A suitable job?: A qualitative study of becoming a nurse in the context of a globalizing profession in India

Background

Research on Indian nurses has focused on their participation as global migrant workers for whom opportunities abroad act as an incentive for many to migrate overseas. However, little is known about the careers of Indian nurses, or the impact of a globalized health care market on nurses who remain and on the profession itself in India.

Objectives

To explore nurses’ accounts of entry into nursing in the context of the globalisation of the nursing profession in India, and the salience of ‘migration’ for nurses’ individual careers.

Design

Qualitative interview study (n = 56).

Settings and participants

The study drew on interviews with 56 nurses from six sites in Bangalore, India. These included two government hospitals, two private hospitals, a Christian mission hospital, a private outpatient clinic and two private nursing colleges. Participants were selected purposively to include nurses from Christian and Hindu backgrounds, a range of home States, ages and seniority and to deliberately over-recruit (rare) male nurses.

Methods

Interviews covered how and why nurses entered nursing, their training and career paths to date, plans for the future, their experiences of providing nursing care and attitudes towards migration. Data analysis drew on grounded theory methods.

Results

Nursing is traditionally seen as a viable career particularly for women from Christian communities in India, where it has created inter-generational ‘nurse families’. In a globalizing India, nursing is becoming a job ‘with prospects’ transcending traditional caste, class and gender boundaries. Almost all nurses interviewed who intended seeking overseas employment envisaged migration as a short term option to satisfy career objectives – increased knowledge, skills and economic rewards – that could result in long-term professional and social status gains ‘back home’ in India. For others, migration was not part of their career plan: yet the increases in status that migration possibilities had brought were crucial to framing nursing as a ‘suitable job’ for a growing number of entrants.

Conclusions

The possibility of migration has facilitated collective social mobility for Indian nurses. Migration possibilities were important not only for those who migrate, but for improving the status of nursing in general in India, making it a more attractive career option for a growing range of recruits.     

Understanding nursing scope of practice: a qualitative study

Background

The past decade has seen increased patient acuity and shortened lengths of stays in acute care hospitals resulting in an intensification of the work undertaken by nursing staff in hospitals. This has ultimately led to a reconsideration of how nursing staff manage their work.

Aim

The aim of this study was to understand how medical and surgical nurses from two Australian hospitals conceive their scope of practice in response to the available grade and skill mix of nurses and availability of unlicensed health care workers and other health care professionals. By exploring these meanings, this study aimed to build an understanding of how nursing work patterns were shifting in the face of changing patient acuity, patient profiles and nursing skill mix.

Method

A constructivist methodology, using critical incident technique (CIT) was used to explore nurses’ role and scope of practice. Twenty nurses, 16 registered nurses (RNs) and four enrolled nurses (ENs), discussed significant events during which they perceived they were undertaking either patient care activities they should be undertaking, or activities that should have either been delegated or undertaken by a higher level of care provider.

Findings

Five themes emerged from the data: (1) good nurses work in proximity to patients providing total patient care; (2) safeguarding patients; (3) picking up the slack to ensure patient safety; (4) developing teamwork strategies; and (5) privileging patients without mental illness or cognitive impairment. A pattern woven throughout these themes was the idea of negotiation. RNs were struggling with the notions that direct patient care was sometimes not the best use of their time, and delegation did not equate with laziness.

Conclusion

Negotiation has become a fundamental aspect of nursing practice given the variety of nursing care providers currently employed in acute care settings. Negotiation has allowed nurses to redefine appropriate nurse–patient proximity, promote patient safety and find innovative ways of working in nursing teams.     

A qualitative study of health service reform on nurses’ working lives: Learning from the UK National Health Service (NHS)

Background and objectives

The need for efficiency and cost effectiveness in healthcare is of international concern and has been an important influence to changes in nursing skill mix in Organisation for Economic Cooperation and Development countries. This article investigates the impact that the British Government's strategy designed to reform the NHS has had on nurses’ day-to-day working lives. Nurses have been presented as key players in changing the culture of the NHS and the government has sought to provide them with greater empowerment primarily through skill mix changes. However, government policy may have resulted in greater productivity not greater empowerment for nurses who have often been required to compensate for loss of medical capacity as a consequence of the reductions in junior doctors’ hours in line with the European Working Time Directive. Furthermore, what constitutes ‘genuine’ nursing has been difficult to define and ‘caring’ difficult to measure. Thus even without work intensification nurses may believe that health service reform has been disempowering by its focus on quantitative targets.

Methods

This article is based on data from interviews with nurses in three English hospitals providing acute care. It compares and contrasts the perceptions of ward sisters, specialist nurses and staff nurses.

Results

Uncertainty concerning what is the proper task of a nurse has been reinforced by skill mix changes which have resulted in staff nurses and ward sisters perceiving that they are ‘losing nursing’. However, the article shows distinct intra-occupational outcomes. In particular specialist nurses believe that NHS reform has provided greater empowerment by increasing their authority in clinical decision-making.

Conclusion

The findings suggest that the consequences of government strategy have been inconsistent for front-line staff often combining empowerment, disempowerment and work intensification. This article provides empirical evidence which contributes to a debate about whether and why ‘caring’ may have become a lost art in nursing. It also demonstrates the possible effects on nursing of using skill mix change as a method for gaining greater workforce efficiency and as a response to medical staff shortages.     

Infection prevention as “a show”: A qualitative study of nurses’ infection prevention behaviours

Background

Control of infection and prevention of healthcare associated infections is an ongoing issue worldwide. Yet despite initiatives and strategies to reduce the burden that these infections cause, healthcare workers’ practice is still reported as suboptimal and these infections persist. Much of the research to date has primarily focused on predicting infection prevention behaviours and factors associated with guideline compliance. While this has given valuable insight, an investigation aiming to understand and explain behaviours that occur in everyday practice from the perspective of the actors themselves may hold the key to the challenges of effecting behaviour change. This study questioned “How can nurses’ infection prevention behaviour be explained?” This paper presents one of three identified themes ‘Rationalising dirt-related behaviour’.

Design

This interpretative qualitative study uses vignettes, developed from nurses’ accounts of practice, to explore nurses’ reported infection prevention behaviours.

Participants

Registered nurses working in an acute hospital setting and had been qualified for over a year. They were recruited while studying part-time at a London University.

Methods

Twenty semi-structured interviews were undertaken using a topic guide and vignettes. Interviews were transcribed verbatim and analysed using the framework method.

Results

The findings demonstrate that participants were keen to give a good impression and present themselves as knowledgeable practitioners, although it was evident that they did not always follow procedure and policy. They rationalised their own behaviour and logically justified any deviations from policy. Deviations in others were criticised as irrational and explained as superficial and part of a ‘show’ or display. However, participants also gave a presentation of themselves: a show or display that was influenced by the desire to protect self and satisfy patient scrutiny.

Conclusions

This study contributes to the identification and explanation of nurses’ infection prevention behaviours which are considered inappropriate or harmful. Behaviour is multifaceted and complex, stemming from a response to factors that are outside a purely ‘scientific’ understanding of infection and not simply understood as a deficit in knowledge. This calls for educational interventions that consider beliefs, values and social understanding of dirt and infection.     

Nurses' knowledge and risk perception towards seasonal influenza and vaccination and their vaccination behaviours: a cross-sectional survey

Background

Seasonal influenza has become a serious public health problem worldwide and vaccination is recognized as the most effective preventative measure. Healthcare workers can be the vectors of influenza outbreaks. Data suggest that nurses’ vaccination remains suboptimal worldwide.

Objectives

To explore the relationship among nurses’ knowledge, risk perception and their vaccination behaviours and the reasons for vaccination uptake.

Design

A cross-sectional survey.

Setting

Participants were recruited from the nurses enrolled on continuing professional education courses at a large university in London.

Participants

A sample of 522 nurses returned completed questionnaires (response rate 77.7%). Most of the respondents were women, worked in hospitals and had direct patient contact. The mean years qualified as a nurse were 11.9 ± 8.75 years.

Methods

The survey instrument examined nurses’ knowledge about influenza and vaccination, risk perception towards influenza and pandemics, vaccination behaviours and reasons for vaccination acceptance or refusal. The survey also collected data regarding gender, age, highest educational qualification, work place, clinical specialty, qualified years as a nurse, and whether they had direct patient contact.

Results

The influenza vaccination rate among the respondents was 36% with about 41% never vaccinated. Nurses with a high knowledge level were more likely to get vaccinated compared to those with a low knowledge level (p < 0.001). Vaccination rates between the high risk perception and low risk perception groups were different (p = 0.019). Sentinel knowledge items were associated with nurses’ vaccination status. Several risk perception items including personal vulnerability to influenza or H1N1, mortality risk of H1N1, and the likelihood of transmitting influenza to patients were also predictors of vaccination uptake. Vaccinated nurses were more likely to recommend vaccination to their patients (p < 0.001). The most frequent reason for vaccination refusal was concern about the side-effects of the vaccination while self-protection was the most frequent reason for vaccination uptake.

Conclusions

This study confirmed a relationship between knowledge, risk perception and vaccination behaviours among nurses. The identified sentinel items of knowledge and risk perception could inform future vaccination campaigns. The clinical specialty of nurses and the importance of accessibility to vaccination as predictors of vaccine uptake require further exploration.     

Job satisfaction and job values among beginning nurses: a questionnaire survey

Background

Concepts such as the theory–practice gap and reality shock call attention to the challenges nurses experience in their professional lives. These challenges seem to be particularly acute in the transition from nursing school to work. Based on an assumption that the theories and skills taught in school are not directly applicable to nursing practice, beginning nurses may find that they are not prepared to do the work for which they have trained. Consequently, nurses may experience challenges to their work ideals, and their level of job satisfaction may decline. In addition, major life changes, such as buying a house/apartment, becoming a parent or getting married are likely to occur in the first year after graduation. Consequently, the emphasis on economic rewards may increase in the transition from school to work.

Objectives

To examine the relationship between work ideals, experiences of work and job satisfaction through a vital period in nurses’ careers. To compare beginning nurses’ job satisfaction, perceived job rewards and values with those of beginning doctors and teachers.

Participants

Survey data were collected from two cohorts of students in several educational programs in Norway. The survey was repeated among the same respondents, as workers, 3 years after graduation. Almost 3000 students were originally invited to participate. The response rate in the surveys varied from 59% to 80%.

Methods

Tabular analyses and linear regression models.

Results

The results indicate similarities in nurses’, doctors’ and teachers’ preferences for work, but differences in what they obtain. In the transition from school to work, nurses increase their emphasis on high income and job security, and 3 years after graduating, nurses’ emphasis on these two job values is higher than that of doctors and teachers. Nurses were fairly satisfied with their present job.

Conclusion

In terms of level of job satisfaction and their preferences for work, the transition from school to work for nurses seems less dramatic than initially assumed.     

Rest break organization in geriatric care and turnover: A multimethod cross-sectional study

Background

Various determinants of nurses’ work motivation and turnover behavior have been examined in previous studies. In this research, we extend this work by investigating the impact of care setting (nursing homes vs. home care services) and the important role of rest break organization.

Objectives

We aimed to identify direct and indirect linkages between geriatric care setting, rest break organization, and registered nurses’ turnover assessed over a period of one year.

Design

We designed a multimethod cross-sectional study.

Setting

80 nursing units (n = 45 nursing homes, n = 35 home care) in 51 German geriatric care services employing 597 registered nurses.

Methods

We gathered documentary, interview, and observational data about the organization of rest breaks, registered nurses’ turnover, and additional organizational characteristics (type of ownership, location, nursing staff, clients, and client-to-staff-ratio).

Results

The findings show that the rest break system in geriatric nursing home units is more regularly as well as collectively organized and causes less unauthorized rest breaks than in home care units. Moreover, the feasibility of collective rest breaks was, as predicted, negatively associated with registered nurses’ turnover and affected indirectly the relation between care setting and registered nurses’ turnover. Care setting, however, had no direct impact on turnover. Furthermore, registered nurses’ turnover was higher in for-profit care units than in public or non-profit units.

Conclusions

This study reveals significant differences in rest break organization as a function of geriatric care setting and highlights the role of collective rest breaks for nursing staff retention. Our study underlines the integration of organizational context variables and features of rest break organization for the analysis of nursing turnover.     

Impact of e-learning on nurses’ and student nurses knowledge,skills, and satisfaction: A systematic review and meta-analysis

Objective

To review the impact of e-learning on nurses’ and nursing student's knowledge, skills and satisfaction related to e-learning.

Design

We conducted a systematic review and meta-analysis of randomized controlled trials (RCT) to assess the impact of e-learning on nurses’ and nursing student's knowledge, skills and satisfaction. Electronic databases including MEDLINE (1948–2010), CINAHL (1981–2010), Psychinfo (1967–2010) and Eric (1966–2010) were searched in May 2010 and again in December 2010. All RCT studies evaluating the effectiveness of e-learning and differentiating between traditional learning methods among nurses were included.

Data extraction and quality assessment

Data was extracted related to the purpose of the trial, sample, measurements used, index test results and reference standard. An extraction tool developed for Cochrane reviews was used. Methodological quality of eligible trials was assessed.

Data synthesis

11 trials were eligible for inclusion in the analysis.

Results

We identified 11 randomized controlled trials including a total of 2491 nurses and student nurses’. First, the random effect size for four studies showed some improvement associated with e-learning compared to traditional techniques on knowledge. However, the difference was not statistically significant (p = 0.39, MD 0.44, 95% CI −0.57 to 1.46). Second, one study reported a slight impact on e-learning on skills, but the difference was not statistically significant, either (p = 0.13, MD 0.03, 95% CI −0.09 to 0.69). And third, no results on nurses or student nurses’ satisfaction could be reported as the statistical data from three possible studies were not available.

Conclusion

Overall, there was no statistical difference between groups in e-learning and traditional learning relating to nurses’ or student nurses’ knowledge, skills and satisfaction. E-learning can, however, offer an alternative method of education. In future, more studies following the CONSORT and QUOROM statements are needed to evaluate the effects of these interventions.     

Living through the death of a child: a qualitative study of bereaved parents' experiences

Design

Cross-sectional qualitative study.

Data sources

Interviews with purposeful sample of 25 recently bereaved parents.

Methods

Semi-structured in-depth interviews.

Results

Four analytically distinct processes were identified in the responses of parents to the death of a child. These are referred to as ‘piloting’, ‘providing’, ‘protecting’ and ‘preserving’. Regardless of individual circumstances, these processes were integral to all parents’ coping, enabling an active ‘doing’ for their child and family throughout the trajectory of their child's illness and into bereavement.

Conclusions

Facilitating the capacity of parents to ‘do’ is central to coping with the stress and uncertainty of living through the death of a child. The provision of informational, instrumental and emotional support by health care professionals in the context of ‘doing’ is core to quality palliative care.     

Simulation technology for resuscitation training: A systematic review and meta-analysis

Objectives

To summarize current available data on simulation-based training in resuscitation for health care professionals.

Data sources

MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, Scopus and reference lists of published reviews.

Study selection

Published studies of any language or date that enrolled health professions’ learners to investigate the use of technology-enhanced simulation to teach resuscitation in comparison with no intervention or alternative training.

Data extraction

Data were abstracted in duplicate. We identified themes examining different approaches to curriculum design. We pooled results using random effects meta-analysis.

Data synthesis

182 studies were identified involving 16,636 participants. Overall, simulation-based training of resuscitation skills, in comparison to no intervention, appears effective regardless of assessed outcome, level of learner, study design, or specific task trained. In comparison to no intervention, simulation training improved outcomes of knowledge (Hedges’ g) 1.05 (95% confidence interval, 0.81–1.29), process skill 1.13 (0.99–1.27), product skill 1.92 (1.26–2.60), time skill 1.77 (1.13–2.42) and patient outcomes 0.26 (0.047–0.48). In comparison with non-simulation intervention, learner satisfaction 0.79 (0.27–1.31) and process skill 0.35 (0.12–0.59) outcomes favored simulation. Studies investigating how to optimize simulation training found higher process skill outcomes in courses employing “booster” practice 0.13 (0.03–0.22), team/group dynamics 0.51 (0.06–0.97), distraction 1.76 (1.02–2.50) and integrated feedback 0.49 (0.17–0.80) compared to courses without these features. Most analyses reflected high between-study inconsistency (I² values >50%).

Conclusions

Simulation-based training for resuscitation is highly effective. Design features of “booster” practice, team/group dynamics, distraction and integrated feedback improve effectiveness.     

The mediating role of organizational justice in the relationship between transformational leadership and nurses’ quality of work life: A cross-sectional questionnaire survey

Background

The importance of transformational leadership for nurses’ well-being is increasingly acknowledged. However, there is a paucity of research examining the mechanisms that may explain the relationships between transformational leadership and nurses’ quality of work life.

Objectives

First, to examine two possible psychological mechanisms that link transformational leadership behaviors to nurses’ quality of work life. Second, to study the relationship between nurses’ quality of work life and their work engagement.

Design

Cross-sectional study design.

Settings

The study took place in 47 different hematology, oncology, and hematology/oncology units in France. Participants were nurses and auxiliary nurses.

Participants

343 nurses completed the questionnaire. Surveys were sent to all nurses working in the units. 95% were female, the average age was 36.30 years.

Methods

Nurses were asked to rate their supervisor's transformational leadership style and their perceptions of distributive and interactional justice in the unit. They were also asked to evaluate their own level of quality of work life and their work engagement.

Results

Distributive justice and interactional justice were found to fully mediate the relationship between transformational leadership and nurses’ quality of work life. In addition, nurses’ quality of work life positively related to their work engagement.

Conclusions

Transformational leaders may help ensure nurses’ quality of work life which in turn increases their work engagement. These leadership practices are thus beneficial for both employees and organization.     

Academisation of nursing: An ethnography of social transformations in Chile

Background

Nursing in Chile is considered to be the leading example of professional development in Latin America – nurses must undertake five years of university education on a full-time programme. Academisation of nursing education is a key aspect in the evolution into professional status. The consequences of education, however, are commonly related to the replication of social institutions and structures that perpetuate social inequalities.

Objective

The study's aim was to comprehend the consequences of nursing academisation and its relationships with the social transformations which that country has witnessed.

Methods

We draw upon ethnographic data, gathered between 2010 and 2011 in a 500-bed, high-quality university hospital in Chile. Participants were nurses ranging from beginners to experienced professionals and recruited from wards representing technically expert nursing and caring-oriented nursing. The data were organised to allow the development of concepts and patterns, using the Grounded Theory approach.

Results

Despite the fact that Chilean nursing originated from the educated elite class, today's nurses share a middle-class consciousness, and a sense of class distinction is encouraged throughout academic training – the ‘eliteness’ of professional groups. This discourse antagonises middle-class people who ‘should’ adopt a professional-class identity. A tension among nurses surfaced, based on a competition for a scarce resource: social mobility. Furthermore, an antagonist stratification between university-trained nurses and auxiliary nurses has developed, and in the process the title ‘nurse’ and the practice of ‘nursing’ have been monopolised by university-trained nurses, resulting in a relationship of domination-subordination.

Conclusions

The academisation process followed by Chilean nursing is rooted in the social-class transformations of that country. Such process has been ineffective in preventing social inequalities, resulting in the reproduction of earlier historical class differences in nursing, inhibiting nurses’ individual development. Class differences are manifest in the socially constructed distinction between the nurse and the auxiliary nurse, resulting in a schism of the nursing family. By reconstituting a broken-up occupation, the political power of nursing could be strengthened.     

Writing ourselves into a web of obedience: A nursing policy analysis

Background

Nursing work is governed by a web of overarching documents from professional bodies, registration bodies, and individual health care organisations. The focus for these documents is to maintain high standards and protect patients and organisations from unnecessary risk. The presentation of the nurse within these documents has important implications for the ability of nurses to function as autonomous professionals.

Objectives

How the role of the nurse is situated in hospital procedural policy, and more specifically how these presentations of the nurse define, limit, and enable nursing practice is the focus of this paper.

Design

A combination of random and purposive sampling of the nursing policies of one tertiary level hospital was utilised to collect policy documents for thematic content analysis.

Setting

The study was completed in a tertiary level health institution, in one Australian jurisdiction with a population of approximately 500,000 people. This health institution employs over 4000 people and admitted 49,000 patients in the 2004-2005 financial year.

Methods

An inductive approach, which utilised theoretical and contextual comprehension of the nursing policies, informed the collation of coded data which determined the themes of the study.

Findings

Analysis consisted of coding of particular words, textual structure and theory content. Practice was presented in the nursing procedural policies in two themes, called ‘lingering tradition’ and ‘bureaucratic template’.

Conclusions

The discourse of hospital procedural policy situates the nurse as obedient to organisational requirements by limiting practice to a performance of actions without explicit recognition of professional autonomy. This sets up a puzzling contradiction between performance expectations from the employing organisation and the nursing profession. Writing hospital policy in the discourse of procedural directives reduces nurses’ ability to act as autonomous, critically thinking professionals, with implications for patient safety, nurse autonomy and the professional status of nursing.     

The impact of an intervention for nurse prescribers on consultations to promote patient medicine-taking in diabetes: A mixed methods study

Background

Nurse prescribers are in a key position to promote medicine-taking in diabetes. Although patients’ beliefs about medicines are important predictors of medicine-taking, evidence suggests nurses do not routinely explore these.

Objectives

To evaluate a theory-based intervention designed to increase nurse prescribers’ exploration of medicines’ beliefs with people with diabetes.

Design

Mixed methods concurrent triangulation design.

Settings

Nurse prescribers were recruited from 7 Trusts in England.

Participants

A purposive sample of 14 nurse prescribers attended four 1 day workshops.

Methods

Audio-recordings of each nurse prescribers’ consultations with diabetes patients were collected at baseline, 1 week, 3 months and 6 months after the intervention. Nurse prescribers were interviewed at 1 month and 6 months post-intervention. Changes in medicines’ discussion and participation in consultations were analysed using MEDICODE. Interview data were analysed using Framework Analysis.

Results

MEDICODE themes of ‘attitudes towards medication’ showed a significant rise at 1 week (p < 0.01) and 3 months (p < 0.05). ‘Asks patient opinion about medication’ significantly increased at 1 week (p < 0.01). Discussion on ‘concerns about medication’ rose significantly at 1 week (p < 0.001) and 6 months (p < 0.01). Discussion on ‘expected effects of medication’, ‘action of medication’ and ‘reasons for medication’ showed no change. There were no significant changes in Dialogue Ratio. However, the Preponderance of Initiative moved towards more patient initiative at 1 week (p < 0.0001), 3 months (p < 0.0001), and 6 months (p < 0.0001). In interviews, nurses reported increased attention to patients’ medication beliefs and adoption of patient-centred skills. Contextual factors that positively influenced ability to explore medicines beliefs in practice settings were: support of colleagues and practicing new skills. Inhibiting factors included: patients’ perceived lack of receptivity, time constraints, and concerns about opening a ‘can of worms’. Six months interviews revealed using skills in practice enhanced nurses’ confidence and sustainability of skills requires a nurse-patient relationship. Method triangulation illuminated how the intervention was implemented in practice contexts.

Conclusions

The intervention was effective at changing some key dimensions of prescribing consultations. The use of a self-efficacy framework in the intervention, to promote nurses’ confidence in working in a different way, may have been instrumental in effecting the changes found. Contextual factors influencing beliefs exploration in medicine-taking consultations were identified.     

Subjective dysphagia in older care home residents: A cross-sectional,multi-centre point prevalence measurement

Background

Dysphagia has been found to be strongly associated with aspiration pneumonia in frail older people. Aspiration pneumonia is causing high hospitalization rates, morbidity, and often death. Better insight in the prevalence of (subjective) dysphagia in frail older people may improve its early recognition and treatment.

Objective

First, to assess the prevalence of subjective dysphagia in care home residents in the Netherlands. Second, to assess the associations of subjective dysphagia with potential risk factors of dysphagia.

Design

Retrospective data-analysis of a cross-sectional, multi-centre point prevalence measurement.

Setting

119 care homes in the Netherlands.

Participants

Data of 8119 care home residents aged 65 years or older were included and analyzed.

Methods

Subjective dysphagia was assessed by a resident's response to a dichotomous question with regard to experiencing swallowing problems. If a resident was not able to respond (e.g. residents with dementia or aphasia), the question was answered by the ward care provider, or the resident's file was consulted for registered swallowing complaints and/or dysphagia. Several residents’ data were collected: gender, age, (number of) diseases, the presence of malnutrition, the Care Dependency Scale score, and the body mass index.

Results

Subjective dysphagia was found in 751 (9%) residents. A final model for subjective dysphagia after multivariate backward stepwise regression analysis revealed eight significant variables: age (B −0.022), Care Dependency Scale score (B −0.985), ‘malnutrition’ (OR 1.58; 95% CI 1.31–1.90), ‘comorbidity’ (OR 1.07; 95% CI 1.01–1.14), and the disease clusters ‘dementia’ (OR 0.55; 95% CI 0.45–0.66), ‘nervous system disorder’ (OR 1.55; 95% CI 1.20–1.99), ‘cardiovascular disease’ (OR 0.81; 95% CI 0.67–0.99) and ‘cerebrovascular disease/hemiparesis’ (OR 1.74; 95% CI 1.45–2.10).

Conclusion

It seems justified to conclude that subjective dysphagia is a relevant care problem in older care home residents in the Netherlands. Care Dependency Scale score, ‘malnutrition’, and the disease clusters ‘dementia’, ‘nervous system disorder’, and ‘cerebrovascular disease/hemiparesis’ were associated with the presence of subjective dysphagia in this study. Age, ‘comorbidity’ and ‘cardiovascular disease’ showed very small influence.     

Exploring nursing students' decision-making skills whilst in a Second Life clinical simulation laboratory

Aim

To explore nursing students' decision-making skills through the use of a 3D virtual environment such as Second Life.

Method

An exploratory qualitative evaluation of the students' experience of learning decision-making skills whilst in a Second Life clinical simulation laboratory. A convenience sample of five third year student nurses entered a simulated world environment where they cared for six patients over 1 h. The written communication text from the Second Life scenario was saved into a Microsoft Word document. Additionally a semi-structured tape-recorded one to one interview was conducted immediately after the Second Life simulation in order to explore the students' decision-making skills.

Results

The communication text illustrated that the majority of decisions (n = 21) were made in response to a situation or a patient request, therefore ‘reactive’ rather than proactive (n = 9). Only one student carried out a vital signs assessment on a newly admitted patient (Willie). The interviews produced two themes, performing decision-making and improving learning. The absence of ‘visual cues’ such as pre-operative checklists, vital sign observation charts and ‘Nil by Mouth’ signs may offer a rationale for why students were more reactive.

Conclusion

Further work is required for students to practice decision-making skills. With further development the innovative 3D virtual worlds such as Second Life could provide this experience.     

ICU nurses’ perceptions of responsibilities and organisation in relation to organ donation—A phenomenographic study

Objectives

According to the Istanbul declaration, health services should create better routines for identifying potential donors. A previous study involving 702 intensive and critical care (ICU) nurses revealed that only 48% trusted clinical diagnosis of brain death without a confirmatory cerebral angiography. The aim was to study ICU nurses’ perceptions of their experiences of professional responsibilities and organisational aspects in relation to organ donation and how they understand and perceive brain death.

Methods

A phenomenographic method was chosen. Data collection (interviews) took place in Sweden and included fifteen nurses; one man and fourteen women, from six hospitals serving different geographic areas.

Results

The findings pertain to three domains: ICU nurses’ perceptions of (1) their professional responsibility, (2) the role of the organisation regarding organ donation and (3) death and the diagnosis of brain death.

Conclusion

The ambiguity and various perceptions of brain death diagnosis seem to be a crucial aspect when caring for a brain dead patient. The lack of structured and sufficient organisation also appears to be a limiting factor. Both these aspects are essential for the ICU nurses’ opportunities to fulfil their professional responsibility during the organ donation process.