我国目前专科护士培训管理中存在的问题与思考

本文分析了我国目前在专科护士培训管理中存在的一系列问题,同时提出了相关的对策,以期为完善我国专科护士培训管理提供参考。     

A before and after study of the impact of Specialist Workers for Older People

Background Case management of vulnerable older people by Community Matrons has been introduced into the UK. A locally designed case management approach, the Specialist Workers for Older People (SWOP) Service, was implemented by a Central England Primary Care Trust. Here, we report an evaluation of this service. Methods Before and after study of 418 people (207 before; 211 after) aged ≥75 at high risk of emergency hospital admission. SWOPs carry out assessments of social and medical needs, produce individual care plans, co‐ordinate care and refer to appropriate agencies. Univariable analysis was used to determine the association of SWOPs on changes in hospital admission rates and primary care workload. Results There was a non‐significant reduction in hospital admissions from 0.91 to 0.67 per patient. There was a significant increase in routine general practitioner surgery visits, from an average 1.3 to 2.6 per patient. The number of emergency home visits decreased from an average 2.8 to 1.1 per patient (P < 0.001). Conclusions Case management might reduce hospital admissions and is potentially a cost‐effective service. However, not all case management schemes are successful. With the introduction of Community Matrons, it is important to understand what elements of the SWOP service contributed to its success.     

我院糖尿病专科护士在高级护理实践中的角色探讨

通过对我院糖尿病专科护士角色,功能的介绍,指出国内高级实践护士的发展尚处于起步阶段。在借鉴国外发展经验的同时,思考我国糖尿病专科护士发展前景与对策,以期为我国糖尿病专科护理的发展提供参考依据,培养出适合我国国情的高素质护理人才。     

Barriers to evidence-based nursing: a focus group study

Title. Barriers to evidence‐based nursing: a focus group study Aim. This paper reports a study to explore the barriers to evidence‐based nursing among Flemish (Belgian) nurses. Background. Barriers obstructing the call for an increase in evidence‐based nursing have been explored in many countries, mostly through quantitative study designs. Authors report on lack of time, resources, evidence, authority, support, motivation and resistance to change. Relationships between barriers are seldom presented. Methods. We used a grounded theory approach, and five focus groups were organized between September 2004 and April 2005 in Belgium. We used purposeful sampling to recruit 53 nurses working in different settings. A problem tree was developed to establish links between codes that emerged from the data. Findings. The majority of the barriers were consistent with previous findings. Flemish (Belgian) nurses added a potential lack of responsibility in the uptake of evidence‐based nursing, their ‘guest’ position in a patient’s environment leading to a culture of adaptation, and a future ‘two tier’ nursing practice, which refers to the different education levels of nurses. The problem tree developed serves as (1) a basic model for other researchers who want to explore barriers within their own healthcare system and (2) a useful tool for orienting change management processes. Conclusion. Despite the fact that the problem tree presented is context‐specific for Flanders (Belgium), it gives an opportunity to develop clear objectives and targeted strategies for tackling obstacles to evidence‐based nursing.     

Nurses' views on ethical codes: a focus group study

AIM: This paper reports a study exploring nurses' views on the 'potential' content and functions of an ethical code for nurses in Belgium. The term 'potential' is used, because Belgian nurses do not have experience with an ethical code. BACKGROUND: Ethical codes have been developed to guide nurses' practice and to improve their professional status. Little empirical research, however, has been undertaken to determine nurses' views on the content and functions of these codes. The available quantitative studies merely give some information on nurses' (lack of) knowledge and use of their ethical code. No nursing ethical code currently exists in Belgium. Qualitative research exploring nurses' views, therefore, was needed in order to find out which functions an ethical code could fulfil and what the code's content could be. METHOD: Eight focus groups were conducted with 50 nurses in different healthcare settings in Belgium. Data were generated during 2003. FINDINGS: According to participants, an ethical code could fulfil several functions, including supporting their professional nursing identity (external function) and giving guidelines for nursing practice (internal function). In addition, some aspects of content were mentioned, including nurses' responsibilities in a relational context: particular attention should be paid to the personality of the nurse and to the specificity of nursing as a relational activity. Most agreement was reached on the 'ethical' function of the code, namely guiding nurses' professional moral practice. Regarding disciplinary use and the need for legalization of the ethical code, on the contrary, opinions were divergent. CONCLUSIONS: It is of utmost importance to take into account nurses' views when developing an ethical code for their profession. This study gave a first picture of the views of nurses themselves. These initial findings should be completed with nurses' views on the formulation, dissemination and promotion of the ethical code. Such evidence-based development of an ethical code will probably give more guarantees that the code will meet nurses' expectations and will function optimally.     

Registered nurses’ perceptions of their professional work in nursing homes and home-based care: A focus group study

Background

In Sweden, as well as in most industrialised countries, an increasing older population is expected to create a growing demand for health care staff. Previous studies have pointed to lack of proficient medical and nursing staff specialised in geriatric care, which poses serious threats to the care of a vulnerable population. At the same time, there are studies describing elderly care as a low-status career choice, attracting neither nurses nor student nurses. Judging from previous research it was deemed important to explore how nurses in elderly care perceive their work, thus possibly provide vital knowledge that can guide nurse educators and unit managers as a means to promote a career in elderly care.

Objective

The aim of the present study was to illuminate how nurses, working in nursing homes and home-based care, perceived their professional work.

Method

This was a qualitative study using focus groups. 30 registered nurses in seven focus groups were interviewed. The participants worked in nursing homes and home-based care for the elderly in rural areas and in a larger city in southern Sweden. The interviews were analysed in line with the tradition of naturalistic inquiry.

Results

Our findings illustrate how nurses working in elderly care perceived their professional work as holistic and respectful nursing. Three categories of professional work emerged during analysis: (1) establishing long-term relationships, (2) nursing beyond technical skills, and (3) balancing independence and a sense of loneliness.

Conclusions

The findings are important as they represent positive alternatives to the somewhat prevailing view on elderly care as depressing and undemanding. Nurse educators might use the key aspects as good examples, thus influencing student nurses’ attitudes towards elderly care in a positive way. Elderly care agencies might find them helpful when recruiting and retaining nurses to a much needed area.     

Literature review: considerations in undertaking focus group research with culturally and linguistically diverse groups

Aims. This integrated literature review seeks to identify the key considerations in conducting focus groups and discusses the specific considerations for focus group research with culturally and linguistically diverse groups. Background. The focus group method is a technique of group interview that generates data through the opinions expressed by participants. Focus groups have become an increasingly popular method of data collection in health care research. Although focus groups have been used extensively with Western populations, they are a particularly useful tool for engaging culturally and linguistically diverse populations. The success of focus groups in this context is dependent upon the cultural competence of the research team and the research questions. Methods. The electronic databases Medline, CINAHL, Embase, Psychlit and the Internet using the Google Scholar search engine were explored using the search terms ‘focus group’, ‘cultural sensitivity’, ‘transcultural nursing’, ‘transcultural care’, ‘cultural diversity’ and ‘ethnic groups’. Hand searching of reference lists and relevant journals was also undertaken. English language articles were selected for the review if they discussed the following issues: (i) methodological implications of the focus group method; (ii) strengths and limitations of the focus group method; (iii) recommendations for researchers and (iv) use of the focus group in culturally and linguistically diverse groups. Conclusions were drawn from each of the articles and consensus regarding a summary of recommendations was derived from a minimum of two authors. Results. Findings from this review revealed several key issues involving focus group implementation including recruitment, sample size, data collection, data analysis and use within multicultural populations. Strengths and limitations of the focus group method were also identified. Conclusions. Focus groups are a useful tool to expand existing knowledge about service provision and identify consumer needs that will assist in the development of future intervention programmes, particularly within multicultural populations. Careful planning related to methodological and pragmatic issues are critical in deriving effective data and protecting participants. Relevance to clinical practice. Focus groups can facilitate increased understanding of perspectives of culturally and linguistically diverse groups and thereby shape clinical practice to better meet the needs of these groups.     

Operating theatre nurses' perceptions of competence: a focus group study

Title.  Operating theatre nurses' perceptions of competence: a focus group study.
Aim.  This paper is a report of a study exploring nurses' perceptions of the components of competence in the operating theatre.
Background.  Competency Standards for operating theatre practice are used in some countries to guide clinical and professional behaviours. The need for competence assessment has been enshrined, but the conceptualization and agreement about what signifies competence in Operating Theatre has been lacking.
Methods.  Three focus groups were conducted with 27 operating theatre nurses in three major metropolitan hospitals in Queensland, Australia. Interviews were audio taped and field notes were taken. Data were collected during 2008. Thematic analysis was performed.
Findings.  From the analysis of the textual data, three themes were identified: 'coalescence of theoretical, practical, situational and aesthetic knowledge within a technocratic environment'; 'the importance of highly developed communication skills among teams of divergent personalities and situations'; and 'managing and coordinating the flow of the list'.
Conclusion.  These findings have identified that competence in respect to components of knowledge, teamwork and communication, and the ability to coordinate and manage are important and should be incorporated in operating theatre Competency Standards. Additionally, findings may assist in the development of an instrument to measure operating nurses' perceived competence.     

Experiences of using the VIPS-model for nursing documentation: a focus group study [corrected

BACKGROUND: The present investigation is part of a study where the Registered Nurses on three hospital wards received a 2 year intervention programme on nursing documentation in accordance with a keyword structure based on the nursing process. AIM: To describe the Registered Nurses' perceptions of and attitudes towards the effects of the intervention, and to generate hypotheses for further research. METHOD: Focus group discussions were used to collect data, with a qualitative content analysis method for the processing of the data. FINDINGS: The most interesting finding in these group discussions was the statements made by participants that the structured way of documenting nursing care made them think more, and think in a different way about their work with their patients. Two types of role changing were reported; from a medical technical focus to a more nursing expertise orientation and from a "hands on clinician" to more of an administrator and secretary. CONCLUSION: A number of issues debated among the participants in this study could be seen as organizational matters and lead to the important issue of multidisciplinary and organizational work when implementing innovations within nursing.     

Nursing the dying within a generalist caseload: a focus group study of district nurses

BACKGROUND: Community nurses (members of UK District Nursing teams) have a key role in the provision of palliative care in the community in the UK. However, their views about delivering palliative care within their generalist workload have not been assessed. OBJECTIVES: To explore community nurses' perceptions of their palliative care role, and their provision of such care within the context of their wider generalist workload. DESIGN: Focus group study. SETTING: Four Primary Care Trusts in London, UK. PARTICIPANTS: A purposive sample of 51 community nurses. METHODS: Nine focus groups (four to seven participants in each) were conducted between 2003 and 2004. Data were analysed using the framework approach. RESULTS: We identified five broad themes. Community nurses felt they had a central role in the provision of palliative care to patients at home. Many felt this role was not recognised by other health care professionals and managers. Palliative care was identified as unpredictable and time-consuming within a pressurized context characterised by staff shortages and consequent lack of time. Whilst rewarding, palliative care took its toll on nurses' emotions, compounded by a perceived lack of formal support. Finally, undertaking palliative within a generalist workload created additional pressures for community nurses. CONCLUSIONS: The integration of palliative care into routine generalist caseloads generated workload stresses in time and emotion. Community nurses felt their palliative care role and its impact on workload was not adequately acknowledged. Palliative care specific support mechanisms and ways of working may be necessary to meet patients' and professionals' expectations of effective, compassionate care at the end of life.     

'The responsibility of someone else': a focus group study of collaboration between a university and a hospital regarding the integration of caring science in practice

Scand J Caring Sci; 2012; 26; 579–586 ‘The responsibility of someone else’: a focus group study of collaboration between a university and a hospital regarding the integration of caring science in practice Aim: The aim of the study was to develop insights into how nurses, senior preceptors and head nurses experience the integration of caring science in practice and how they value the contributions of nursing students to the integration of caring science in practice. Background: Research still reveals differences between theory and practice by nursing students. In Sweden, clinical education units have become one way of creating consistency between university and health care practices on values of caring. Method: The study is hermeneutic in design comprising data from three focus group interviews. The participants include registered nurses, senior preceptors and head nurses. Result: The study shows that roles and mandates are not clearly defined between the different actors. The university and hospital collaboration in caring science integration was regarded as ‘someone else’s responsibility’. Research and development seemed excluded from the everyday life of the hospital units. The students seemed to fall somewhere between the hospital ‘practice and concrete world of production’ and the university ‘theory world of education and research’. Three themes emerge: ‘integration – someone else’s responsibility’, ‘the hospital – a culture of production’ and ‘the hospital and the university – different realities’. Discussion: The results suggest the need for professionals within health care and university to reflect on their responsibilities in terms of research and development. The ethos of caring science implies the alleviation of suffering and caring for vulnerable patients including research and development.