Nurse supervisors' actions in relation to their decision-making style and ethical approach to clinical supervision

AIM: The aim of the study was to explore the decision-making style and ethical approach of nurse supervisors by focusing on their priorities and interventions in the supervision process. BACKGROUND: Clinical supervision promotes ethical awareness and behaviour in the nursing profession. METHODS: A focus group comprised of four clinical nurse supervisors with considerable experience was studied using qualitative hermeneutic content analysis. FINDINGS: The essence of the nurse supervisors' decision-making style is deliberations and priorities. The nurse supervisors' willingness, preparedness, knowledge and awareness constitute and form their way of creating a relationship. The nurse supervisors' ethical approach focused on patient situations and ethical principles. The core components of nursing supervision interventions, as demonstrated in supervision sessions, are: guilt, reconciliation, integrity, responsibility, conscience and challenge. The nurse supervisors' interventions involved sharing knowledge and values with the supervisees and recognizing them as nurses and human beings. CONCLUSION: Nurse supervisors frequently reflected upon the ethical principle of autonomy and the concept and substance of integrity. The nurse supervisors used an ethical approach that focused on caring situations in order to enhance the provision of patient care. They acted as role models, shared nursing knowledge and ethical codes, and focused on patient related situations. This type of decision-making can strengthen the supervisees' professional identity. The clinical nurse supervisors in the study were experienced and used evaluation decisions as their form of clinical decision-making activity. The findings underline the need for further research and greater knowledge in order to improve the understanding of the ethical approach to supervision.     

The significance of nurse supervisors' different ethical decision-making styles

BACKGROUND: The role of the nurse supervisor is very important, because of his/her ability to influence the atmosphere within the clinical nursing supervision group. AIM: To present and interpret nurse supervisors' different ethical decision-making styles. METHOD: A hermeneutic interpretation of three studies on nurse supervisors' different ethical decision-making styles. RESULTS: The significance of the nurse supervisor's ethical decision-making style is reflected in the awareness of their responsibility for creating a relationship with the supervisee. The supervisors focus on ensuring safety, integrating theoretical knowledge and clinical practice, willingness and preparedness to supervise on the substance of nursing, sharing the supervisees' feelings and challenging them, reflecting on the content of clinical nursing supervision as well as promoting justice and integrity in clinical nursing supervision. CONCLUSIONS: The interpretation highlights the importance of the nurse supervisor's style for the outcome of clinical nursing supervision, as they are role models for the supervisees. There is a need for further research to explore the advantages and disadvantages of nurse supervisors' different ethical decision-making styles, especially in relation to the influence of clinical nursing supervision on the quality of care and various support systems.     

The development of a caring curriculum in nursing

Caring is the essence of nursing and the core of nursing education. This paper describes the experience of developing a caring curriculum in a five-year junior college nursing program which included three core courses in caring, in the hope of stimulating further dialogue with fellow educators and cultivating students' caring competencies. The first course was Introduction to Caring, which gave students an understanding of basic concepts of caring, along with the opportunity to practice and experience caring by caring for oneself, one's family and one's peers. The second course was Application of Caring Concepts, which enabled students to learn about caring models, especially the dynamic caring model, and expanded their knowledge of caring behaviors from interpersonal caring to caring for society. The third course was Professional Caring, which explained professional caring and related caring theories, and introduced the caring model used in nursing in Taiwan, showing students how to practice caring in clinical situations. The participating teachers used the action research method to plan, design, implement, and evaluate the caring curriculum. These teachers set the teaching objectives and developed course materials by working together in workshops and participating in teachers' caring groups. They adopted various teaching strategies, such as role modeling, dialogue, caring groups, confirmation, literature, film, caring action projects, reflection, and journaling, which have been proven to be effective at raising students' learning motivation and caring performance.     

Undergraduate nursing students’ experiences of practicing caring behaviours with standardised patients

Rationale

Undergraduate nursing students’ learning opportunities to practice caring behaviours to assure compassionate and competent nursing practice with standardised patients are few. Earlier studies primarily focused on practicing communication skills in relation to mental health or developing psychomotor skills while caring for a patient with a specific diagnosis.

Aim

The study aim was to describe undergraduate nursing students’ experiences of practicing caring behaviours with a standardised patient.

Method

A sample of forty-eight undergraduate nursing students in semester four at a school of nursing in southern Sweden, enrolled in a full-time, 5-week, on-campus elective caring behaviour course, were at the first and last week individually video-recorded during two caring behaviour simulations encountering a standardised patient. After observing each of their video-recordings, students completed written reflections focusing on their own compassionate and competent verbal and nonverbal caring behaviour. In total, 96 individual written reflections were analysed using qualitative content analysis to describe the experience.

Results

One main theme emerged: The challenge of being mindfully present in patient encounters. Four themes further described the experience: A challenging but realistic learning experience, learning the impact of nonverbal behaviour, recognising the complexity of verbal behaviour, and learning to be with the patient instead of only doing for the patient.

Conclusion

When caring is intertwined with visible and realistic nursing practice in simulations using standardised patients it facilitates undergraduate nursing students learning compassionate and competent caring behaviour. The learning experience opened the students’ eyes to the impact of practicing caring, recognising that being with is not the same as doing for the patient, and thus, how challenging it is to be mindfully present in patient encounters. Designing caring behaviour simulations with standardised patients is a feasible and efficacious educational learning didactic to facilitate students’ learning caring behaviour and enhancing patients’ experiences.     

Factors influencing nurse supervisor competence: a critical incident analysis study

AIM: The aim of the study was to identify factors related to critical incidents that influence the competence of nurse supervisors. BACKGROUND: Nurse supervisors require considerable competence in order to help supervisees to reflect on their clinical work and to interpret the needs of the patient. METHOD: A qualitative approach involving the critical incident technique was used. Critical incidents were collected by means of self-reports from 25 nurse supervisors. FINDINGS: Two main areas emerged: a professional and a personal stance. The professional stance described the nurse supervisors' awareness of the importance of creating a secure learning environment and facilitating reflection. The supervisors structured the material and created awareness of fundamental nursing values. The second main area, personal stance, described the nurse supervisors' behaviour when they gave the participating nurses the opportunity to work through the experiences gained in the daily provision of nursing care. Although they experienced lack of self-assurance during the supervision session, they also expressed security regarding their own performance as nurse supervisors. CONCLUSIONS: Nurse supervisors need to include more nursing theory and focus on the nursing process as well as being aware of their own shortcomings and resources. One way for the supervisor to scrutinize his/her actions is to discuss and examine them with a more experienced nurse supervisor colleague.     

Nurses' experiences of caring encounters with older people living in Swedish nursing homes

Aim. The aim of the study was to describe and interpret the meaning of nurses' experiences of caring encounters with residents in nursing homes. Background. Life for residents in nursing homes can be characterized as a process of decreased physical and psychological resources. Therefore, encounters with nurses are important activities for providing meaning and security for the residents. Research in this field has previously focused on communication, attitudes and job satisfaction, but gives limited knowledge about what the human encounters in this context mean for the nurses. Method. A hermeneutic method was used in this study. Interviews were conducted with 14 nurses from two nursing homes about their experiences of caring encounters. The transcribed interview texts were interpreted as a whole. Results. In the interpretation of the text concerning the meaning of nurses' experiences of encounters with resident's four themes and 11 subthemes emerged. The comprehensive interpretation mainly showed possible ways available being present, being significant and being aware of opportunities for the nurse to find meaning in the encounter with the resident, but impossible ways as being inadequately were also revealed. Conclusion. This study shows the importance of caring encounters between nurses and residents in nursing homes. The good encounters provide various possible ways for nurses to find meaning and a sense of communion with residents. However, bad encounters, described as being inadequate, were found to inhibit nurses from finding meaning in their encounters with residents. Relevance to clinical practice. Meeting the needs of older people in nursing homes requires special knowledge about the importance of the caring encounter. Therefore, nurses in this care context need supervision and continuous education in order to gain relevant knowledge about the meaning of caring encounters for themselves and residents.     

优质护理服务的实践与成效探讨

[目的]探讨如何更好地开展和落实优质护理服务。[方法]实施责任包干制,充分发挥护士潜能;开展温馨服务、全程关爱活动;提高护理管理水平,提升护理质量。[结果]护理工作更加贴近临床、贴近病人,病人满意度提高,护理工作得到了同行的肯定,护士的主动服务意识增强,陪护率下降。[结论]开展优质护理服务以实现提升护理质量的目标,并提升病人满意度,更有利于医疗质量的全面提升。     

A learning model for nursing students during clinical studies

This paper presents a research project where the aim was to develop a new model for learning support in nursing education that makes it possible for the student to encounter both the theoretical caring science structure and the patient’s lived experiences in his/her learning process.A reflective group supervision model was developed and tested. The supervision was lead by a teacher and a nurse and started in patient narratives that the students brought to the supervision sessions. The narratives were analyzed by using caring science concepts with the purpose of creating a unity of theory and lived experiences.Data has been collected and analyzed phenomenologically in order to develop knowledge of the students’ reflection and learning when using the supervision model.The result shows that the students have had good use of the theoretical concepts in creating a deeper understanding for the patient. They have learned to reflect more systematically and the learning situation has become more realistic to them as it is now carried out in a patient near context. In order to reach these results, however, demands the necessity of recognizing the students’ lifeworld in the supervision process.     

Creating a Caring Learning Environment

This article discusses creating a caring learning environment for undergraduate nursing students. The purpose is to apply the results of a research study in which students described their lived experience with caring in the nursing environment. Students (N = 23) shared caring and uncaring stories about their curricula. The study identified two patterns: "The Power of the Faculty" and "Creating a Caring Learning Environment." The authors discuss the implications of these patterns for developing caring faculty practices and a caring learning environment.     

The meaning of consolation as experienced by nurses in a home-care setting

Aims and objective. The aim of this study was to illuminate nurses’ experiences of consolation and how these experiences relate to suffering and care. Background. Consolation is commonly associated with the relief of suffering. The question of consolation in terms of its definition and relevance for care has, however, been a matter of discussion among nurse researchers. The question raised concerns about the nature of consolation, its place and its role in relation to care and the caring sciences. Design. An explorative qualitative interview study with 12 participants, six registered and six enrolled nurses, was carried out in a home‐care context. Methods. A phenomenological‐hermeneutic method inspired by the French philosopher Paul Ricoeur was used for the text analysis. Results. Two main aspects of consolation appeared: ‘the present consolation’, which is flexible, sustaining and opening and ‘the absent consolation’, which conceals the suffering and is incapable of consoling. The result was interpreted from a philosophical‐ethical perspective, based on the works of Levinas and Lögstrup. Conclusions. Consolation appears as a complex phenomenon, both in terms of its existence and its absence consolation, constituting a caring and non‐caring consolation. A caring consolation entails meeting the other as different and being present in a way that gives the other space to be the one he or she really is. It requires acceptance, accepting the sufferer and his/her way of suffering as unique. Relevance to clinical practice. The clinical nurse is involved in complex care situations, which entails both reflecting upon and using intuition when consoling. A caring consolation is a contradictory phenomenon that requires a nurse to be capable of both reflecting upon and acting intuitively on the unique suffering of the other.     

关怀护理研究现状

从关怀概念、关怀护理的研究及关怀能力的研究方面，介绍了关怀护理研究现状，提出培养护理人员的关怀能力，必须重视关怀意识的培养和能力的评估。     

Factors associated with students' orientations to nursing

Factors associated with students' orientations to nursing This paper presents the results of a study focusing on the factors associated with orientations to nursing. Students' orientations to nursing have not as yet been a focus of nursing research. In some other professions, however, professional orientation has been associated with learning motivation and study performance, and has been seen as a predictor of work satisfaction. In this study, students' orientations to nursing were defined in terms of caring, nursing expertise and life orientation. The hypothesis of whether students' pre-educational experiences of nursing, gender, choice of nursing specialty, problems with nursing studies and intention to stay in nursing were associated with different orientations was tested. The extent to which students were orientated to caring, nursing expertise and their own life was also examined. The orientation to nursing measurement tool, which has been developed on the basis of a qualitative study, was used to collect the data. Nurse teachers collected the data from nursing students (n=184) who were studying in three different nursing programmes in Finland. Non-parametric assessments (Mann-Whitney U-test and Kruskal-Wallis test) of the differences between the students' orientations were carried out. A majority of the students were highly life-orientated, and two-thirds had average nursing expertise or caring orientation scores. The results supported the study hypothesis of an association between students' orientations and their gender, choice of nursing speciality, problems with nursing studies and intention to stay in nursing. However, the hypothesis of an association between students' pre-educational nursing experiences and orientation to nursing was not supported. The contradictions between students' orientation to nursing and the philosophy of nursing underlying the study programme may be a source of motivational problems and dissatisfaction with nursing education. Therefore, nurse educators are challenged to discuss curriculum matters and student supervision in order to promote flexibility in planning personal study programmes.     

Reflection on how clinical nursing supervision enhances nurses' experiences of well-being related to their psychosocial work environment

Aim The aim of this study was to make a synthesis of three studies that deal with the following research question: ‘How does clinical nursing supervision enhance nurses’ experiences of well‐being in relation to their psychosocial work environment?’ Background Clinical nursing supervision is one way to support nurses in coping with their stressful work situation. Method A hermeneutic approach was used to reflect and interpret nurses’ experiences of well‐being in relation to clinical nursing supervision and psychosocial work environment. Results The findings suggest that clinical nursing supervision has an influence on nurses’ experiences of well‐being and in relation to their psychosocial work environment. Nurses attending clinical nursing supervision reported increased satisfaction with their psychosocial work environment. Conclusions The significance of caring and nursing becomes evident when nurses realize and understand that clinical nursing supervision positively influences their existence and well‐being. The value of work becomes clear when nurses reflect on themselves as professionals and as authentic human beings in clinical nursing supervision. This will lead to the emergence of self‐recognition.     

护理部在创建先进机关科室中的做法与效果

目的探讨护理部在创建先进机关科室中的做法。方法通过实施主动服务，简化办公程序，强化学习意识及成本、节约意识，加强科室管理和职能部门的监督机制等措施加强护理部自身建设。结果各部门对护理部工作满意度提高，护理部提出并开展了37项管理新举措，办公及招待费用明显减少。结论创建先进机关科室活动，有效促进了护理部工作作风的转变与工作效率的提高。     

Mediating consolation with suicidal patients

Psychiatric nurses frequently encounter suicidal patients. Caring for such patients often raises ethical questions and dilemmas. The research question for this study was: 'What understandings are revealed in texts about consolation and psychiatric nurses' responses to suicidal patients?' A Gadamerian approach guided re-interpretation of published texts. Through synthesizing four interpretive phases, a comprehensive interpretation emerged. This revealed being 'at home' with self, or an ethical way of being, as a hermeneutic understanding of a way to become ready to mediate consolation with suicidal patients. Trustworthiness was addressed by means of the qualities of auditability, credibility and confirmability. This re-interpretation adds to nursing knowledge, enhances understanding of previous research findings, provides pre-understanding for further research and reveals the value of hermeneutic inquiry in nursing. It also deepens understanding of a published model of consolation. These understandings may help to guide nurses who are struggling with suicidal patients.     

All real living is meeting: the task of international education in a nursing curriculum

Our experience suggests two significant benefits of shaping an international education focus in a nursing curriculum. First, a genuine understanding and appreciation of a foreign health care system is strengthened by identification of and confrontation with the socio-political context in which it is embedded. The second, and perhaps most fundamental benefit, is not so easy to verbalize. This involves the participant's personal confrontation with another culture. What is external, the experience of a foreign culture, translates into an encounter with the foreign territory of one's own thinking. The participant is challenged to overcome the traditional limitations of professional discipline, experience and vision and to move toward notions of world community and human solidarity. It seems to us that the development of concepts, resources and methods to move American nursing in the direction of greater solidarity with the world health care community is a legitimate task for nursing education.     

护理本科生对护理关怀行为的认知及其影响因素

目的探讨护理本科生对护理关怀行为的认知及其影响因素,为培养护生的关怀理念、关怀能力及关怀行为提供依据。方法采用关怀维度测量表（caring di mensions inventory,CDI）对4个年级210名护生集中进行问卷调查。结果护生CDI测量结果总分为（74.43±13.61）分,属于中等程度,且随着年级升高呈现下降趋势。得分最高的5项依次为：真诚对待患者,把患者视为整体的人,为患者保密,观察患者的用药效果,指导患者有关自我照顾的事宜;得分最低的5项依次为：与患者分享你的个人问题,探究患者的生活方式,与患者同座,保持患者家属的知情,把患者需要放在首位。护生每学期参加社会活动次数、对护理关怀重要性的认同、对护理课程的兴趣等因素与关怀行为的认知呈显著正相关（P〈0.01）。结论护理本科生对护理关怀行为的认知水平有待提高,应对护生加强整体护理内涵及护理观念的教育,且重视学校、社会、家庭和临床的共同参与。可以通过增加学生社会活动的次数、促进学生对护理关怀重要性的认同及提升学生对护理课程的学习兴趣等措施来提高护生护理关怀行为的认知水平。     

Australian clinical nurse supervisors' ethical decision-making style

This paper explores clinical nurse supervisors' ethical styles with regard to supervision in healthcare. Eighty-six registered nurses, all with experience of supervising clinical nurses and students in nursing, completed a specifically designed questionnaire. A qualitative interpretative content analysis identified three core themes: (i) 'Is it safe?'; (ii) 'Is it right?'; and (iii) 'Is it kind?', describing the clinical nurse supervisors' ethical styles. The first core theme 'Is it safe?' covered the supervisors' rules, codes and values that guide their supervisory actions, as well as two sub-themes: (i) empowerment and (ii) integrity. The second core theme 'Is it right?' described the supervisors' responsibility and advocacy as well as the ethical dilemmas experienced in the supervisory process. The third core theme 'Is it kind?' included the supervisors' relationships with patients, professionals and supervisees. The results demonstrate the value of offering a support system, such as clinical supervision, which helps nurses to explore their professional identity for the benefit of the patients.     

Ethical dimensions of supervision: the supervisors' experiences

Group-orientated supervision is provided continually to student nurses during their education. In the supervision process it is necessary to create a relationship between the supervisor and the supervisee that is based on an ethical, trusting relationship. The aim of the study was to investigate supervisors' (n = 18) experiences of the ethical dimensions of ongoing group-orientated supervision. An additional aim was to describe the supervisors' values by which they are guided in supervision. Data were collected by means of an open-ended questionnaire and analysed using the hermeneutic transformative process. The findings revealed the following themes: respect and responsibility; carefulness and sensitivity; reflection and confirmation; and genuineness and fairness. The values guiding the supervisors were dignity, normative ethics, privacy and confidentiality.