Attentiveness in care: towards a theoretical framework

The purpose of this article is to shape a theoretical framework of attentiveness in care, which may function as a background to study attentiveness in a health care setting empirically. More insight into the functions, forms, and aspects of attentiveness in a particular health care setting is important, as there is a lack of indicators and criteria that enable a sharp picture of the caring side of health provision. The concept of attentiveness and its relation to care have seldom been examined thoroughly and broadly. This article argues that attentiveness is constitutive for good care, as it can create a space in which a relationship may arise.     

Individual,practice, and system causes of errors in nursing: a taxonomy

Practice errors by nurses can cause harm to patients, families, practitioners, systems, and the profession. Because the nursing errors reported to the State Boards of Nursing are typically serious, analyzing their data has great potential for developing new strategies to reduce dangerous errors. With the guiding rationale being identification of categories central to the nurse's role and function in healthcare delivery errors, 21 case studies of nursing errors from 9 State Boards of Nursing files were analyzed to develop a taxonomy of nursing errors. Eight categories of nursing errors representing a broad range of possible errors and contributive or causative factors were identified: lack of attentiveness; lack of agency/fiduciary concern; inappropriate judgment; lack of intervention on the patient's behalf; medication errors; lack of prevention; missed or mistaken MD/healthcare provider's orders; and documentation errors. Causes for the error, at the system and practice responsibility levels, were identified in each case. The categories, an assessment of causes of errors, and an examination of the remediation actions taken were the first steps in devising a taxonomy of nursing error, designed with prevention in mind. The authors discuss their work and present the taxonomy.     

Academic freedom: protecting "liberal science" in nursing in the 21st century

Generating new knowledge through science is one of the most valued contributions of American universities, and is wholly dependent on the tenets of academic freedom. This article provides an overview of academic freedom in the United States, lack of attentiveness to academic freedom in the discipline of nursing, and its relevance for advancing nursing science. Three issues are critically evaluated as they relate to "the free search for truth" that is imperative for scientific progress to occur, including (a) its importance in a liberal science system, (b) recent trends to politically manipulate science, and (c) movements to restrict speech on campus.     

Heart failure and weight gain monitoring

Heart failure is one of the most common diagnoses of the elderly in the United States. The nursing literature has demonstrated that nursing interventions aimed at effective discharge planning and appropriate self-care activities can improve outcomes for patients hospitalized with heart failure. The purpose of this research was to identify, through retrospective medical record review, the discharge instruction related to self-weight monitoring provided to a sample of heart failure patients. The patients in the sample were 65 years and older with an ICD-9 diagnostic code of heart failure upon discharge from an acute care hospital in the Midwest. Results demonstrated the lack of nursing attentiveness to teaching self-monitoring weight gain to heart failure patients while hospitalized and the need for more comprehensive planning for appropriate discharge referrals. Suggestions are made for expanding documentation tools to improve nursing discharge planning and case management to ensure that the patient or caregiver is able to carry out self-care activities at home.     

Facilitating and constraining factors on autonomy: the views of stroke patients on admission into nursing homes

This article describes a model changing autonomy which was developed in a grounded theory study among stroke patients on admission into nursing homes for rehabilitation. Three dimensions of autonomy were identified: self-determination, independence, and self-care. On admission, patients' conditions (disabilities, multimorbidity, emotional state, and feeling like a layperson) and patients' strategies (waiting and seeing, and acting as a subordinate) constrain autonomy. Several environmental factors facilitate patient autonomy. The nursing home sustains patient autonomy by providing a hopeful atmosphere and room for autonomy. The health professionals facilitate autonomy by giving therapy, support and information, attentiveness and respect, paternalism and teamwork, Facilitating strategies of the family encompass emotional and instrumental support Care routines, lack of privacy, an unfamiliar environment, waiting periods, boredom, and lack of information were identified as constraining environmental factors. Developing guidelines and multidisciplinary courses regarding the approach to patient autonomy on admission is recommended.     

Maintaining student interest in CAI

Students seem to be losing interest in computer assisted nursing instruction (CAI). CAI needs to be stimulating and motivating to promote optimal learning. This article presents four instructional design features of CAI that facilitate interest and motivation: objectives, attentiveness, individual control, and reinforcement. Authors of software should use these features in design and nurse educators should include these design issues when evaluating CAI for purchase.     

Waiting: the experience of persons in a critical care waiting room.

The purposes of this study were to discover the essences of the experience of waiting, to provide new knowledge about what it is like to wait, and to contribute to nursing knowledge. Participants were 12 persons who were family members or friends of persons in an adult critical care unit. The Parse research method was used to answer the research question: What is the structure of the lived experience of waiting? The central finding of this study was this structure: The lived experience of waiting is a vigilant attentiveness surfacing amid an ambiguous turbulent lull as contentment emerges with uplifting engagements. The structure is discussed in relation to nursing knowledge and in relation to how it can inform future research and practice. © 2002 John Wiley & Sons, Res Nurs Health 25:58–67, 2002.     

Oncology patients' perceptions of quality nursing care

The purpose of this study was to analyze theoretically oncology patients' perceptions of the attributes and outcomes of quality nursing care. The grounded theory method as described by Strauss and Corbin (1998) was used. The purposive sample comprised 22 oncology patients being treated at an urban medical center; they were interviewed using a semistructured schedule. Eight attributes of quality nursing care emerged from the data. From the patient's perspective, excellent care was characterized by professional knowledge, continuity, attentiveness, coordination, partnership, individualization, rapport, and caring. In addition, two outcomes of quality care included increased fortitude and a sense of well-being with its constituents of trust, optimism, and authenticity. These findings can inform investigations of how oncology patients may experience "being well cared-for by nurses. Copyright John Wiley & Sons, Inc.     

Antecedents to engrossment in Noddings' theory of care

BACKGROUND: Nel Noddings theorized caring as a universal social process comprised of three phases: engrossment or mental attentiveness, affective engagement or empathy and a mental imperative to act on behalf of another. If Noddings' theory is correct, caring is a learned process. AIM: The goal of this research was to understand the process, particularly engrossment, and to facilitate students' development of caring relationships. DESIGN: This qualitative study of 13 baccalaureate nursing students uncovered six antecedents that facilitated student's engrossment and extends Noddings' theory. CONCLUSION: Further research, to deepen and synthesize understanding of antecedents and their influence on facilitating or inhibiting the caring process, is advocated.     

Transcultural care values and nursing practices of Philippine-American nurses.

The purpose of this ethnonursing research was to discover, explicate, and analyze the nursing care values and caregiving practices of Philippine nurses working in an American hospital context. The study, which was part of a larger study, was conceptualized within Leininger's theory of culture care. Consistent with the tenets of the theory, a brief overview of Philippine world view, social structure, culture, and ethnohistory was provided. Qualitative analysis of observation-participation and interview data revealed a major care theme of obligation to care. This care theme was supported by three care patterns which were: 1) expressed seriousness and dedication to work, 2) attentiveness to physical care as comfort, and 3) respect and patience as caring modalities. The study also showed that Philippine-American nurses attempted to achieve cultural care congruence by preserving some generic care values and practices, by accommodating to some of the host professional culture's values and practices, and by restructuring or repatterning less serviceable values. Implications for transcultural nursing education, practice, and research were discussed.     

Achieving care and social justice for people with dementia

This article draws on two studies that have used an ethic of care analysis to explore lay, nursing and social work care for people with dementia. It discusses the political as well as the practice application of ethic of care principles and highlights the necessity to understand both what people do and the meanings with which such practices are imbued in order to identify ;good care' and the relationship between this and social justice. Examples of care for people with dementia are discussed by reference to core principles of an ethic of care: attentiveness, responsibility, competence, responsiveness and trust. These illustrate the potential for the development of a shared language within which different disciplines, lay carers and people with dementia can communicate about how needs could best be met in complex and difficult circumstances.     

五年制高职护生学习策略与学业成绩的相关性分析

[目的]分析五年制高职护理专业学生的学习策略与学业成绩的相关性,为策略教学干预提供依据。[方法]横断面随机调查五年制高职护理专业224名学生的学习策略状况,采集调查对象期末考试课成绩,进行统计分析。[结果]不同学业成绩等次护生学习策略水平差异有统计学意义(P<0.01),资源管理策略水平影响所有年级高职护生学业成绩,动机激发和时间管理对高职护生的学业预测效果最佳。[结论]资源管理策略是影响五年制高职护生学业成绩的主要因素,同时对低年级护生须加强专心程度、自我测试、考试策略的元认知学习策略指导,高年级护生则要关注情感策略的引导。     

Role ambiguity in nursing: undergraduate students' struggle for direction

An experience common to many undergraduate nursing students, particularly whilst on placement in the clinical area, is a sense of aimlessness, lack of direction and standard role, and an overall ambiguity about what nursing is and does. Research in the nursing literature contributes to and supports the concept of the lack of clarity of the nursing role. Whilst the discourse of nursing is diverse and covers many aspects of nursing, a number of core issues may be seen to emerge. These contribute to form a concept that may be identified as the ambiguity of nursing. This paper identifies those issues and represents this concept of role ambiguity. These issues include the concept of caring and the apparent lack of clarity over what this actually is in a nursing context.     

Barriers and facilitators of oral health care experienced by nursing home staff

Objectives to explore attitudes, perceptions, and perceived barriers to and the perceived facilitators of daily oral health care and the actual daily oral health care performances among nursing home staff.Methods A mixed methods study in 21 nursing homes was completed; a) questionnaires for nursing staff and managers; b) focus group interviews with nursing staff.Results 409 (21%) questionnaires were completed by nursing staff and 14 focus group interviews organized.Conclusions attitude was not a barrier in this study, while oral care was not performed according to guidelines. Nursing staff reported a lack of products, while toothbrushes are available. The most frequently mentioned barriers were lack of support of dental staff, oral care for clients with cognitive impairment, and a lack of education. Increasing facilitators could be; more (practical) education combined with tailored advice from internal dental staff.Where and on whom will the research have an impact?Nursing home staff, nursing home organizations/ managers and dental professionals working in nursing homes.     

Barriers to implementing an integrated care pathway for the last days of life in nursing homes

AIM: this paper explores the barriers that needed to be overcome during the process of implementing an integrated care pathway for the last days of life as a way of developing quality end-of-life care in nursing homes. METHODS: an action research methodology underpinned the study. Qualitative and quantitative data were collected in eight nursing homes before, during and after the implementation of the care pathway. FINDINGS: six main barriers were identified: a lack of knowledge of palliative care drugs and control of symptoms at the end of life; lack of preparation for approaching death; not knowing when someone is dying or understanding the dying process; lack of multidisciplinary team working in nursing homes; lack of confidence in communicating about dying; some nursing homes are not ready or able to change. These findings highlight a functional 'rehabilitative' culture that may not be so appropriate in the current context of nursing home care, and one that makes implementing an integrated care pathway for the last days of life less straightforward than in other settings. CONCLUSION: it cannot be presumed that the implementation of a care pathway for the last days of life in nursing homes is straightforward. This study suggests that an action research framework was extremely useful in highlighting and overcoming some obstacles when developing evidence-based practice. Action at both local and public policy level is required to fully address barriers that prevent quality end-of-life care in nursing homes.     

Compassion in care: a qualitative study of older people with a chronic disease and nurses

This article describes compassion as perceived within the relationship between nurses and older persons with a chronic disease. The aim of the study is to understand the benefit of compassion for nursing practice within the context of long-term care. The design of the study involves a qualitative analysis of in-depth interviews with nurses and patients in three different care-settings. Results show the nature of compassion in seven dimensions: attentiveness, listening, confronting, involvement, helping, presence and understanding. Analysis of the data also shows in what way opinions of participants relate to issues raised in a previous literature study, for example the difference between pity and compassion. The conclusion states that compassion is a valuable process which motivates patients as well as nurses to cooperate in achieving relevant outcomes of care. The discussion involves some methodological issues. For one thing, further confirmation of the dimensions found is recommended.     

Policy as an influence on public health nursing education in the Republic of Ireland

Nurses are recognizing the need to influence health care policies; this requires an understanding of the ways in which policies are made. The key players and processes which influence public policy in the Republic of Ireland and the lack of policies referring explicitly to nurses and nursing are discussed in relation to a public health nursing curriculum. The lack of specific policies on nursing has had deleterious effects on some aspects of the curriculum but has also given the planners freedom to include primary health care and nursing values. It is argued that it may be better to have few policies than inappropriate ones. The preferred solution would be for nurses to be more involved in wider policy-making, ensuring that policies reflect nursing values and concerns. An opportunity for a nursing voice to be heard and relevant policies recommended is provided by the Irish government's Commission on Nursing.