patient's stay on a surgical ward, nurses hold a great deal of responsibility for pain management, especially when analgesics are prescribed on a PRN ('as needed') basis. Despite the availability of effective analgesics and new technologies for drug administration, studies continue to demonstrate suboptimal pain management. AIM OF THE STUDY: To identify perceived barriers to effective pain management in nursing practice. METHODS: The data are drawn from six nurse interviews and a survey of 180 nurses in 14 United Kingdom (UK) hospitals, which built upon detailed observations of nurses on surgical wards. RESULTS: In a question about possible reasons for suboptimal pain management, nurses identified a number of barriers that concerned organizational aspects such as workload and lack of staff, and also legal or institutional constraints. Nurses further stated that analgesic prescribing was sometimes inadequate, or that doctors or the pain team were unavailable to review medication. Further barriers that nurses may be less aware of were identified in a question concerning nurses' reasons for not asking patients a pain-related question during drug rounds. Previous observations had shown this to be the predominant time for pain questioning. The most commonly mentioned reasons were that patients were asleep, on epidural or patient controlled analgesia (PCA), or had recently had an analgesic. Nurses' replies also revealed that they relied considerably on patients' nonverbal behaviour and used this to assess analgesia requirements. Nurses' views and judgements regarding pain management were further supported in replies to a number of attitude statements and a question about the aim of administering analgesia. CONCLUSION: The strength of this work is that it identified two types of potential barriers to effective pain management, recognized and more subconscious ones, and both need to be addressed before introducing systems aimed at improving pain management.     

Autonomy,privacy and informed consent 4: surgical perspective

This is the fourth article in a four-part series that considers the issues of patient autonomy, privacy and informed consent. The article discusses these issues in the context of surgical patients and their nurses. There is an abundance of references to issues of autonomy and informed consent within the healthcare literature, although there are few empirical studies investigating these issues within practice. The issue of privacy has been somewhat less explored than that of autonomy or consent, particularly in the UK literature. This article reports the findings of a Scottish study that formed part of a multisite comparative study funded by the European Commission. A convenience sample of surgical patients (n = 282) and their nurses (n = 260) participated in the study. Data were collected by means of a self-completion questionnaire for both patients and nursing staff. Results indicated that there are significant differences in patient and staff perceptions on issues of patient autonomy, privacy and informed consent. However, the most marked difference in perceptions of patients and staff were found on the information-giving element of the autonomy subscale. Implications for nursing practice, education and research are highlighted.     

An integrative review of primary health care nurses’ mental health knowledge gaps and learning needs

BackgroundThe global COVID-19 pandemic has escalated the prevalence of mental illness in the community. While specialist mental health nurses have advanced training and skills in mental health care, supporting mental health is a key role for all nurses. As front-line health care professionals, primary health care (PHC) nurses need to be prepared and confident in managing mental health issues.AimTo critically analyse and synthesise international literature about the knowledge gaps and learning needs of PHC nurses in providing mental health care.Design and methodsAn integrative review. The quality of papers was assessed using the Mixed Methods Appraisal Tool. Data were extracted into a summary table and analysed using narrative analysis.Data sourcesCINAHL, Ovid MEDLINE, Web of Science and EBSCO electronic databases were searched between 1999 and 2019. Papers were included if they reported original research which explored mental health education/training of nurses working in PHC.FindingsOf the 652 papers identified, 13 met the inclusion criteria. Four themes were identified: preparedness; addressing knowledge gaps, education programs, and facilitators and barriers.DiscussionDespite increasing integration of physical and mental health management in PHC, there is limited evidence relating to knowledge gaps and skills development of PHC nurses or their preparedness to provide mental health care.ConclusionFindings from this review, together with the global increase in mental illness in communities arising from COVID-19, highlight the need for PHC nurses to identify their mental health learning needs and engage in education to prepare them to meet rising service demands.     

Nursing management of medication errors

Medication error is the most common and consistent type of error occurring in hospitals. This article attempts to explore the ethical issues relating to the nursing management of medication errors in clinical areas in Macau, China. A qualitative approach was adopted. Seven registered nurses who were involved in medication errors were recruited for in-depth interviews. The interviews were transcribed and analyzed using content analysis. Regarding the management of patients, the nurses acknowledged the mistakes but did not disclose the incidents to patients and relatives. Concerning management of the nurses involved by senior staff, most participants experienced fairness, comfort and understanding during the process of reporting and investigation. The ethical issues relating to the incidents were discussed, particularly in the Chinese context. There is a need for further study relating to the disclosure of medication incidents to patients and some suggestions were made.     

Role stress in nurses: review of related factors and strategies for moving forward

The aim of this paper was to review the literature on factors related to role stress in nurses, and present strategies for addressing this issue based on the findings of this review while considering potential areas for development and research. Computerized databases were searched as well as hand searching of articles in order to conduct this review. This review identified multiple factors related to the experience of role stress in nurses. Role stress, in particular, work overload, has been reported as one of the main reasons for nurses leaving the workforce. This paper concludes that it is a priority to find new and innovative ways of supporting nurses in their experience of role stress. Some examples discussed in this article include use of stress education and management strategies; team-building strategies; balancing priorities; enhancing social and peer support; flexibility in work hours; protocols to deal with violence; and retention and attraction of nursing staff strategies. These strategies need to be empirically evaluated for their efficacy in reducing role stress.     

Evolution of the perioperative clinical nurse specialist role

Perioperative nursing roles continue to rapidly change as we enter the twenty-first century. The need for strong leadership skills, expert clinical skills, creative management, ongoing continuing education, and research continues to grow in every department of surgical services. The clinical nurse specialist plays an important role in addressing each of these needs. Great opportunities exist within the field of nursing for perioperative nurses to expand their practice using their creativity, ideas, and skills. Using the clinical nurse specialist in the perioperative setting can foster creativity, stimulate development of new methods based on research, and maximize the delivery of high quality care by the entire OR staff.     

我国护理人员分层次使用的实施现状

阐述了我国护理人员分层次使用的实施现状。护理人员分层次使用的优点包括有利于人力资源的合理配置、提高护理质量、提高病人满意度、增进医护沟通、推进护理科研的开展和护理教育的发展,但在实施过程中仍面临着护理人员缺编、思想认识不够和缺乏审核标准的量化指标等问题,需要护理管理者有针对性地制订护理管理体制,将分层次使用护理人员更好地应用于临床。     

Resourcefulness Training for Women Dementia Caregivers: Acceptability and Feasibility of Two Methods

Mental health nurses are ideally placed to assess mental health service users’ physical health and provide relevant interventions. However, they may lack the confidence and knowledge to do so, as a result of limited education on physical health issues. This mixed methods pilot study sought to evaluate the effect of education on confidence in assessing and addressing physical health needs following attendance at a module entitled “Physical Health Issues in Adult Mental Health Practice.” An explanatory sequential design was used in which quantitative data regarding participants’ perceptions of their confidence on assessing and addressing physical health issues with service users were collected via a questionnaire pre- and post-module. Additionally, a focus group interview was conducted to expand on survey responses. Findings indicated that confidence scores increased for all participants following the module, with participants identifying new knowledge and plans for practice change. Further research is needed to educate and support mental health staff in improving their confidence and knowledge in this area.     

The nursing view of clinical governance

This article outlines the findings from three RCN discussion groups, which aimed to gain an understanding of how nurses were responding to clinical governance and to what extent they were involved in its implementation. The article focuses mainly on the third round with clinical nursing staff, senior managers and clinical governance facilitators. Three key issues were reported by nurses taking part in all three rounds of discussion groups. First, there is the need to raise awareness among frontline clinical staff to ensure that clinical governance becomes recognised as an integral part of their clinical workload rather than being seen as an optional extra. The second issue is the need to change organisational culture to make it more receptive to clinical governance. Third is the requirement to establish greater levels of partnerships between clinicians and managers, patients and professionals, and professional groups. However, the authors caution that the organisational cultural change necessary for the successful implementation of clinical governance is not as straightforward as the literature appears to suggest, and argue that this remains a key challenge for organisational leaders, managers and clinical staff.     

Nursing and medical staff knowledge regarding the monitoring and management of accidental or exposure hypothermia in adult major trauma patients

Recording a patient's vital signs is a basic requirement that in part informs clinical decision-making. Practice suggests that recording a trauma patient's temperature is occasionally overlooked in the emergency department. A staff survey was undertaken to gain an appreciation of knowledge and understanding of the issues that surround accidental or exposure hypothermia in trauma patients. Results demonstrate that nurses and doctors are unsure of how to define hypothermia and are not conversant with simple ways to prevent heat loss or rewarm patients. Complications from hypothermia such as coagulopathy and metabolic acidosis were seldom identified. Issues that limit staff recording temperature include patient access and acuity, lack of knowledge and confidence and access to temperature-measuring devices. These results emphasize the need for regular education. Implications for clinical practice were considered; an algorithm to guide staff on ways to improve the monitoring and management of temperature in trauma patients was developed. Opportunities for ongoing and further research were identified.     

Providing care to the elderly with depression: the views of aged care staff

The purpose of this paper was to scope the views of care staff working in an aged care setting in an effort to understand the issues these staff face in the delivery of care to the elderly with depression. Seventeen care staff working in metropolitan, regional and rural areas of Queensland participated in one-on-one interviews in order to elicit their views on the identification of depression in the elderly and the care processes staff employed to manage depression. Interview notes were taken, reviewed, transcribed and analysed using content analysis. Discussion with participants revealed five themes regarding the management of depression in both community and residential aged care settings. These included: the extent to which depression is an issue for clients and residents; staff understanding of depression and the ability to recognize when a client or resident is depressed; discussing depression with general practitioner's and other healthcare professionals; processes and procedures for treating and addressing depression; and education and training on depression for staff. The findings revealed that care staff need greater education and training about depression and targeted strategies for its identification and management.