Primary nursing: staff perception of changes in ward atmosphere and role

The value of a primary nursing care delivery structure remains undecided. This study was carried out on an acute psychiatric admissions unit as it changed its care delivery system to that of primary nursing. A review of the literature highlights the inconclusive nature of previous investigations. The principle of evidence-based practice raises the need for further research to put this issue to rest. The staff perception of this change on both the atmosphere of the ward and on the role of the nurses themselves was analysed. A general reduction in satisfaction with role was discovered, as was a reduction in eight out of 10 subscales of the Ward Atmosphere Scale (Moos 1989). As primary nursing generally receives favourable reviews by nurses, and was in fact positively received by the staff in this study at the time of initiation, this negative result is surprising. It is conjectured that primary nursing may be an ideal philosophy of nursing that is difficult to realize due to constraints surrounding contemporary nursing practice.     

优质护理服务示范病房不同学历、职称、工作年限护理人员工作现状调查分析

目的:调查山东省三级综合性医院优质护理服务示范病房不同学历、职称、工作年限护理人员工作现状。方法:采用问卷调查法,对山东省6所三级医院优质护理服务示范病房546名护士工作现状进行调查。结果:优质护理服务示范病房护理工作的主力是大专学历、初级职称及工作年限1～3年的护士,夜班护理工作主要由大专学历、护士职称及工作年限1～3年的护士承担;不同学历、职称、工作年限护士从事各护理项目有所侧重,差异有统计学意义(P<0.001),但均从事所有工作项目。结论:不同学历、职称、工作年限护士任职标准、岗位职责不明确,应构建合理的优质护理服务示范病房护理人员能级体系,确保护理质量的持续改进。     

Indicators of quality in nursing care — an alternative approach

Indicators of quality of nursing care were developed from a conceptual framework for geriatric nursing based on the twin concepts of care and having a positive attitude to the health and welfare of old people. These primary concepts were further developed using structural aids, in particular the theoretical guidelines for practice disciplines propounded by Dickoff et al. From this, a measure, called the Therapeutic Nursing Function (TNF) Indicator, was devised which attempted to identify those ward sisters who provided more patient-centred or therapeutic nursing care from ward sisters who gave routine-centred or non-therapeutic nursing care. The TNF Indicator, based on the conceptual framework, comprised a list of statements to which ward sisters responded. The scaling system divided responses into more--or fewer--therapeutic nursing responses. A stratified random sample of 25 ward sisters was used in the study and from this the characteristics of ward sisters in the upper and lower range of the scale were compared. Distinct variations were noted between groups in relation to demographic information, perception of geriatric nursing, use of nursing information, management approach and the ward sisters' concept of rehabilitation. A further instrument, the Therapeutic Nursing Function Matrix, attempted to measure the quality of care patients were receiving on geriatric wards. Nurse-patient interaction on a ward where the ward sister had a high TNF Indicator score was compared to a ward where the ward sister had a low score. The results showed that quality of care seemed to be related more to the orientation and perception of the ward sister than to any number of extraneous variables such as medical and paramedical input, ward facilities and ancillary staff support.     

Record-keeping and routine nursing practice: the view from the wards

This paper examines general nurses' views of the nursing record and its routine usage in contemporary hospital practice. It draws on ethnographic data generated on a surgical ward and a medical ward in a single District General Hospital in the United Kingdom (UK). A key research finding was ward nurses' equivocal attitudes to the nursing record. On the one hand, because of its links with the nursing process, the nursing record was highly valued as a symbol of professionalism and ward staff were loathe to criticise it directly. On the other hand, however, the nurses in this study clearly found it difficult to reconcile their professional ideals with the ways in which the nursing record was routinely employed on the wards. In this paper it is suggested that at one level, nurses' ambivalence towards the nursing record reflected the distortion of its founding philosophy by the new managerialism in the contemporary UK health care context. At another level, however, there are also difficulties which arise from the tension between the assumptions about the nature of nursing work which underpin the nursing record and the workplace reality on hospital wards.     

A comparison of primary nursing and team nursing in a geriatric long-term care setting

The purpose of this study was to evaluate primary and team nursing on two 45-bed geriatric units. A 2 year longitudinal study with a quasi-experimental ABA cross-over design and a staff survey, permitted comparisons of the two nursing systems on indices of patient well-being, nursing practice, staff morale and costs. Differences in nursing practice, in selected measures of patient well-being and in responses to the staff survey were positively associated with primary nursing. No differences emerged in relation to staff morale or costs. The benefits of primary nursing and implications for further research are discussed.     

三级护理质量控制体系在病区护理管理中的应用

目的采用三级护理质量控制体系管理病区。方法介绍护士长、兼职质量控制员、执行护士对病区护理工作进行质量控制的操作方法。结果实现了病区护理管理的自我控制和逐级控制,不断发现工作中的问题和安全隐患,及时采取纠正和预防措施。结论三级护理质量控制体系强化了全员的质量监控意识,使质量管理由个人转变为全员、由被动转变为主动,各项制度及护理措施都能得到有效落实,保证了护理质量和护理安全。     

General satisfaction and satisfaction with nursing communication on an adult psychiatric ward

A client satisfaction survey was undertaken on an adult psychiatric admission ward in Sheffield, England, being sent to all clients discharged from the ward over 12 months The questionnaire consisted of a general satisfaction element, and two questions asking about satisfaction with nursing communication The response rate was 81 from 199 forms sent General satisfaction levels were lower than for a sample of 3120 mainly out-patient psychiatric clients in the USA Satisfaction with nursing communication was significantly correlated with general satisfaction The survey allowed the number of dissatisfied clients to be identified, and their views highlighted One aspect often reported by dissatisfied clients was a perceived lack of time from staff The importance of nursing communication with respect to client satisfaction is highlighted by the study     

Changing handover practices: One private hospital's experiences

McKenna L, Walsh K. International Journal of Nursing Practice 1997; 3 : 128–132
Changing handover practices: One private hospital's experiences
The handover practice has long been an important component of clinical nursing practice allowing nurses to exchange relevant client information from one shift to the next and ensure continuity of patient care. Traditional approaches have seen nursing handovers taking place in a room away from general ward activity. Oncoming nursing staff receive the information verbally from nurses on the previous shift about all patients within the ward or unit. This practice has been proven over time to present difficulties and consequently, many hospitals are choosing to adopt models that better address current needs. This analysis describes the creative approaches taken by one private hospital in modifying handover practices with the view to reduce time and increase overall efficiency and effectiveness, whilst ensuring that staff and ward requirements are considered. The study highlights how action research principles can be applied to introduce change into the clinical practice environment.     

Classifying nursing organization in wards in Norwegian hospitals: self-identification versus observation

Background  

The organization of nursing services could be important to the quality of patient care and staff satisfaction. However, there is no universally accepted nomenclature for this organization. The objective of the current study was to classify general hospital wards based on data describing organizational practice reported by the ward nurse managers, and then to compare this classification with the name used in the wards to identify the organizational model (self-identification).     

Towards defining the organization of nursing care in hospital wards: an empirical study

The method of organizing nursing care known as 'primary nursing' is increasingly being introduced into hospital wards on the assumption that it will have beneficial effects for both patients and staff. Operational definitions of primary nursing, essential to provide replicable research into the organization of nursing care, are, however, lacking in available research literature. This study describes the development of a questionnaire intended to identify and discriminate between three methods of organizing nursing staff and nursing work: task allocation or functional nursing, team nursing and primary nursing. The questionnaire was distributed to 36 ward sisters on 27 acute and rehabilitation care of the elderly wards. Questionnaires were returned from 17 wards, a response rate of 63%. Findings indicate that few wards meet five or more criteria for classification as a particular method of nursing organization. The findings illustrate the difficulties in matching and discriminating between wards in order to conduct research in which organizational modality is an independent variable.     

Organization of nursing care and stressful work characteristics

BACKGROUND: Occupational stress is assumed to arise from social arrangements that are partially determined by the modes of organization of work. However, there is little systematic research on the extent to which modes of organizing nursing work are related to stressful characteristics of work. OBJECTIVES: This study explored the relationship between modes of organizing nursing and stress. METHODS: Survey responses on modes of organization of nursing were collected from 27 ward sisters and those on stressful work characteristics from 568 nurses working in 27 wards with different nursing modes. RESULTS: Four different nursing modes (primary, modular, team and functional nursing) were not consistently associated with stress. Statistically significant associations involved only certain features of these modes and specific components of stress. After the effects of demographic and ward characteristics were controlled for, hierarchical regression analyses showed that opportunity to write nursing notes decreased the likelihood of nurses' stress because of problems in interpersonal relationships. Writing nursing notes is common in patient-focused nursing modes (primary and modular nursing). Other features of nursing modes were not associated with stress. DISCUSSION: In general, nursing mode is not associated with stressful job characteristics. However, certain aspects of patient-focused nursing reduce the likelihood of interpersonal problems among staff.     

Why don't nurses monitor the respiratory rates of patients?

Early warning systems (EWS) are being introduced to acute ward areas across the country to support the early recognition of patients at risk of developing a critical illness. All the systems are based on the monitoring of physiological observations of pulse, blood pressure, temperature, respirations and consciousness level. The main problem identified when attempting to introduce an early warning system to the acute general ward areas in one hospital was the general paucity of monitoring of patients observations by the nursing team. Respiratory rate was identified as the one parameter which nursing staff recorded less than 50% of the time. This qualitative study used focus groups in an attempt to understand the reasons behind the paucity in patient observation practice and explore the nurses' values and beliefs about patient monitoring within the context of care. The study identified four major factors associated with the paucity of patient monitoring: organization of nursing care activities, development of nursing observation skills, clinical decision making processes and equipment management issues.     

Experimental study to evaluate nursing staff morale in a high stimulation geriatric psychiatry setting

This work is part of a larger study carried out at Murray Royal Hospital, Perth, Scotland. The study was concerned with staff morale under two distinct management approaches towards the care of the elderly patient with dementia. In one ward a dynamic, high stimulation approach was adopted including reality orientation, reminiscence therapy and socialization therapy. This was run in a well-structured manner by the ward staff and other agents. The other ward had no such structure imposed and was left to carry out 'traditional' nursing care to a high standard. The tool used to collect the data was a precoded questionnaire developed by Jones & Galliard. The hypothesis on which the study was based was as follows, 'that morale is increased in nursing staff involved in a high stimulation ward environment for the hospitalized elderly patient with dementia'. The findings of the study appear to indicate that the hypothesis is supported. It appears that the imposition of the structured high stimulation management approach was responsible for such an outcome and that nursing staff respond well to such an approach.     

The nursing practice of taking level 1 patient observations.

Nurses have a pivotal role in the early identification of patients at risk of deterioration through the taking of patient observations and assessment. This paper presents the findings from an ethnographic qualitative study to discover the practice of recording basic observations of general ward patients and discusses how these observations are used in the assessment of the physical state of the patient. The research is a triangulation method including participatory observation (n = 20) and semi-structured interviews (n = 8) of registered (n = 4) and unregistered (n = 4) nursing staff. Although the research is limited by its exploratory nature and the size of both the interview group and the observational study, the findings suggest that the experience of staff is important in the assessment of patients to detect indicators of patient deterioration. The practice of taking basic observations as a part of assessing patients has changed from being the qualified nurses' role to a role delegated to health care assistant. In addition, there appears to be a reliance on the use of electronic monitoring equipment. The results of the research will be utilised to inform where the practice might be improved.     

The content of morning time conversations between nursing home staff and residents

Aim. The aim of this paper was to investigate what nursing home staff and residents converse about when they first meet each other in the morning and to investigate who starts the conversation. It is a pilot project about communication in a nursing home in Sweden and a basis for a practice development programme. Background. Studies in Sweden have shown that nurse assistants working in care of the older people felt they had too little training in how to communicate. Communicative behaviour influences patients, but little is known about the content of morning time communication in nursing homes. Method. Non‐participant observation of 18 staff was carried out using an observation schema. Content analysis was performed. Results. The findings were that it was the staff who initiated conversation and chose the content of conversation. The most common topic in morning time conversation was residents’ health and sickness. Conclusion. Staff in nursing homes, both nurses and nurse assistants need to reflect on their interaction with residents and be conscious of their important role because they create the climate on the ward through conversation. Further studies are needed in order to explore residents’ opinions of what the content of a good communication could be and also to find out how nurses and other staff members’ communication with residents could be improved. Relevance to clinical practice. Staff need more training and knowledge about how to communicate with older people.     

Operational competency development in E and F grade nursing staff: preparation for management

There is limited literature for operational management competency development in E and F grade nursing staff. These grades of nursing staff have to take over from G grade nurses ward managers on a regular basis. With human resources doing less of the operational management and taking more of an advisory role, nursing staff are now required to deal with disciplinary procedures and other management issues in a more consistent manner. Therefore, this development programme in a Scottish primary care NHS psychiatric service was designed to enable E and F grade nurses to take over from ward managers and to enable ward managers to 'succession plan' for times when they will be absent. The literature is reviewed, the background to the development programme described and the design of the development programme is explained. The results from both the pilot study (n=13) and first group (n=8) through the course are presented, evaluated discussed.     

移动护士工作站应用前后对患者床边直接护理时间的影响

目的 调查移动护士工作站应用前后护理工作情况及对患者床边直接护理时间的影响,为医院推进移动护士工作站的应用提供参考。 方法 比较应用移动护士工作站前后护理人员巡视病房的次数、对患者床边直接护理时间、护理人员往返办公地点的次数。 结果 应用移动护士工作站后护理人员巡视病房次数和对患者床边直接护理时间增加,而往返办公地点的次数减少。 结论应用移动护士工作站后护理人员节约了工作时间,提高了工作效率,真正把护理时间还给了患者。     

Acute pain services - effecting change in nursing attitudes towards postoperative analgesia

Previously, postoperative pain relief was rarely achieved due to misconceptions held by the nursing and medical staff about opioid analgesia. The introduction of acute pain services in many hospitals has changed practice, methods and attitudes towards the management of postoperative pain. This paper reports on two surveys conducted five years apart to see if the analgesic techniques introduced to the ward setting had been accepted by the nursing staff and if any changes in attitudes were noted.The findings show that a change in practice and attitudes was evident after the introduction of new pain relief techniques and was sustained over the period of time assessed. Nursing awareness about the advantages and disadvantages of epidural and patient controlled analgesia techniques was also heightened between the two surveys.In conclusion, acute pain services are important role models and catalysts in changing practice and attitudes towards postoperative pain management at an institutional level.