The technological mediation of the nursing-medical boundary

Norwegian medical emergency communication (AMK) centres are staffed by nurses, who administer requests for ambulance services or access to a doctor. The central position of nurses and the fact that they communicate with doctors by telephone and radio, make this a setting where the doctor-nurse relationship is highly visible. A two-year study of AMK centres showed that much of the work of these centres proceeds quite independently of doctors, as nurses function as competent suppliers of advice or 'medical oracles'. The doctor-designed Index for Medical Emergency Assistance is deficient as a tool for guiding nurses' decisions, since it fails to take account of the dynamics of real nursing practice, which is based on experiential knowledge, support from colleagues and collective learning. Data on nursing work in the AMK centres suggest that these nurses have more influence and autonomy in the nurse-doctor interaction than most past studies have indicated.     

Rethinking nurses' observations: psychiatric nursing skills and invisibility in an acute inpatient setting

In sociological, managerial and clinical investigations of psychiatric nursing, the skills of observing patients are compared unfavourably with nurses' ability to listen, to interview and to engage with patients. This paper examines how nurses in an acute psychiatry unit used observation as a significant part of their everyday assessments of patients, through a working shift. We argue that the knowledge generated in observations is essential to the nurses' gaze in this setting. Based on an ethnographic study of the assessment practices of 11 psychiatric nurses and the first author in an Australian hospital setting, we found that nurses' observations of patients were rich in situated assessment detail and a powerful strategy for producing civil conduct among patients. In particular, we noted how nurses deliberately obscured their practice of observation, in order not to provoke patients. While such discreet practice is productive for everyday clinical work, the invisibility of nursing observations undermines the status of acute inpatient psychiatric nurses. Devaluing of tacit practice may encourage experienced nurses to leave inpatient units, at a time when hospitals struggle to address nursing shortages worldwide. We recommend instead that the productive value of diverse and situated practices be investigated and articulated.     

免用手技术传递手术锐器意愿性调查与分析

目的 了解外科医师和手术室护士对免用手技术的接受、接纳程度.方法 选择外科医师、手术室护士为调查对象,采用自行设计的问卷,调查手术室实施免用手技术传递锐器的意愿性,并了解不同意实施的具体原因.结果 共发放199份问卷,回收153份,总回收率为76.9％;被调查者多为女性、工龄＞5年、初级职称及医院工作人员,分别占调查人数的70.6％、47.7％ 、34.6％及44.4％;85.62％被调查者认为有必要在手术室实施免用手技术,护士比医师,初、中级职称比高级职称更容易接受(P＜0.01);不同意实施的主要原因为影响手术进行,延长手术时间等.结论 调查采用循证手段,根据调查结果实施相应干预,利于新技术的推广和应用,达到减少医院职业暴露、维护医务人员职业健康的目的.     

分级管理模式在手术室护理管理中的应用效果分析

目的探讨分级管理模式在手术室护理管理中的应用效果。方法选取本院86名手术室护理人员作为研究对象,于2017年6月实施分级管理模式,干预时间为6个月。比较实施分级管理模式前(2017年1—5月)、后(2017年6—12月)不良事件发生率、护理业务知识考核情况、满意度。结果实施后护理人员不良事件发生率(6.98%)低于实施前(17.44%),差异有统计学意义(P<0.05);实施后护理人员理论知识、操作技术评分均优于实施前,差异有统计学意义(P<0.05);实施后护理人员自身满意度(90.70%)高于实施前(79.07%),差异有统计学意义(P<0.05)。结论分级管理模式可有效降低手术室护理人员不良事件发生率,提高护理人员理论知识、操作技能水平,改善其对自身的满意度,优化手术室护理质量。     

Nurses' professionalism in Canada: a labor process analysis.

This article draws on a body of research conducted by the author over the past ten years on the social organization of nursing work. It explores questions surrounding nurses' contemporary labor process control and its meaning for nurses' professionalization and proletarianization. Both are dynamic processes, changing as public administration of the Canadian health care system changes and as nurses are successful in winning more complete self-regulation. Nurses are currently being articulated more and more securely to dominant ideas of public sector management through textually mediated technologies. Nurses find new upwardly mobile careers and challenging, responsible, and more respected work. However, as the generation of objective information for professional accountability, cost-accounting, and managerial decision-making becomes unified in computerized patient information systems, producing and using such information becomes a central and determining core of everyday nursing work. It organizes nurses into a "managed" practice of patient care, contradictory for them in many ways. Outstanding among these contradictions is a new professionalized standpoint of cost-efficiency that subordinates nurses' traditional interests and grounding of their work in the standpoint of care.     

A survey of static and dynamic work postures of operating room staff

Summary Work in health care units is associated with considerable physical strain and many musculoskeletal complaints. Most investigations have concentrated on the work of general hospital nurses; little is known about the physical stress load on other health care workers. We therefore carried out an ergonomic study amongst operating room staff in order to (i) determine the work (posture) stress load on this particular group of health care workers and the effect of static posture on this stress, (ii) identify activities involving poor work postures, and (iii) determine differences between specialities in regard to work posture stress load. The work postures and related work activities of four different groups of staff in operating rooms (surgeons, assistant anaesthesists, instrumentation nurses and circulating nurses) were recorded and evaluated using the specified Ovako Working posture Analysing System (OWAS). Observation during the course of 18 daily surgical programmes (total number of observations: 3714) in the specialities general surgery and ear-nose-throat (ENT) surgery revealed that the workload according to OWAS for circulating nurses and assistant anaesthesists was not harmful. Some work postures seen among instrumentation nurses and surgeons, however, need improvement. The work posture stress load in these groups is mainly due to the high prevalence of static work postures during the activities surgery (surgeons) and assisting surgery (instrumentation nurses). Significant differences in ergonomic stress load were observed between general surgeons and ENT surgeons. This survey in operating theatres relates work postures to basic activities and can be used as a starting point from which to improve work conditions in order to reduce or eliminate physical complaints among operating room staff.     

Impact of an educational program based on evidence related to Fever management

Quality care is dependent on best evidence. Children's nurses are no exception to this and their philosophy of "the child first and always" will ensure that their evidence base for practice is commensurate with stance. For this reason, this study was conducted to assess the impact of an educational program based on evidence related to fever management on nurses' evidence-based knowledge and reported practices. An Educational program based on evidence was designed according to nurses' needs and new evidence findings in fever management. Results of the study showed that at the pre program phase, nurses had lower level of evidence-based knowledge than at the first follow-up. Their means of knowledge scores related to fever, measuring temperature, nursing management, administration of antipyretics and documentation were 3.69 vs 8.00, 5.06 vs 7.49, 3.99 vs 6.94, 4.07 vs 7.33 and 6.81 vs 9.76 respectively. Also, there was no statistical significant difference between level of evidence-based knowledge for nurses at the first and second follow-ups. It was concluded that an educational program based on evidence promotes the quality of nursing care in fever management.     

手术室护士锐器伤害现状及上报情况调查

目的了解手术室锐器意外伤的发生状况及上报处理情况并进行原因分析,为提出应对措施提供依据。方法 2012年4月采用自编问卷调查泰安市5家医院手术室176名护士的锐器意外伤的情况及锐器伤后的上报制度执行及处理情况和原因。结果锐器意外伤发生率100%,针刺伤占66.48%,主要是手术缝针和注射器针头刺伤;接触血液、体液污染的占76.14%,被污染后采取正确处理方式的仅有46人(34.33%);不同工作年限、职称、学历的护理人员遭受锐器意外伤的人数差异有统计学意义(P<0.05),发生锐器伤后上报医院的例数仅占38.64%,不愿上报的主要原因是报告程序繁琐,其次是太忙没有时间报告;85.23%的护士认为获得防护知识的途径主要是临床工作实践。结论手术室护士发生锐器意外伤害率高,发生伤害后上报情况及采取的防护措施情况不容乐观,防护知识的获得途径主要是临床实践。提示医院应建立完善有效的锐器伤报告反馈系统,加强手术室护士职业防护培训,保障职业安全。     

手术室的职业损伤与防护对策

目的：调查手术室护士在职业损伤后的防护,以完善防护措施。方法：采用问卷调查和访谈的方式,对本院手术室护士被损伤后的自我防护进行调查。结果：所有手术室护士都不同程度地受到损伤,其中有三人接受过防护知识的培训,但除一人外其他人都不能采取较完善的防护措施。结论：手术室护士对周围各种损伤防护性差,应加强职业防护知识的培训教育,丰富专业知识和技能。     

ICU专科护士在NICU培训基地临床实践的管理

目的:临床实践性教学与管理是培养ICU专科护士运用所学知识解决实际问题能力的关键.方法:对安徽省首批ICU专科护士在NICU培训基地的临床实践管理过程,分成接受带教前准备、入科时进行评估、制定培训内容及计划、培训过程中的质量管理、出科前师生相互评估、总结这几个阶段.结果:33名ICU专科护士通过几个月的临床带教,NICU的理论知识与临床技能均有明显提高,对带教满意度达到97%.结论:通过NICU临床基地培训,能激发学员对新生儿急救知识的学习热情和兴趣,提高了危重新生儿病情观察能力和急救技能,保证了带教质量完成.     

以绩效精细化管理提升手术室护理质量

探索适合手术室护理工作的绩效管理模式。方法建立基于技术级别、年资、岗位、工作量及工作质量的多维度绩效考核方案,比较实施绩效改革前后3个月的连台手术衔接时间、护理工作质量、外科医生及手术室护士的满意度。采用SPSS 20.0统计软件进行数据处理。结果绩效改革实施后,连台手术衔接时间缩短了10.59min;护理工作质量显著提升;外科医生满意度由85.07%提升至96.67%;护士对绩效考核指标设置满意度由82.09%提升至95.52%,对考核指标配比满意度由85.07%提升至98.51%,差异均有统计学意义（P＜0.05）。结论将精细化管理引入手术室护理绩效中能够提高手术室运行效率,提升手术室护理工作质量,改善外科医生及手术室护士满意度。     

Gatekeeping practices of nurses in operating rooms

This paper explores the gatekeeping practices used by operating room nurses to control information flow in their everyday clinical practice. In nursing, gatekeeping appears only sporadically in the literature and usually emerges as a secondary concept rather than being the primary focus of studies. As gatekeeping is a communication practice that has the potential to impact directly on patient safety, a more in-depth exploration of its pervasiveness and effect needs to be undertaken. Accordingly, in this paper we aim to provide an in-depth understanding about gatekeeping practices in operating room nursing by drawing on a ‘network’ model of gatekeeping to highlight the power relationships between stakeholders and how information is controlled. To illustrate our points, we provide four different examples of gatekeeping at an interpersonal level of interaction. Data are drawn from an ethnographic study in Australia that explored nurse–nurse and nurse–doctor communication at three different operating room departments. We explore the impact of gatekeeping on social and professional relationships as well as how it has practical and ethical ramifications for patient care and the organisation of clinical work. The findings show that nurses are selective in their use of gatekeeping, depending on the perceived impact on patient care and the benefit that is accrued to nurses themselves.     

Sources of practice knowledge among nurses

Several studies have been published listing sources of practice knowledge used by nurses. However, the authors located no studies that asked clinicians to describe comprehensively and categorize the kinds of knowledge needed to practice or in which the researchers attempted to understand how clinicians privilege various knowledge sources. In this article, the authors report findings from two large ethnographic case studies in which sources of practice knowledge was a subsidiary theme. They draw on data from individual and card sort interviews, as well as participant observations, to identify nurses' sources of practice knowledge. Their findings demonstrate that nurses categorize their sources of practice knowledge into four broad groupings: social interactions, experiential knowledge, documents, and a priori knowledge. The insights gained add new understanding about sources of knowledge used by nurses and challenge the disproportionate weight that proponents of the evidence-based movement ascribe to research knowledge.     

Rural School Nurses'Attitudes about AIDS and Homosexuality

ABSTRACT: The AIDS epidemic has spread to rural areas of the United States. Conservative rural communities are facing the challenge of having children with HIV entering school. School nurses, as the only health care providers in the schools, are in a strong position to facilitate the education of children with HIV and to provide AIDS education to students, faculty, and parents. School nurses' knowledge and attitudes about AIDS and people with AIDS influence their effectiveness in prevention activities and care of HIV-infected children. This study examined the relationship between specific demographic, practice, and cultural variables and rural school nurses' attitudes about AIDS and homosexuality. Sixty-nine school nurses responded to a mailed questionnaire as part of a larger study of rural nurses. Results indicate attitudes about homosexuality were related to nurses' homosexual knowledge and religious beliefs while attitudes about AIDS were related to nurses' willingness to care for people with AIDS and feeling prepared to do so.(J Sch Health. 1997;67(8):341–347)     

Gender and power: Nurses and doctors in Canada

BACKGROUND: The nurse-doctor relationship is historically one of female nurse deference to male physician authority. We investigated the effects of physicians' sex on female nurses' behaviour. METHODS: Nurses at an urban, university based hospital completed one of two forms of a vignette-based survey in January, 2000. Each survey included four clinical scenarios. In form 1 of the questionnaire the physicians described were female, male, female, and male. In form 2, vignettes were identical but the physician sex was changed to male, female, male, and female. Differences in responses to questions based on the sex of the physician in each vignette were studied RESULTS: 199 self-selected nurses completed the survey. The responses of 177 female respondents and 11 respondents who did not specifiy their sex, and were assumed to be female based on the overall sex ratio of respondents, were analysed. Persistent sex-role stereotypes influenced the relationship between female nurses and physicians. Nurses were more willing to serve and defer to male physicians. They approached female physicians on a more egalitarian basis, were more comfortable communicating with them, yet more hostile toward them. CONCLUSION: When nurses and doctors are female, traditional power imbalances in their relationship diminish, suggesting that these imbalances are based as much on gender as on professional hierarchy. The effects of this change on the authority of the medical profession, the role of nurses, and on patient care merit further exploration.     

"Never again" stories of nurses: dilemmas in nursing practice

The authors describe significant turning points immanent in "never again" stories that practicing nurses, having participated in previously, vowed not to allow to recur during future, similar situations. Nurses submitted written accounts of critical, "never again" situations. The authors used critical incident technique and employed Colaizzi's approach to reveal the essential structure. Patient outcomes were fatal, close calls, dehumanizing, or isolating. Never again stories incorporated ethical dilemmas, deficits in nurses' knowledge, lack of confidence in clinical abilities, and failure to act correctly. Patients' welfare was the center of accounts. Circumstances threatened patients' and family members' trust in nurses and other providers. Patients' wishes were denied because of haste, providers' arrogance, or providers' desire not to be inconvenienced. Nurses' emotions mirrored a sense of failed responsibility for patients. Regret was tempered by nurses' pledges. Critical incidents revealed dilemmas in which nurses' autonomous clinical practice was constrained by feelings of powerlessness.     

Caring and researching: complementary or exclusionary practices?

The conception of empirical nursing has been disseminated, based on "doing", updated according to professional practice, impairing the interdisciplinarity between care, research and the building of a specific knowledge able to provide scientificity to its actions. Thus, authors aimed at understanding nurses' conceptions on care and research, analyzing their practices and verifying if they are complementary or exclusionary. They used participant observation and semi-structured interviews with nurses working at a University Hospital located in the state of Rio de Janeiro, Brazil. Results showed different discourses on care and research as well as the difficulties to associate these activities that, for nurses, are theoretically complementary but practically exclusionary.