Discourse on humanistic clinical care and nurse healing

The Humanistic Clinical Care and Nurse Healing series of graduate studies courses at National Yang-Ming University reflects the mission and goals of the master's and doctoral programs to cultivate the core competence of students. The humanistic nursing curriculum is designed to engender nurse subjectivity by integrating multidisciplinary knowledge. Courses focus on humanistic ideals and ontological, epistemological and methodological nurse fitness while cultivating nurses' humanistic caring competence and humanistic knowledge development. The Humanistic Clinical Care and Nursing Healing curriculum addresses core subject areas including psychoanalysis and humanistic caring, humanistic clinical knowledge exploration, western philosophy and humanistic caring, imaging art and humanistic caring, and the humanistic caring aspect of helping others as well as discusses creative and evidence-based ideas in health promotion and humanistic nursing. The curriculum begins with identifying and understanding concepts, then advances toward applying concepts in practice, reflection, and healing. This paper introduces curriculum structure and content, evaluates student learning through focus groups and assignment content analysis, and discusses the future development potential of humanistic clinical care and nurse healing.     

Strategies for nurse leaders to address aggressive and violent events

According to a 2010 report from the Bureau of Labor Statistics, 48% of all nonfatal injuries from occupational assaults and violent acts occur in healthcare and social service settings. A recent increase in workplace violence has been noted causing a heightened awareness among nurses. Information is scarce both in the literature and in healthcare settings regarding the proper steps to take in the event that violence occurs and de-escalation techniques for aggressive behavior do not work. Nurse leaders should prioritize time to become involved in developing and implementing workplace violence policies including offering education for nurses to deal with aggressive behaviors and violent acts and, learn de-escalation techniques.     

Managing nurses through disciplinary power: a Foucauldian analysis of workplace violence

AIMS: This paper describes discipline as a specific technique of power which constitutes, in our view, a form of institutional violence. BACKGROUND: The need to create and maintain safe and healthy work environments for healthcare professionals is well documented. EVALUATION: Foucault's concept of disciplinary power was used to explore institutional violence from a critical perspective. KEY ISSUE: Violence is identified as an important factor in the recruitment and retention of healthcare professionals. Given the shortage of such professionals, there is an urgent need to take a fresh look at their working environments and working conditions. CONCLUSION: Power, surveillance and disciplinary techniques are used at all levels of hospital management to control and contain both human resources and costs. IMPLICATIONS FOR NURSING MANAGEMENT: By associating common workplace practices with institutional violence, employers who have a policy of zero tolerance toward workplace violence will need to re-examine their current ways of operating.     

Workplace violence in healthcare environments

Violence in the workplace is making headlines across the United States. Healthcare workers are not immune to violent encounters. Many healthcare workers will experience workplace violence at least once during their professional careers. Nurses are in a unique position to develop and provide assistance to implement prevention programs that can decrease the incidence and prevalence of violence in healthcare environments. This article reviews the definition of violence and its elements, and outlines a plan to reduce violence in healthcare environments.     

Countering workplace aggression: an urban tertiary care institutional exemplar

PURPOSE: The purpose of this process improvement project was to provide nursing staff with evidence-based knowledge and skills to manage patients and/or visitors with the potential for violence. SIGNIFICANCE: Current statistics describing workplace violence in healthcare settings are alarming. Workplace violence significantly impacts nursing practice and may contribute to physical injuries, psychological trauma, decreased productivity, and low morale among nurses. This is particularly germane to those nurses who have been inadequately trained to manage aggressive patients and/or family behaviors. RATIONALE: Following a series of disruptive episodes on the pulmonary-medical service that occurred at our facility in the winter of 2006, an employee safety team was formed to address the issue of workplace violence. Around this same time frame, a team comprising system hospital representatives was also initiated to globally address workplace violence. METHODS/DESCRIPTION: A Workplace Violence Education Program was devised to equip nurses with information, skills, and practical tools that will empower them when encountering clinical situations characterized by disruptive or abusive patient and/or family behaviors. The ultimate goal was to diffuse progressive, escalating aggressive behaviors in the clinical setting. FINDINGS/OUTCOMES: Evidence-based approaches formed the basis of an educational offering focusing on workplace violence prevention and management. This informational intervention was devised to empower clinical nursing staff with knowledge to enhance judgment, decision making, and implementation of behavioral strategies to reduce the likelihood of patient/family behaviors escalating to aggression. CONCLUSION: Interdisciplinary collaboration that included clinical experience, expertise, and knowledge generated from current literature reviews contributed to a successful educational program for nurses focusing on a historically neglected topic--workplace violence.     

Workplace Violence in Healthcare Settings: Risk Factors and Protective Strategies

This article describes the risk factors and protective strategies associated with workplace violence perpetrated by patients and visitors against healthcare workers. Perpetrator risk factors for patients and visitors in healthcare settings include mental health disorders, drug or alcohol use, inability to deal with situational crises, possession of weapons, and being a victim of violence. Worker risk factors are gender, age, years of experience, hours worked, marital status, and previous workplace violence training. Setting and environmental risk factors for experiencing workplace violence include time of day and presence of security cameras. Protective strategies for combating the negative consequences of workplace violence include carrying a telephone, practicing self‐defense, instructing perpetrators to stop being violent, self‐ and social support, and limiting interactions with potential or known perpetrators of violence. Workplace violence is a serious and growing problem that affects all healthcare professionals. Strategies are needed to prevent workplace violence and manage the negative consequences experienced by healthcare workers following violent events.     

A cross‐sectional examination of factors associated with compassion satisfaction and compassion fatigue across healthcare workers in an academic medical centre

Compassion satisfaction (CS) among healthcare professionals is a sense of gratification derived from caring for their suffering patients. In contrast, compassion fatigue, often a consequence of burnout (BO) and secondary traumatic stress (STS), is detrimental to healthcare professionals’ productivity and patient care. While several studies have examined CS, BO, and STS among healthcare professionals, the majority have assessed samples in specific disciplines. However, the comparative differences in these factors by discipline or work setting are not well known. The aims of this study were to examine the differences in CS, BO, and STS by discipline and work setting, and to assess demographic, work‐related, and behavioural factors associated with these outcomes. An electronic survey was administered (N = 764) at a large academic medical centre in the southeast United States. Questions elicited demographic variables, work‐related factors, behavioural/lifestyle factors, experience with workplace violence, and the Professional Quality of Life Scale. Findings of the study determined that the rates of CS, BO, and STS vary across healthcare disciplines and work settings. Demographic, work‐related, behavioural, and work setting (i.e., experience of workplace violence) factors were differentially associated with experiences of CS, BO, and STS. The results of the study suggest two potential areas for research, specifically workplace violence and sleep quality as a means of further understanding reduced CS and increased BO and STS among healthcare workers. These findings have important implications for future research and policy interventions to enhance healthcare workers’ health and safety.     

医院工作场所暴力与护士工作压力的相关性研究

目的了解护士遭受医院工作场所暴力的情况,探讨医院工作场所暴力对护士工作压力的影响。方法使用医院工作场所暴力调查表和护士工作压力源量表,调查三级甲等综合性医院工作至少1年的946名护士,了解医院工作场所暴力发生情况和护士的工作压力水平。结果医院工作场所暴力总发生率为55．07％。遭受暴力组护士的工作压力及5个维度得分较未遭受暴力组的护士高,差异具有统计学意义（P〈0．01）;单纯心理暴力组护士工作压力得分明显低于其他组的护士,心理＋身体＋性暴力组护士的工作压力得分明显高于其他组护士,差异具有统计学意义（P〈0．01）。结论护士在医院工作场所遭受暴力的风险较高,对护士的工作压力造成了深刻的影响,有必要采取相关措施减少医院工作场所暴力的发生。     

Valvular Heart Disease

Nurse practitioners will encounter patients with valvular heart disease (VHD) because 5 million Americans are diagnosed with VHD every year. The American Heart Association and the American College of Cardiology released VHD guidelines in 2014. Once VHD is recognized, evidence-based guidelines need to be used in the management of patients with VHD. Nurse practitioners must have an understanding of the latest guidelines in order to initiate treatment, collaborate with the heart team members, and monitor and follow up on patients with VHD. Timely referral to cardiology and cardiac surgery is imperative for optimal outcomes in patients with VHD.     

Incidence and Cost of Nurse Workplace Violence Perpetrated by Hospital Patients or Patient Visitors

Introduction

Workplace violence against nurses is a serious problem. Nurses from a US urban/community hospital system employing more than 5,000 nurses researched the incidence of workplace violence against nurses perpetrated by patients or visitors in their hospital system.

Methods

Survey research and retrospective database review methods were used. Nurse participants (all system-employed nurse types) completed a 34-item validated survey in electronic format. Retrospective database review provided annual nurse workplace violence injury treatment and indemnity charges. Institutional review board approval was received.

Results

Survey research participants (N = 762) were primarily white female registered nurses, aged 26 to 64 years, with more than 10 years of experience. Over the past year, 76.0% experienced violence (verbal abuse by patients, 54.2%; physical abuse by patients, 29.9%; verbal abuse by visitors, 32.9%; and physical by visitors, 3.5%), such as shouting or yelling (60.0% by patients and 35.8% by visitors), swearing or cursing (53.5% by patients and 24.9% by visitors), grabbing (37.8% by patients and 1.1% by visitors), and scratching or kicking (27.4% by patients and 0.8% by visitors). Emergency nurses (12.1%) experienced a significantly greater number of incidents (P < .001). Nurses noted more than 50 verbal (24.3%) and physical (7.3%) patient/visitor violence incidents over their careers. Most serious career violence incidents (n = 595, 78.1%) were physical (63.7%) (60.8% by patients and 2.9% by visitors), verbal (25.4%) (18.3% by patients and 7.1% by visitors), and threatened physical assault (10.9%) (6.9% by patients and 4.0% by visitors). Perpetrators were primarily white male patients, aged 26 to 35 years, who were confused or influenced by alcohol or drugs. Per database review, annual workplace violence charges for the 2.1% of nurses reporting injuries were $94,156 ($78,924 for treatment and $15,232 for indemnity).

Discussion

Nurses are too commonly exposed to workplace violence. Hospitals should enhance programs for training and incident reporting, particularly for nurses at higher risk of exposure, caring for patients with dementia or Alzheimer disease, patients with drug-seeking behavior, or drug- or alcohol-influenced patients.     

The Cooperative Care model: an innovative approach to deliver blood and marrow stem cell transplant care

Competition among healthcare institutions, the need to improve outcomes, and the desire to decrease costs have motivated blood and marrow stem cell transplant centers to develop innovative care models. In an effort to meet these challenges, a major midwestern medical center adapted the transplant process to the outpatient setting. This transition created greater educational and care demands for patients and families. To address these demands and provide improved accommodations and amenities for patients and families, the center adopted an innovative model of care, Cooperative Care, for transplant recipients. Cooperative Care embraces patients and families as key members of the healthcare team. A family member serves as a primary caregiver for the patient during the acute inpatient phase of the transplant. Care becomes more personal and individualized, cost is reduced, the rate of rehospitalization potentially is decreased, and patients ultimately become more confident and competent in caring for themselves. The healthcare team shifted its care philosophy to incorporate a care partner, increase patient control and independence, and create greater emphasis on education. Outcomes, including patient satisfaction, have demonstrated success and motivated expansion of this model to other patient populations.     

Nursing as caring theory: living caring in practice

This column features a report of a research project in a community hospital. Staff members were given opportunities to engage and act on the ideas of Boykin and Schoenhofer in their nursing as caring theory. Feedback from patients, family members, and all staff who touched patients informed the creation of a new model of care that positively transformed the workplace in the hospital setting. Strategies that were implemented to guide the values of nursing as caring theory are described. The result of the project was an environment that nurtures persons in their caring and growing in caring while illuminating the fullness of nursing.     

The Beat Goes On: Emergency Nurses’ Song of Resilience

Since the beginning of the COVID-19 pandemic, emergency nurses have been on the frontlines. Not only were emergency nurses caring for patients with physical symptoms, they were also confronted by anxiety, depression, stress, and uncertainty in patients, peers, and themselves. Even as nurses cared for patients seeking their help, they were dealing with their own struggles as members of the larger community and the organization. The purpose of this study was to examine emergency nurses’ resiliency and to provide nurse leaders a different lens for viewing resilience. Five interconnected elements surfaced through direct observations with live environmental music therapy, focus groups, and essays with emergency room nurses. Fostering the elements of emergency nurses’ song of resilience: harmony, melody, rhythm, silence/rest, and beingness may enhance individual, team, and organizational performance. Nurse leaders can support resiliency and promote healthy work environments by perceiving resilience creatively and through reflection.     

Workplace violence against nurses,job satisfaction,burnout, and patient safety in Chinese hospitals

BackgroundMost nurses have experienced some form of workplace violence, which could lead to physical or psychological harm and reduced job performance. Previous studies have examined the effects of workplace violence on nurses' job satisfaction and patient safety, but there have been very few examinations of whether workplace violence affects patient safety through nurse job satisfaction and burnout.PurposeTo investigate the relationships among workplace violence, nurse outcomes and patient safety. To explore whether nurse burnout and job satisfaction play mediating roles in the association of workplace violence and patient safety.MethodsA cross-sectional survey was conducted in 23 hospitals in Guangdong province in China to collect data from 1502 nurses. A structural equation model design was tested with validated measurement instruments.FindingsNurse-reported workplace violence was found to be associated directly with higher incidences of burnout, less job satisfaction, lower patient safety and more adverse events. Nurse burnout was associated directly with lower patient safety and more adverse events. Higher nurse job satisfaction was associated directly with higher patient safety. Nurse burnout and job satisfaction played mediating roles in workplace violence and patient safety. The model explained 19.8% and 35.0% of nurse-reported patient safety and adverse events, respectively.DiscussionIt is important for administrators to consider how to protect nurses from workplace violence, to improve their wellbeing at work, and to deliver safe patient care. When nurses experience workplace violence, it is necessary to pay attention to their emotional reactions and job attitudes, and to provide them with support in order to avoid adverse impacts on patient safety. Further practices and research initiatives to support nurses' safety at work are recommended.     

Informed consent and truth-telling: cultural directions for healthcare providers

As the United States becomes more diverse in the healthcare beliefs and practices of its residents, delivery of culturally competent healthcare in an ethical manner becomes increasingly complex. Nurse administrators, who are responsible for interpreting policy and organizational expectations to their employees as well as ensuring that providers maintain the American Nurses Association's code of ethics, are challenged when providing care for diverse populations. Critical to providing culturally sensitive care is an understanding of different approaches to truth-telling. The authors present Korean, Southeast Asian, and First Nations (American Indian) case studies illustrating concepts of truth-telling and informed consent related to issues that arise when group-oriented persons or families respond to their health-care providers' actions.     

Patient aggression in intensive care: A qualitative study of staff experiences

BackgroundWorkplace violence comprises abuse, assaults, threats, and harassment. Reaching epidemic proportions in healthcare, workplace violence compromises staff and patient safety and service efficiency and effectiveness. Although workplace violence is a nontrivial problem in intensive care, little is known about circumstances in which violence occurs in this setting.ObjectiveThe objective of this study was to describe and reflect upon aggression towards staff in the intensive care unit (ICU) from the perspectives of staff members.MethodsWe investigated workplace violence in a qualitative study with data collected from semistructured interviews with 19 staff members of a 10-bed ICU, analysed using a framework approach.FindingsAll participants reported witnessing or experiencing physical and/or verbal aggression. While acknowledging that ‘any patient’ could become aggressive, participants differentiated ‘any patients admitted for treatment of somatic illnesses’ from ‘dangerous’ patients and interpreted violence differently dependent on characteristics of perpetrators. ‘Dangerousness’ was associated with patients who had a comorbid mental illness. Aggression of ‘dangerous patients’ was construed as intentional and/or ‘normal aberrant’ behaviour for the individual. Staff reported feeling ill-prepared to work effectively with this cohort and having difficulty responding empathically. Mental health services were considered ‘responsible’ for managing patients' drug use, personality, and psychiatric problems.ConclusionPerceived knowledge and skill deficits, as well as stigma when engaging with certain subpopulations, contribute to workplace violence in the ICU setting. ICU staff members seek education and support to improve management of patients and reduce risk of violence. However, effectiveness depends on robust service and organisational commitment and strategies to promote workplace health and safety.