Sustaining well-being and enabling recovery: the therapeutic effect of nurse friendliness on clients and nursing environments

A variety of studies identify friendliness/being friendly in their findings however, no research reports on the phenomenon of nurse friendliness. Moreover, all prior findings are coincidental to the phenomenon under investigation, so nurse friendliness is superficially represented and poorly understood. In turn, the significance of nurse friendliness has gone unnoticed. Because the present study focused on nurse friendliness, it revealed a deeper dimension to this phenomenon and expanded prior, limited understandings. This study, conducted in 2003, used Gadamerian hermeneutics to explore 12 clients' encounters with friendly nurses. Findings reveal that nurse friendliness results in mutuality, humour, fondness and reciprocity, in purposeful and thoughtful nursing action, and in a light-hearted environment where clients feel affirmed, included and uplifted. Because of this, nurse friendliness sustains clients and enables their recovery. In revealing the phenomenon of nurse friendliness, this study findings add to knowledge regarding the therapeutic potential and significance of nurse-client relationships.     

Responding to responsive behaviours: A clinical placement workshop for nursing students

As our population ages, it is important for the next generation of nurses to feel prepared to care for people with dementia. Communicating with a person with dementia who is experiencing responsive behaviours can be challenging. Furthermore, new graduate nurses may experience a phenomenon called reality shock when they do not feel prepared for the reality of nursing. Reality shock can lead to nurse turnover and poor retention rates. This study evaluated a workshop for first-year practical nursing students focusing on applying a person-centered communication framework when caring for people with dementia experiencing responsive behaviours. The results suggested that training students during their clinical placements on dementia communication may be effective in helping prepare nurses to care for this patient population.     

Seeking and defining the ‘special’ in specialist mental health nursing: A theoretical construct

In the context of an enduring debate about the distinct identity of mental health nursing, this qualitative study explored the nature, scope and consequences of mental health nursing practice. Data for interpretation were generated through interviews with 36 mental health nurses, five of their clients and one health care colleague, each of whom were asked to speak in as much detail as possible about what they believe is special about mental health nursing and what had influenced them to arrive at this understanding. Using a constructivist grounded theory approach, the study generated a substantive theory of recovery‐focused mental health nursing expressed as ‘Being in the here and now, side by side, co‐constructing care’. The study revealed that the distinct nature and identity of mental health nursing provides the foundation that primes and drives practice scope and consequences. Conceptual interpretations of the data emphasized the mental health nursing perspective of care as an acquired lens founded in nursing as a profession and enhanced by the relational interplay between the nurse and the client that facilitates the nurse to adopt recovery‐focused practices. This theoretical construct holds the potential to be the mediating connection between client and mental health nurse. By situating mental health nursing and its central role in practice as something co‐constructed, findings from this study can be expanded beyond the Australian context, particularly in terms of mental health nursing's distinct professional identity and practice.     

Counselling and mental health nursing: a qualitative study

The author draws upon his experience of training, practising and teaching both counselling and mental health nursing in order to examine the relevance of counselling skills training to mental health nurses. The qualitative study reported in this paper elicits the feelings and thoughts of five mental health nurses about their attitude towards individual counselling work with mental health clients. It is asserted that newly qualified mental health nurses may feel inadequately prepared for this aspect of their work and they may also feel inadequately supported. Additional counselling training may help equip mental health nurses for the skills they need to work within the therapeutic relationship. By not providing adequate counselling skills training, mental health nurse educators may contribute to a cycle of incompetence. Training methods are identified that may enhance nurse training and help promote competence and confidence for the newly qualified nurse.     

The use of special observations: an audit within a psychiatric unit

Observation is a fundamental skilled nursing intervention. Special observation is an intensified and often prolonged form of this intervention. Depending upon their nature, and the circumstances under which they are carried out, special observations may invoke varying degrees of stress in both the observer and the observed. They may also raise important ethical and significant financial questions. In psychiatry, special observations are usually imposed where a patient is assessed as representing some degree of risk to themselves or others because of their behaviours or potential behaviours. Special observations vary in their degree of intrusiveness and restrictiveness, and may arouse strong emotions in the patient and staff. Patients may be denied privacy for their most intimate needs, and staff may become a focus for patients' acting-out behaviours. Special observations may be medically imposed with minimal consultation with nursing staff, and where there is no nursing and medical staff agreement on their need, nursing staff may at times feel frustrated and powerless to reduce the patients' discomfort with their situation. This paper presents a study into the use of special observations on psychiatric inpatients across a range of clinical settings. The literature on special observations is reviewed, and the findings of an audit into the documentation of special observations is presented and discussed. The study sites comprised two open acute wards, one elderly functionally mentally ill assessment unit which also treats patients with eating disorders, and a secure high dependency unit, which provides rehabilitation within a secure environment for patients with severe and enduring mental illness.     

Amorphous practice: nursing in a remote Indigenous community of Australia

Nurses are key providers of health care in remote Indigenous communities throughout Australia. Evidence of nurses' actual practice and the outcomes of their care for clients in this context, however, is lacking. This exploratory research describes how nursing is practised in a remote Aboriginal community and reveals many anomalies. The overall theme, termed amorphous practice, defines the changeable character of practice from nurse to nurse and from situation to situation. The themes underlying amorphous practice are termed detachment, diffusion, and beyond the nursing domain. Each theme is described by way of its characteristics, the strategies nurses use to deal with the situation, and the consequences. The significance of these findings raise concerns for the accountability of nursing and most of all for the rights of Indigenous people in remote areas to basic standards of safe health care.     

Home‐visit nurses' attitudes for providing effective assistance to clients with schizophrenia

There were two objectives of this study. The first was to identify the attitudes of home‐visit nurses towards clients with schizophrenia that lead to the provisions of effective care and positive client outcomes for clients with schizophrenia. The second was to develop a framework to understand how nurses acquire nursing attitudes that lead to such provisions. Seven expert home‐visit nurses who had successfully prevented rehospitalization of clients with schizophrenia for more than 2 years were interviewed. In the semistructured interviews, the nurses described their experiences in assisting one or two clients. Data were analyzed qualitatively. The central theme was having equal footing with the client. An effective nursing attitude was acquired through recognizing one's own preconceptions of clients with schizophrenia through two steps: encountering unexpected client behaviours and becoming aware of one's problematic care. For these clients, it was essential that the nurses reflect on their preconceptions towards clients with schizophrenia and alter these preconceptions by working with the clients and believing in their innate ability to live in the community. The findings suggest that the field of mental health home‐visit nursing might benefit from adding these educational components in order to cultivate effective nursing attitudes for assisting clients with schizophrenia.     

The transition from nursing student to registered nurse: The mentor’s possibilities to act as a supporter

The transition from nursing student to registered nurse can be exciting, stressful and challenging. It is common for nursing students to feel insecure about their competence and ability to step into working life. The role of the mentor in the final clinical practice is essential, as they guide students in their clinical learning process and professional growth. This study describes the mentor’s support in the transition from nursing student to registered nurse. Sixteen nursing students wrote narrative essays about the significance of the clinical mentor in their role change in the transition process from nursing student to registered nurse. The essays were analysed using inductive content analysis. The findings show that the mentor has a significant role. Three main categories emerged in mentor’s role: role change support, the mentor’s actions and the qualities of the mentor. In future in clinical nursing practice, it is important to allocate resources to the mentor’s work and understand its importance for nursing students’ transition to nursing.     

Nurse teachers' attitudes to research: a phenomenological study

This research project looks at nurse teachers' attitudes to research. It addresses the question of how nurse teachers view their responsibilities and abilities to promote nursing research. The requirement for nursing practice to be founded upon a firm basis of research is increasing. It may be argued that nurse teachers are highly influential and may provide the linchpin to the future of nursing research in the clinical environment. This research, using a phenomenological approach, attempts to reveal what nurse teachers think and feel about their role in research.     

Reconciling professional identity: A grounded theory of nurse academics' role modelling for undergraduate students

Role modelling by experienced nurses, including nurse academics, is a key factor in the process of preparing undergraduate nursing students for practice, and may contribute to longevity in the workforce. A grounded theory study was undertaken to investigate the phenomenon of nurse academics' role modelling for undergraduate students. The study sought to answer the research question: how do nurse academics role model positive professional behaviours for undergraduate students? The aims of this study were to: theorise a process of nurse academic role modelling for undergraduate students; describe the elements that support positive role modelling by nurse academics; and explain the factors that influence the implementation of academic role modelling. The study sample included five second year nursing students and sixteen nurse academics from Australia and the United Kingdom. Data was collected from observation, focus groups and individual interviews. This study found that in order for nurse academics to role model professional behaviours for nursing students, they must reconcile their own professional identity. This paper introduces the theory of reconciling professional identity and discusses the three categories that comprise the theory, creating a context for learning, creating a context for authentic rehearsal and mirroring identity.     

Clients' reflections on relationships with nurses: comparisons from Canada and Scotland

It has been suggested that the crucial elements in nursing situations are the nurse, the client, and what goes on between them. This paper examines what goes on between clients and nurses during interpersonal relationships, from the perspective of the clients. Data are presented from studies conducted in Canada and Scotland. It is shown that what clients want, or do not want, during relationships with their nurses, is similar on both sides of the Atlantic. The findings reported in this paper are relevant to transcultural nursing, ethical care, the growth in consumerism, and client advocacy. The findings suggest also that there is a need for nursing research to focus on clinical outcomes in order to establish whether clients' perceptions of helping relationships have any relevance to favourable health outcomes, and the evidence base for clinical nursing.     

Caring for those who care: a tribute to nurses and their safety

From the clinics of South Africa, where there are "No Gun" signs on the walls; to the rural island hospital in Micronesia, where there is no running water; to the urban hospitals of Los Angeles serving non-English speaking clients from around the globe; to the nurse-run clinics in the harsh Alaska frontier, nurses are focused on doing their best to give quality nursing care. This focus on providing quality care is commendable. However, nurses must also focus on taking care of themselves so they are able both to continue providing quality care for their patients and to maintain the profession's ability to recruit and retain new nurses. In nursing textbooks from the late 1980s and early 1990s, risks to health care workers were listed only as sub headings in sections such as infectious agents and musculoskeletal injuries, or in general chapters on "women's work." It is a remarkable sign of progress that there is now a discrete focus on the health and safety of health care workers. This article provides a general introduction to the topic of nurse safety. First the major areas of health and safety concerns and the Hierarchy of Controls framework for risk reduction will be outlined. Next, findings from American Nurses Association (ANA) surveys which helped to crystallize the issue of safety and challenged the profession to focus on nurse safety will be presented. Following this, the linkages between patient safety and nurse safety will be discussed. Finally national reports, environmental initiatives, and policy successes and opportunities related to nurse safety will be noted.     

Clinical nurses as teachers: insights from students of nursing in their first semester of study

This paper reports the findings of a study which sought to gain insights about the role of clinical nursing staff in the planned clinical experience of undergraduate nursing students. This study differs from others in that the perspectives of students of nursing in their first year of the undergraduate programme are sought, and the role of clinical nurses rather than clinical teachers is of particular interest. Using a story-telling approach, an exploration of students' perspectives on the role of clinical nursing staff in their clinical learning was undertaken. Analysis allowed findings to be grouped into helpful and unhelpful behaviours, Helpful behaviours included understanding and being friendly, showing interest and explaining. Behaviours that students found unhelpful to their learning were often passive rather than active, but they made students feel acutely aware of being unwelcome in the clinical area. Several students described feeling intrusive, uncomfortable and even unwelcome in clinical areas because o the attitudes and behaviour of clinicians. Findings of this study highlight the importance of clinicians and academic nurses working together to ensure that students of nursing, who represent the future of the profession, are provided with the best possible opportunities for clinical learning.     

Leader empowering behaviours, staff nurse empowerment and work engagement/burnout

Efforts to improve nursing working conditions are critical to retaining nurses currently in the system and attracting newcomers to the profession (Laschinger et al. 2003b). The nurse leader's empowering behaviours can be pivotal in the way nurses react to their work environment. The purpose of this study was to test a model examining the relationship between nurse leaders' empowerment behaviours, perceptions of staff empowerment, areas of work life and work engagement using Kanter's theory of structural power in organizations. A cross-sectional correlational survey design tested the model in a random sample of 322 staff nurses in acute care hospitals across Ontario. Overall, staff nurses perceived their leaders' behaviours to be somewhat empowering and their work environment to be moderately empowering. Fifty-three percent reported severe levels of burnout. Leader empowering behaviour had an indirect effect on emotional exhaustion (burnout) through structural empowerment and overall fit in the six areas of work life. The final model statistics revealed a good fit (chi(2)=30.4, chi=3, chi=0.96, chi=0.95, chi=0.95). These findings suggest that the Leader's empowering behaviours can enhance person-job fit and prevent burnout. These findings have important implications in the current nursing shortage.     

Nursing students' attitudes to health promotion to: implications for teaching practice

For several decades now the World Health Organization has indicated the need for a reorientation of the health services away from focusing solely on illness and disease to one that considers both disease prevention and health promotion. Successive publications that guide public health policy both nationally and internationally reiterate the need for health promotion and the principles of health for all to become integral to the fabric of health care delivery. The role of the nurse as health promoters is well recognized. However despite acknowledgement by professional nursing bodies and nurse educators that health promotion forms a central tenet of undergraduate nurse education curricula, there are varied approaches to teaching and learning and little formal evaluation of the consequences of approaches taken. The aims of this study are to identify current health promotion curricular content within the Irish undergraduate nursing programme context; to measure nursing students' attitudes towards health promotion and to examine nursing students' reported lifestyle behaviours.     

Developing effective institutionai managers in the 1980s-Part 1: A current analysis

Two dominant themes are developed in this two part paper. One is that the organizational behaviour of nurse managers has its origins in the social defence system learned during early nursing; the other is that many of the assumptions which underpin current thinking on management training can do little either to help unlearn these early behaviours or to enable managers to be more innovative in their roles. In part one management training is examined in some detail from the three perspectives of the institution, the management trainers and the nurse managers, and in particular the widely differing assumptions and expectations which each have about the management training process. The social defence system of nursing is then analysed and tentative evidence is offered to illustrate how nurse managers transfer this system to managerial positions, with dysfunctional consequences. Although primarily concerned with nurse management training, there are implications for managers and management trainers in a much wider range of institutions and professions.     

Nurses' Perspectives of Encouraging Clients' Care‐of‐Self in a Short‐Term Rehabilitation Unit Within a Long‐Term Care Facility

This article presents a study conducted on a short‐term rehabilitation unit in a long‐term care facility. The purpose of the study was to explore, through qualitative methods, nurses' perspectives of encouraging clients to care for themselves. Although the literature suggested that encouraging self‐care does not occur, the findings of this study showed that nurses have a broader view than what is currently known in nursing as “self‐care.” Potential impediments to nursing practice were overcome by the development of nurse‐client relationships through which the nurses encouraged clients in what is described throughout this study as “care‐of‐self” Rehabilitation nurses play an important role in helping clients to integrate and reclaim the care of their emerging new selves. Care‐of‐self may be critical to clients not only in reaching their outcome goals for discharge but also in maintaining outcomes beyond discharge.