Reflecting on the psychosocial care of patients with a terminal illness

The exercise of reflecting on nursing practice and on the theories used to inform that practice can enable nurses to learn to better understand the experiences of patients facing death. By sharing patients' fears and fostering hope nurses can help them to regain a sense of control over their lives and promote feelings of hope for the time they have left.     

Addressing the need for education: curriculum development for nurses about intellectual and developmental disabilities

People with disabilities and national and international agencies are voicing their views, forcing health care providers to look at how people with disabilities are treated in the health care system and to find ways to help them achieve equal access to quality care. Education about nursing care of patients with I/DD is limited in basic nursing education programs and for nurses who are in practice. A number of developmental disabilities nursing projects are addressing this need with curriculum development that has validated the need for education and has begun testing the various methods of instruction. As the curriculum is disseminated in written or Internet-accessible formats, nurses in education and practice will be able to find resources that target a specific topic area or a set of comprehensive instructions to acquire a better understanding of the comprehensive needs of people with I/DD and better ways to provide care. There is a need for a greater integration of curriculum about nursing care of people with developmental disabilities into basic nursing education at all levels and further evaluation of the impact of this curriculum on nursing care for people with I/DD. The hope is that these efforts can improve the education of nurses and other health care providers for the direct benefit of individuals with intellectual disabilities.     

由造口治疗师为主体的延续护理对肠造口患者自我护理能力的影响

目的探讨由造口治疗师为主体的延续护理对提高永久性肠造口患者自我护理能力的效果。方法选择78例永久性肠造口患者,按照随机数字表法将患者分为观察组和对照组,每组各39例,对照组由责任护士常规进行出院指导,观察组实施由造口治疗师为主体的延续护理。患者出院3个月后,采用自我护理能力测定量表(exercise of self-care agencyscale,ESCA)对患者进行测评。结果观察组患者ESCA得分高于对照组,两组比较,差异均有统计学意义(P0.01)。结论由造口治疗师为主体的专科护理团队对永久性肠造口患者进行出院后延续护理,能使患者巩固肠造口知识和技巧,从而提高患者自我护理能力。     

Mental illness in the nursing workplace: a collective autoethnography

Many nurses are burned out, exhausted and have a high intent to leave their jobs. These factors, when experienced over a period of time, are consistent with the development of mental illness. This study takes a collective autoethnographical approach to mental illness in the nursing workplace by focusing on the stories of nurses who have experienced mental illness in clinical practice. It highlights three ways in which nursing and mental illness are connected; the nurse who is vulnerable to mental illness prior to entering the profession, the nurse who develops mental illness that is independent of her work but is nevertheless impacted by it, and the nurse who develops mental illness as a result of her work and/or role. This paper explores the hyphenated lives and bullying these nurses experience, and recommends strategies that the profession, employing organisations, and individuals can adopt to reduce nurses' progression from stress to distress and mental illness.     

Do healthier nurses make better health promotors? A review of the literature

This discussion paper draws on a review of the literature to explore factors that might promote or inhibit healthier nursing practice. The term healthier nursing practice, used here, refers to the way commitment to health promoting practices at organisational, professional and personal levels is demonstrated and achieved. Health promotion is a holistic concept that calls for the creation of empowered relationships between self, others, and the environment to improve wellness. Nurses have often struggled to achieve this within their patient encounters and even more so within their own personal and professional life experiences. Two factors were identified in the literature review that appear to significantly impact on this situation, the organisational environment within which nurses practice and their educational exposure to health promoting opportunities. There are a number of parallel processes identified that illustrate the difficulties nurses have in their experiences of working with patients and with themselves in promoting healthier lives. Action learning is advocated as an effective way for nurses to address what are sometimes perceived as being insurmountable barriers to developing health promoting opportunities for patients and the individual nurse.     

Preparing to retake the NCLEX-RN. The experience of graduates who fail

Many schools of nursing counsel and provide practice sessions to their students in initial preparation for the National Council Licensure Examination (NCLEX). What then of the graduates who fail and are now outside of the educational and often supportive environments of schools of nursing? Graduates cannot be employed to practice what they have learned, nor do schools of nursing have the programs to assist graduates who have failed. How can these graduates be enabled to succeed? The authors discuss the stories of 10 graduates who failed the examination and their preparation to retake it. Data from their study reveal important ways that nurse educators can help graduate nurses during this stressful period in their lives.     

Changes and sticking points in adult safeguarding: a discussion

The care and treatment of vulnerable adults was the subject of regular public and media concern in 2011. This article discusses the potential impact of these concerns on community nursing practice and reflects on the ways in which such concerns may be discussed in professional development activities. It alerts nurses to the importance of considering the effects on patients and carers of exposure to negative findings from inquiries and inspections. It identifies ways in which professional development opportunities can be used to update general skills in safeguarding practice. These are likely to be of growing importance to the work of community nurses in the context of an ageing society and occasional potential conflicts between patients and carers. Keeping abreast of legal frameworks will be required of nurses if they are to advise and to advocate for their patients.     

Evidence-based practice: a practical approach to implementation

Organizations often do not have processes in place to support nurses through a systematic approach for developing and evaluating nursing interventions, protocols, critical pathways, and policies that are derived from scientific evidence. The development of a framework to guide inquiry will have a positive impact on patients. This process may foster a higher level of professional engagement by nurses that may, in the long-term, help improve nurse retention and recruitment. The authors discuss a nursing evidence-based practice model and guidelines that were developed by a team of hospital and academic nurse leaders and is practical and easy to use. This model has been successfully implemented across the department of nursing as a strategic initiative. Results of the implementation have shown that staff nurses can effectively use this model with the help of knowledgeable mentors.     

Implementing a postcolonial feminist perspective in nursing research related to non-Western populations

In this article, I argue that implementing a postcolonial feminist perspective in nursing research transcends the limitations of modern cultural theories in exploring the health problems of non-Western populations. Providing nursing care in pluralist countries like Canada remains a challenge for nurses. First, nurses must reflect on their ethnic background and stereotypes that may impinge on the understanding of cultural differences. Second, dominant health ideologies that underpin nurses' everyday practice and the structural barriers that may constrain the utilization of public healthcare services by non-Western populations must be further examined. Postcolonial feminism is aimed at addressing health inequities stemming from social discriminative practices. I will draw on extant literature and data of an ongoing ethnography exploring the Haitian caregivers' ways of caring for ageing relatives at home to unveil how the larger social and cultural world has an impact on caregivers' everyday lives. Marginalized locations represent privileged sites from which health problems, intersecting with power, race, gender, and social classes, can be addressed. Postcolonial feminism provides the analytic lens to look at the impact of these factors in shaping health experiences. It also suggests redirecting nursing cultural research and practice to achieve social justice in the healthcare system.     

The challenges of caring in a technological environment: critical care nurses' experiences

Purpose. This paper presents and discusses the findings from a phenomenological study which illuminated the lived experiences of experienced critical care nurses caring within a technological environment. Background. While nursing practice is interwoven with technology, much of the literature in this area is speculative. Moreover, there is a debate as to whether and how ‘high tech’ and ‘high touch’ are reconcilable; this orientation is referred to as the optimism vs. pessimism debate. On a personal level, the motivation for this study came from the author's 13 years’ experience in the critical care area. Method. Following ethical approval, 10 experienced nurses from two cardiothoracic critical care units in Ireland participated in the study. A Heideggerian phenomenological methodology was used. Data collection consisted of unstructured interviews. A method of data analysis described by Walters was used. Findings. The findings provide research‐based evidence to illuminate further the optimistic/pessimistic debate on technology in nursing. While the study demonstrates that the debate is far from resolved, it reveals a new finding: life‐saving technology that supports the lives of critically ill patients can bring experienced nurses very close to their patients/families. The three main themes that emerged: ‘alien environment’, ‘pulling together’ and ‘sharing the journey’ were linked by a common thread of caring. Conclusion. Experienced critical care nurses are able to transcend the obtrusive nature of technology to deliver expert caring to their patients. However, the journey to proficiency in technology is very demanding and novice nurses have difficulty in caring with technology. Relevance to clinical practice. It is recommended that more emphasis be placed on supporting, assisting and educating inexperienced nurses in the critical care area and that the use of technology in nursing be given serious consideration.     

Beyond generational differences: a literature review of the impact of relational diversity on nurses' attitudes and work

wolff A.C., ratner P.A., robinson S.L., oliffe J.L. & Hall L.M. (2010) Journal of Nursing Management 18, 948–969
Beyond generational differences: a literature review of the impact of relational diversity on nurses' attitudes and work Aim Based on a review of the empirical literature, we examine the influence of selected diversity attributes on nurses’ work-related attitudes and behaviour. Background The nursing workforce has become increasingly heterogeneous in its age, educational attainment, and ethnicity/race distributions. There is considerable speculation, in the literature, that the work values of recent nursing graduates are discordant with more experienced nurses. Results A review of studies published between 1980 and 2009 in nursing, healthcare, psychology, and organizational behaviour led to the inclusion of 19 peer-reviewed research articles, from which our analyses are drawn. Key issues The findings indicate that age diversity leads to negative behaviour toward others in the workgroup (e.g. poor collegial relationships) whereas perceived work-values diversity is negatively associated with individuals’ own attitudes and behaviour toward their work as well as toward other members of their workgroup. Conclusions There is inconclusive evidence about the attributes that most significantly influence nurses’ attitudes and work; however, preliminary evidence supports the salience of work values. Implications for nursing management Irrespective of the actual diversity within workgroups, how nurses see one another can have a significant impact on members of their workgroups and their functioning. Broader conceptualizations of diversity are necessary.     

A review of the literature on the impact of renal cancer therapy on quality of life

Aim. To explore the impact of renal cancer treatment on patients’ quality of life. Background. Renal cancer accounts for 95,000 deaths worldwide and its incidence rate is rising. At present there are several therapeutic approaches to the treatment of renal cancer, ranging through surgery, immunological therapies and vaccine treatment. Each of these therapies may have a substantial effect upon patients’ quality of life. However, a systematic appraisal of the empirical evidence about treatment impact is lacking. Design. Literature review. Methods. A structured review of the empirical literature on the impact of renal cancer treatment upon quality of life was undertaken. Literature was appraised and themed according to the treatment modalities included in the study. Results. From 873 papers initially identified 52 were retrieved for detailed scrutiny resulting in a final 16 papers being included in the review. Conclusions. This review discusses the complex effect of renal cancer upon a patient’s quality of life as treatment modalities change. The need for nursing education and awareness of these issues is therefore highlighted to maximise patient care. Relevance to clinical practice. Understanding the impact of treatment for renal cancer enables nurses to empathise more significantly with patients and also act as mediators in regard to treatment choice and treatment cessation. It also enables nurses to inform and educate renal cancer patients prior to making treatment choices.     

Effectiveness of the PLISSIT model for solving the sexual problems of patients with stoma

Aims and objectives. This study was carried out to assess the effectiveness of the PLISSIT model in solving sexual problems of individuals with stoma. Background. Creating a stoma due to intestinal cancer may prolong the life expectancy of individuals. However, the problems resulting from stoma may cause significant changes in an individual’s life and adversely affect relations with family members and social and sexual life. Design. Experimental. Methods. The study consisted of individuals with stoma, living in Ankara. The sample consisted of 60 patients. The case group consisted of 30 patients living in Ankara; and the control group consisted of 30 patients living outside Ankara. In data collection, a questionnaire form, the PLISSIT model intervention plan and Golombok–Rust Inventory of Sexual Satisfaction (GRISS) were used. The individuals in the case group were paid eight home visits. During these visits, sexual problems of individuals with stoma were assessed and solutions sought under the guidance of the PLISSIT model intervention plan. Results. Increase of mean scores of Golombok–Rust Inventory of Sexual Satisfaction and subgroups before evaluating the sexual problems by the PLISSIT model and the sixth week scores which the sexual activity is anticipated to start have been observed, but after evaluating the sexual problems by using the model, the mean scores decreased. It was determined that negative effects of concerns related to sexual life; some physical and emotional features and physiological problems have been observed and difference between the groups is significant (p < 0·05). Conclusions. As a result, it can be claimed that decreasing sexual problems can be accomplished by using the PLISSIT model. Relevance to clinical practice. People with stoma can meet sexual problems. However, nurses experience some difficulties while handling sexual problems. It is thought that an intervention plan prepared within the framework of the PLISSIT model will guide nurses in solving sexual problems of individuals with stoma and providing integrated care and help individuals to express their sexual problems.     

Identity and resistance: why spiritual care needs 'enemies'

Aims. This paper explores certain key critiques of spirituality‐in‐nursing as they have been offered by people outside of the discipline. It argues that nurses have not taken seriously enough the recent criticism of the nature and role of spirituality in nursing. Not to listen to the ‘enemies’ of spirituality‐in‐nursing is to risk stagnation and a drift into obscurity. Background. The area of spirituality has become a growing field of interest for nurses and has produced a burgeoning body of research literature. Yet, whilst much has been written about the positive aspects of spirituality, nurses have offered almost no critique of the ways in which spirituality and spiritual care are understood, despite the fact that there are clearly certain key issues that require robust critique and thoughtful reflection. Almost all of the major criticisms of spirituality‐in‐nursing have come from people outside of the discipline of nursing. The paper argues that nurses need to listen carefully to the criticisms of spirituality and spiritual care offered by the ‘enemies’ of spiritual care in nursing. When listened to constructively, they highlight issues that are vital for the development and forward movement of this important area of nursing practice. Methods. Literature review and critical reflection on current critiques of spirituality in nursing practice. Conclusions. The paper concludes that nurses need to begin to develop spirituality as a specific field of enquiry with its own bodies of knowledge, methodologies, assumptions and core disciplines. Relevance to clinical practice. In listening to and taking seriously its ‘enemies’, nursing has the opportunity to establish spirituality as an important, creative and vibrant aspect of nursing practice that has the capacity to grow and respond constructively to its ‘enemies’, in ways that make whole‐person‐care a real possibility.     

Healing ourselves, healing others: first in a series

The healing role of nurses has been undervalued and undeveloped for a long time. A literature review of nurses and healing reveals the fears and frustration generations of women healers and nurses experienced as they strived to practice their art. The current nursing shortage reflects the toxicity of the nursing work environment. The satisfaction and liberation of nurses who have found ways to practice their calling also emerges, giving hope to those in the field as well as their patients. The first in a series, this literature review served as the foundation for a qualitative study entitled, "Medical-Surgical Nurses' Self-Perceptions as Healers," which will appear in the next issue of Holistic Nursing Practice.     

Talking about persons – Thinking about patients: An ethnographic study in critical care

BackgroundNursing involves caring for the ‘whole person’ and it is considered inappropriate for nurses to think or talk about patients in objectifying or dehumanising ways. Objectifying discourses can dominate within the arena of critical care, and critical care nurses can experience moral distress as they struggle to think about patients as persons. No previous study has examined the role played by ‘impersonal’ talk in the delivery of nursing care. This paper reports a study which examined the relationship between nursing practice and the way(s) in which critical care nurses think and talk about patients.ObjectivesThe study objectives were to (1) identify and characterise the ways in which critical care nurses think and talk about patients; and (2) describe patterns of nursing practice associated with these different ways of thinking.Study designAn ethnographic study was undertaken within one critical care unit in the United Kingdom. Data were collected over 8 months through 92 h of participant observation and 13 interviews. Seven critical care nurses participated in the study. Data analysis adopted the perspective of linguistic ethnography.FindingsAnalysis of these data led to the identification of seven Discourses, each of which was characterised by a particular way of talking about patients, a particular way of thinking about patients, and a particular pattern of practice. Four of these seven Discourses were of particular significance because participants characterised it as ‘impersonal’ to think and talk about patients as ‘routine work’, as a ‘body’, as ‘(un)stable’ or as a ‘medical case’. Although participants frequently offered apologies or excuses for doing so, these ‘impersonal’ ways of thinking and talking were associated with practice that was essential to delivering safe effective care.ConclusionsCritical care practice requires nurses to think and talk about patients in many different ways, yet nurses are socialised to an ideal that they should always think and talk about patients as whole persons. This means that nurses can struggle to articulate and reflect upon aspects of their practice which require them to think and talk about patients in impersonal ways. This may be an important source of distress to critical care nurses and emotional exhaustion and burnout can arise from such dissonance between ideals and the reality of practice. Nursing leaders, scholars and policy makers need to recognise and legitimise the fact that nurses must think about patients in many ways, some of which may be considered impersonal.