Mental Health and Harassment in the Workplace

Harassment in the workplace has become all too common in today’s society. Acts of uncivil behavior and bullying create stressful and difficult working environments. Individuals or groups are targeted without legitimate cause, thus creating feelings of stress, fear, anger, and anxiety that can affect mental health. Fear of speaking up owing to retaliation allows the uncivil behavior to continue. Emergency nurses should take action to stop the behavior and may need to seek professional help for mental health care.     

Health care transition in congenital heart disease: the providers' view point

Unfortunately, despite recommendations for educational training of ACHD health care providers and the goal to create regional ACHD centers, current needs still far outweigh appropriate available services. From a practical standpoint, we will need to work from our current models of health care delivery, which vary because of geographic and institutional issues and the availability of appropriate resources, toward the ideal goal of regional ACHD centers. Successful transition of adolescents and adults with CHD requires collaboration and planning between the pediatric health care team and the ACHD health care team. Good communication and an atmosphere of mutual respect are essential. All members of the ACHD health care team need to be committed to improving the process of transition for the adolescent and adult with CHD. The advanced practice nurse (CNS or ARNP) from both the pediatric program and the adult program are often key players in this process. As ACHD health care providers, we must work toward decreasing barriers to care and become organized advocates for our patients. Ultimately, our goal is not only to provide a smooth transition from one model of care to another, it is to create a health care delivery system that will maximize the lifelong potential and function of adults with congenital heart disease.     

Palliative care in a coronary care unit: a qualitative study of physicians' and nurses' perceptions

Background. Earlier research has shown that physicians and nurses are motivated to provide good palliative care, but several factors prevail that prevent the best care for dying patients. To provide good palliative care it is vital that the relationship between nurses and physicians is one based on trust, respect and sound communication. However, in settings such as a coronary care unit, disagreement sometimes occurs between different professional groups regarding care of dying patients. Aim and objectives. The aim of this study was to describe and understand physicians’ and nurses’ perceptions on their working relationship with one another and on palliative care in a coronary care unit setting. Design. Using a convenience sample, professional caregivers were interviewed at their work in a coronary care unit in Sweden. Methods. Data collection and analysis were done concurrently using a qualitative approach. Results. From the interviews, a specific pattern of concepts was identified. The concepts were associated with a dignified death, prerequisites for providing good palliative care and obstacles that prevented such care. Conclusions. Caregivers who work in a coronary care unit are highly motivated to provide the best possible care and to ensure a dignified death for their patients. Nevertheless, they sometimes fail in their intentions because of several obstacles that prevent good quality care from being fully realized. Relevance to clinical practice. To improve practice, more attention should be paid to increasing dying patients’ well‐being and participation in care, improving strategic decision‐making processes, offering support to patients and their relatives, and improving communication and interaction among caregivers working in a coronary care unit. Caregivers will be able to support patients and relatives better if there are good working relations in the work team and through better communication among the various professional caregivers.     

Evaluation of interprofessional relational coordination and patients’ perception of care in outpatient oncology teams

ABSTRACT

This pilot study was designed to measure teamwork and the relationship of teamwork to patient perceptions of care among 63 members of 12 oncology teams at a Cancer Centre in the Midwest. Lack of teamwork in cancer care can result in serious clinical errors, fragmentation of care, and poor quality of care. Many oncology team members, highly skilled in clinical care, are not trained to work effectively as members of a care team. The research team administered the Relational Coordination survey to core oncology team members—medical oncologists, nurse coordinators, and clinical secretaries—to measure seven dimensions of team skills (four relating to communication [frequency, timeliness, accuracy, and problem solving] and three relating to relationship [shared goals, shared knowledge, and mutual respect]) averaged to create a Relational Coordination Index. The results indicated that among the team member roles, nurse coordinator relational coordination indices were the strongest and most positively correlated with patient perception of care. Statistically significant correlations were intra-nurse coordinator relational coordination indices and two patient perception of care factors (information and education and patient’s preferences). All other nurse coordinator intra-role as well as inter-role correlations were also positively correlated, although not statistically significant.     

Pathway leadership: a mature framework for teams

Shared Governance has been a successful organizational design for Central Baptist Hospital. We are addressing critical issues that impact our success, with involvement and facilitation of the employees who make up the organization. It will continue to change as our environment and system evolve. The movement from a traditional organizational structure and culture to one of embracing shared decision making gives leaders today an additional stressor. It is difficult to critically analyze your organization when you are faced daily with the external pressures of health care competition and the internal daily pressures of operations. It takes extra effort and introspection to recognize that you and your management team must undertake new and different behaviors to lead your organization into the next millennium. One thing is clear: If you do not create an environment that is flexible and able to accommodate change, your competitor will!     

Managing intensive care units: Make LOVE,not war!

Objective

Describe a program set up in a French intensive care unit (ICU) aimed at improving communication inside the team and communication information given to patients and their relatives; explain how those actions can improve communication inside the ICU and ultimately why it could improve patient's outcome.

Design and Methods

Position paper.

Intervention

Progressive implementation of multifaceted quality improvement program.

Results

The program Leadership, Ownership, Values, and Evaluation (LOVE) was developed over 10 years. It was usually well accepted by the members of the team, patients, and relatives, in particular the 24-hour visiting program that was prospectively evaluated. Information and decisions were shared with the patients or more often with the relatives, who became for some of them really “part of the team.” Additional actions such as participation to some of the simplest cares by the families are under investigation. A prospective evaluation of such programs, although difficult to perform, remains probably necessary.

Conclusion

Quality of life within the ICU is based on many factors including a strong and positive leadership, an absolute respect of individuals, and a rigorous evaluation of quality of care, which could influence heavily the quality of life in the ICU for patients, relatives, and health care professionals and facilitate team work. Whether this could really influence outcome remains to be demonstrated.     

Back to Basics: Positioning the Patient

Positioning the surgical patient requires special attention from the entire surgical team because anesthetized or sedated patients are not able to reposition themselves when needed to relieve discomfort or alert team members of the need for repositioning. Perioperative nurses must pay attention to positioning details and the possibility of injury at all times during the patient’s procedure. This includes assessing the patient’s circulatory, respiratory, integumentary, musculoskeletal, and neurological structures to help ensure that the patient is properly positioned and safe from injury. Working as a member of the surgical team, the perioperative RN is key to speaking up when positioning issues need to be addressed and helping to minimize the risk of injury to the patient. This “Back to Basics” article discusses positioning the patient in the prone position.     

Intraoperative monitoring technician: a new member of the surgical team

As surgery needs have increased, the traditional surgical team has expanded to include personnel from radiology and perfusion services. A new surgical team member, the intraoperative monitoring technician, is needed to perform intraoperative monitoring during procedures that carry a higher risk of central and peripheral nerve injury. Including the intraoperative monitoring technician on the surgical team can create challenges, including surgical delays and anesthesia care considerations. When the surgical team members, including the surgeon, anesthesia care provider, and circulating nurse, understand and facilitate this new staff member's responsibilities, the technician is able to perform monitoring functions that promote the smooth flow of the surgical procedure and positive patient outcomes.     

Troubled units: creating change

Your unit may be in trouble. Are conversations among team members authentic or do real conversations happen in the hallways after the meeting? Are staff afraid of voicing their disagreements for fear of being labeled, while other team members complacently agree to a consensus, then go off and work from their own agenda? Some units have fallen into the habit of disrespectful communication and uncaring behaviors toward team members. The impact this has on staff, units, and organizations can be deleterious. More importantly, these behaviors impact the quality of patient care a unit is able to provide. Fostering teamwork must be a top priority for leaders. In a healthy team, differences and conflict exist, but they are acknowledged and dealt with openly. Creating change in a troubled unit is not a fast fix, but rather needs a well-devised plan. This article describes how leaders can seek out appropriate resources, develop strategies, and intervene to create a healthy, professional work environment.     

Eliminating lateral violence in the ambulatory setting: one center's strategies

Lateral violence (eg, disruptive, disparaging, or uncivil behavior inflicted by one peer on another) creates an unpleasant work environment that can have harmful effects on individual nurses, team members, patients, and the bottom line of the health care organization. Educating nurses about the most common forms of lateral violence and strategies for handling inappropriate behavior can be the first step toward eliminating this behavior. Effective nursing leaders develop and maintain a “zero-tolerance” culture that includes clear and concise behavioral expectations and consequences for employees who exhibit unprofessional behavior. Use of a code of conduct, open communication, and quick resolution of issues that arise are strategies that one ambulatory surgery center has used to successfully combat lateral violence in the workplace.     

Nurses' perceptions of success in self-management support: An exploratory qualitative study

Nurses play an important role in supporting patients in self-managing their chronic conditions. However, it is uncertain how nurses define their success and what might create feelings of disillusionment. This exploratory qualitative study sought to understand the origin, meanings, and processes underlying nurses' feelings of success in supporting patients to self-manage their life with a chronic illness. Semi-structured interviews were held with 16 nurses who were purposively sampled. Data were iteratively collected and analyzed (November 2017–September 2018). The origin and meaning of nurses' feelings of success in supporting patients in self-management converged around the intertwining of “maintaining and promoting health” as a primary goal in chronic care, while an “intrapersonal conflict” arises. Patients maintaining physical health by optimal medical management boost nurses' feelings of success, whereas patients dealing with sub-optimally provoke “an intrapersonal conflict”. When nurses observe unhealthy patient behavior, this is difficult to accept as it conflicts with their normative ideas of good care and health. Nurses' perception of success is refined by three interconnected processes, namely “keeping on track”, “considering own role,” and “protecting self”. Nurses experienced and processed success differently depending on whether they interacted with patients from a more directive approach or an attuning approach. This study highlighted the fact that nurses expect compliance from patients, and thereby often feel empty-handed. By adopting a broader perspective of what successful patient behavior is, nurses might be able to provide a more comprehensive meaning to their own success regarding the care of patients living with a chronic illness.     

Avoiding restraints in patients with dementia: understanding, prevention, and management are the keys

Older adults with dementia are at higher risk than other patients for being placed in restraints, despite numerous negative physical and psychological outcomes associated with their use. Many nurses continue to believe that restraints are necessary to control behavioral symptoms and prevent falls or the disruption of life-sustaining therapies in patients with dementia. Reducing the use of restraints depends on interpreting patient behavior to identify unmet needs; regular assessment for changes in mental or physical status; individualized care focused on communication, consistency, surveillance, and appropriate environments; and a flexible team approach based on dialogue among staff members and respect for patients' needs and rights. For a free online video demonstrating the use of the practice guide, go to: (http://links.lww.com/A231).     

The effect of a teamwork intervention on staff perception of teamwork and patient care on a medical surgical unit

As a result of the ever‐changing health care environment and patient complexity, it is difficult for nursing teams to provide safe quality care and complete all tasks, also known as missed nursing care. Missed nursing care is a global health care issue and defined as any aspect of care missed in part, in whole, or delayed. Teamwork has been found to not only positively impact the performance of a team, but also patient outcomes. Teamwork strategies are needed to help nursing teams provide the best care to their patients. Inpatient nursing teams work in complex environments and handle many patient issues making it difficult to find one workable solution. The purpose of this study was to determine if a teamwork intervention would impact the nursing team’s perception of teamwork and missed nursing care on a medical surgical unit. In this quasi‐experimental design study there was an increase in both teamwork and missed nursing care pretest and posttest survey scores. Despite the increase not being statistically significant, based on the staff feedback, the intervention shows promise to be a viable teamwork strategy. Future studies should include larger sample size and longer duration.     

"Trading bickering for teamwork"

Bickering is an unpleasant phenomena found wherever groups of people congregate. Bickering on a health care team such as that found in the nurse department can create a negative environment and poor morale. The nurse manager should take responsibility for action which can deter this type of behavior and should visibly lead the staff to more productive interactions.     

Implementing Non-violent Resistance,a Method to Cope with Aggression in Child and Adolescent Residential Care: Exploration of Staff Members Experiences

Staff members in residential care for youth are frequently confronted with aggressive behaviour, which has adverse effects on their stress levels and work satisfaction. This paper describes a qualitative evaluation to find out how staff members benefit from Non-violent Resistance (NVR), a method to create an aggression mitigating residential climate. Staff members were positive about NVR and reported feeling more relaxed. Most valued aspects of this method were the focus on being a team, delayed response and giving up the illusion of control. However, training and the intention to use NVR isn't enough, high quality implementation and maintenance are crucial.     

“Just working in a team was a great experience…” – Student perspectives on the learning experiences of an interprofessional education program

Interprofessional education (IPE) programs aim to improve collaboration between health- and social-care professionals and to optimize clinical outcomes. Such programs are complex to design, and evaluation of effectiveness is difficult. Combining qualitative and quantitative data may provide greater understanding of how a program affects participants and what aspects are influential on attitudes and behavior. This qualitative study used semi-structured interviews and interpretative phenomenological analysis to explore undergraduate student perspectives on what attributes of a 4-week IPE program they considered contributed to a successful learning experience. Due to the fact that the students were not formally assessed, the realistic context of the activities and the quality of the facilitators created an environment where the students felt empowered to interact freely without fear of reproach. Learning the roles of other professions and their contribution to a healthcare team broadened the students' perspectives on healthcare and increased their sense of self-worth and pride in their professions. In addition, being able to identify the relevance of the learning experience to their future practice motivated the students. This information can be used to create optimal learning environments for facilitating the development of successful future healthcare teams.     

Caring with difficulty: Brazilian nurses' experiences of gynaecological surgery care

da Costa Vargens OM, Berterö CM. International Journal of Nursing Practice 2010; 16 : 159–165
Caring with difficulty: Brazilian nurses' experiences of gynaecological surgery care This study was made by a qualitative approach based on symbolic interactionism and grounded theory. The subject was defined as what mutilation means for nurses who take care of women submitted to gynaecological surgery. The aim was to identify the interaction relationship of nurses as female with the phenomenon of mutilation in gynaecological surgeries and how it affects their relationship with female patients in this situation. Data were obtained by interviews with 16 nurses who work in gynaecology units. The findings present two core categories: speaking as a professional and speaking as female. When they spoke as professional nurses they defined mutilation technically. As females they verbalized their conflict and difficulty in working with mutilation and redefined it as being the loss of something very important for themselves. We conclude that female nurses when confronting female surgery distances themselves behind the professional nurse and performs nursing care as a daily routine. It means that these nurses live a personal conflict that influences directly on how they supply care. They care for but do not care about, the ethos of biomedicine leads carers on to a technical path from which it is difficult to get off.     

Designing an interprofessional training program for shared decision making

For implementation of patient-centered treatment in interprofessional health care units, such as rehabilitation teams, external participation (interaction between patient and health care professionals) and internal participation (communication, coordination and cooperation in the interprofessional team) need to be considered. The aim of this study is to identify the preferences of patients and health care professionals concerning internal and external participation in rehabilitation clinics, in order to develop an interprofessional shared decision-making (SDM) training program for health care professionals to enhance both types of participation. Therefore, a cross-sectional mixed-methods study was implemented in four rehabilitation clinics. The study consists of two parts: focus groups with patients and a survey of experts (senior health care professionals from medicine, psychotherapy, physical therapy and nursing). More time, more respect from the health care professionals and the desire for more participation in decision-making processes were mentioned most frequently by patients (n = 36) in the focus groups. The health care professionals (n = 32) saw most deficits in internal participation, e.g. management of feedback, talking with difficult team members and moderate conflict discussion. The results of both assessments have been used to develop an interprofessional SDM training program for implementing internal and external participation in interprofessional teams in medical rehabilitation.