Capabilities that experienced nurses expect of new nurses in pediatric wards: A research study using Q methodology

BackgroundTo meet the expected levels of nursing care in pediatric wards, it is necessary to identify and strengthen the skills, job satisfaction levels, and personality characteristics required of nurses.ObjectivesThis study aimed to identify the types of capabilities experienced nurses expect of new nurses in order to perform professional nursing in pediatric wards.DesignQ methodology was used to explore the subjective perceptions of experienced nurses regarding new nurses.SettingThe research was conducted in the pediatric wards of university hospitals.ParticipantsA convenience sample of 31 experienced nurses was recruited for the P-set from the pediatric wards of university hospitals.MethodsData were collected from the 31 participants from August to December 2019.ResultsBased on the study results, the abilities experienced nurses expect new nurses to possess were grouped into three categories: 1) “honesty and effort type,” 2) “problem-solving type,” and 3) “relationship-oriented type.”ConclusionsThis study provides basic data for constructing a program that is advantageous for clinical practice and for the education of pediatric nurses. The results also suggest that increasing the effectiveness of collaboration, understanding, and communication between newly graduated and experienced nurses may improve the level of professional care provided in pediatric wards.     

Competencies of genetic nursing practise in Japan: A comparison between basic and advanced levels

Aim: The purpose of this study was to identify the competencies of genetic nursing practise required for general and genetic nurses. Methods: We conducted a four‐stage survey using a Delphi process. We conducted an interview with 27 nurses who were involved in genetics‐related care and extracted 89 items in seven categories. In the second survey, we mailed a questionnaire to 20 experts in genetics. In the third and fourth surveys, we asked 491 health‐care providers, including nurses and physicians, who were involved in genetics‐related care and agreed to participate in the study at 113 institutions in 40 prefectures. The respondents were asked to choose one of three options in each of 89 items: “A: General nurse’s role”, “B: Genetic nurse’s role”, and “C: Not appropriate as the nurse’s role”. The data were collected from August 2000 to March 2001. There were 295 final subjects, and the response rate was 60%. Results: The competencies required for general nurses were identified as “living support”, “psychological support”, and “identification of the client’s wishes”, while those required for genetic nurses were “provision and exchange of accurate genetic information”, “referral to and collaboration with other organisations”, and “client support to understand disease.” Conclusions: These results suggest a direction for genetic nursing curricula. It is our challenge to incorporate genetics into the education programming.     

Nurses’ experiences of prehospital care encounters with children in pain

BackgroundPain relief in children is a complex issue, partly an ethical dilemma and due to a lack of nursing competence. There are few studies regarding prehospital care encounters with children in pain.AimThe aim of this study was to describe nurses’ experiences in prehospital care encounters with children in pain and the specific related challenges.MethodThis study has a qualitative design. Eighteen Swedish nurses participated in three focus group interviews analysed using qualitative content analysis.FindingsThe findings consist of a theme, “A challenge to shift focus and adjust to the child”, and three categories describing prehospital care encounters with children in pain: “Being receptive and focusing on care,” “Developing a trusting relationship,” and “Providing professional nursing care.” Caring for children in pain was stressful for the nurses. The nurses described how they had to shift focus and used different methods to build trust, such as playfulness, making eye contact, attracting curiosity, and using the parents to create trust. The also had to adjust to the child regarding dosages and materials.ConclusionNurses has to be practically, mentally, and theoretically prepared to care for children with prehospital pain. It is essential to evaluate the administration of adequate pain relief to children, and more evidence-based knowledge is necessary concerning the different modes of administering pain-relieving drugs to prehospital children.     

The use of physical restraints as a safety measure in the care of older people in four rehabilitation wards: findings from an exploratory study.

We investigated the prevalence and type of physical restraint used with older persons on four rehabilitation wards in Northern Ireland. A longitudinal observational approach was used. One hundred and two patients were observed on four occasions over a three-day period. Most of the patients (68%) were subjected to some form of physical restraint, side-rails being the most commonly observed method. Those who were restrained were dependent on nursing care to meet their needs and received more drugs than those whose mobility was not restricted. No association was found between restraint use and nursing staffing levels, nor was there any association with the incidence of falls. Nurses rationalised their use of restraint as being linked to wandering and patient protection in cases of confusional type behaviours. An association was found between stroke and the maintenance of positional support through the use of restraints (side-rails and screw-on tabletops). Approximately, one-third of those restrained had this noted in their care plans, with concomitant evidence of patient/family involvement in the restraining decision.     

家庭医生服务模式下社区护士工作现状调查

目的了解深圳市家庭医生服务模式下社区护士的工作现状。方法采用自制调查问卷,对深圳市24个社区健康服务中心共186名社区护士进行调查。结果家庭医生服务模式下,深圳市社区护士目前最常做的工作主要有:基本医疗服务(81.3%)、健康管理(76.1%)、计划免疫(75.8%)、儿童保健(75.0%)、老年人保健(74.5%)、慢性病管理(72.3%)、健康教育(71.7%)以及计划生育指导(68.0%),而传染病管理(56.7%)、精神卫生保健(56.6%)、残疾人管理(56.3%)等工作开展相对较少。结论深圳市社区护士的工作内容既有基础医疗服务,又有公共卫生服务,已逐步向社区"六位一体"的功能扩展,但还需针对工作中开展不足的项目逐步完善。     

Restraint use in elder care: decision making among registered nurses

? This study aimed to illuminate nurses’ reasons for using physical restraint in nursing practice, and in addition, to explore the relationship between nurses’ attitudes and decisions regarding physical restraint use. ? To provide data about nurses’ reasoning when deciding whether or not to use restraints, 30 registered nurses working in two nursing homes were asked to read a written clinical vignette describing a fall‐prone person with dementia who refused to be physically restrained. The association between the decision made and the nurses’ attitudes toward restraint use was measured by Perceptions of Restraint Use Questionnaire (PRUQ). ? Twenty‐one nurses would at first disregard the patient’s wish and use the restraint in the given situation while nine would not. When new relevant facts were provided all nurses except two were ready to change their decision. A significant relationship between nurses’ decisions and their attitudes toward restraint use was also found. ? The results showed that, although nurses endeavour to decide what they consider to be in the patient’s best interests, this ambition is affected by a variety of variables, especially in relation to the working conditions and the nurses’ willingness to take the risk when not restraining the patient.     

Nurses' feelings and thoughts about using physical restraints on hospitalized older patients

Aim. To explore nurses’ feelings and thoughts about physically restraining older hospitalized patients. Background. The use of physical restraints is still highly prevalent in hospitals; furthermore, older patients are most likely to be so restrained. Studies in acute care settings have focused mainly on nurses’ knowledge, attitudes, or practice concerning physical restraints, on physical restraint reduction programmes, on nurses’ perceptions about the use of physical restraints, or on elderly patients’ experiences with physical restraints. To the best of our knowledge no studies have been conducted on hospital nurses’ feelings and thoughts about the use of physical restraints in Taiwan. Design and methods. A qualitative approach was used to understand this phenomenon. Semi‐structured interviews were carried out, from August 2002 to March 2003, with 12 nurses working in three hospitals. The interviews were audiotaped and transcribed verbatim; content analysis was used to analyse the data. Results. Nurses reported a variety of emotional responses regarding the use of physical restraints, including sadness, guilt, conflicts, retribution, absence of feelings, security, and pity for the restrained older people. Rationalization, sharing with colleagues, and compensating behaviours were ways that nurses used to manage their negative feelings. Conclusions. Most nurses had negative feelings towards the use of physical restraints. Among these nurses there was a struggle between patients’ autonomy and the practice of care. However, other nurses said they had ‘no feelings’ or ‘feeling of security’ while using physical restraints. Relevance to clinical practice. The findings of this study may contribute to filling the gaps in nursing knowledge, to improving protocols for physical restraint use in hospitals, and may also assist nurse managers to create a supportive practice environment. It is recommended that in‐service training programmes should cover misconceptions regarding physical restraint use, ethical issues and how to cope with feelings while using physical restraints.     

The use of physical restraint in institutional care of older people in Finland: nurses’ individual,communal and alternative modes of action

Aims and objectives. The aim of the study was to map nursing staff’s individual, communal and alternative modes of action in situations where they used physical restraint of older people in Finland. Background. The use of physical restraint in institutional care of older people involves modes of action that are linked to the personalities and modes of operation of individual nurses or to communal modes of operation mutually agreed on in the workplace. Nurse’s individual modes of operation are linked to consideration towards older people when using physical restraint. Communal modes of operation include joint discussion among nurses, decision‐making and written guidelines concerning the use of physical restraint. Design. A quantitative survey. Methods. The data were collected from nurses (n = 1148) working in healthcare centre wards, municipal and private nursing homes in Finland using a structured questionnaire (response rate 78%). Results. Older nurses and those with the longest working experience were most active in using individual modes of operation in situations where physical restraint was applied. Nurses’ participation in continuing education in care of older people increased the use of both individual and alternative modes of action. The alternative modes of action were one that understands the older person and one that focuses on negotiation. The use of physical restraint was often discussed in the workplace during information sessions or during work, but only 33% had written guidelines on the use of physical restraint. Conclusions. Education can be used to increase nurses’ ability to use alternative modes of action and thus decrease the use of physical restraint in institutional care of older people. Nursing management has a key role in making sure that units caring for older people receive written guidelines on the use of physical restraint. Relevance to clinical practice. Locums especially need more education to avoid the use of physical restraint.     

Interactions between nurses during handovers in elderly care

This paper explores the role of nursing interaction within the context of handovers and seeks to identify the clinical discourses used by registered nurses, student nurses and care assistants in acute elderly care wards, to determine their influence on the delivery of patient care. The study design involved an ethnographic approach to data collection which involved: observations of formal nursing end of shift reports (23 handovers) and informal interactions between nurses (146 hours); interviews (n = 34) with registered nurses, student nurses and care assistants; and analysis of written nursing records. A grounded theory analysis was undertaken. Data were collected from five acute elderly care wards at a district general hospital in the south of England. Results from this empirical study indicate that handovers were formulaic, partial, cryptic, given at high speed, used abbreviations and jargon, required socialized knowledge to interpret, prioritized biomedical accounts and emphasized physical aspects of care. Patients' resuscitation status was highly salient to all grades of nurse. Doing 'paperwork' was accorded less status and priority than patient care, and was regarded as excessively time consuming. Despite this, there was evidence of repetition in nursing documents. Moreover, the delivery of clinical nursing appeared to be guided by personal records rather than formal records.     

Spiritual needs during COVID 19 pandemic in the perceptions of Spanish emergency critical care health professionals

ObjectivesTo investigate the perceptions and attitudes of health professionals working in emergency services and critical care units in Spain about spiritual care provided during the COVID-19 pandemic.MethodsA qualitative investigation was carried out using in-depth interviews.SettingEmergency and emergency and ICU health professionals from different regions of Spain.FindingsThe sample consisted of 47 nursing and one nursing assistant. The qualitative analysis yielded four main themes that reflect the following categories: “the experience with spirituality in clinical practice”; “resources and barriers to provide spiritual care”; “the COVID pandemic and spiritual care” and “training in spiritual care”. In addition, two subdeliveries were also obtained: “ethical dilemma” and “rituals of death”.ConclusionsThe majority of emergency and critical care nurses believe spiritual care is important to their clinical practice, but there are still several barriers to address patients’ spiritual needs. During the COVID-19 pandemic in Spain, professionals felt that spiritual beliefs have emerged as important needs of patients and the restrictions imposed by the pandemic made health professionals more exposed to ethical dilemmas and end-of-life religious issues. The general impression of health professionals is that more training and resources are needed on this topic.Implications for clinical practiceHealth professionals in emergency intensive care must provide nursing care that meets the spiritual needs of their patients to improve care in crisis situations such as the one suffered by the COVID-19 pandemic. For this, emergency services professionals must work and participate in the development of measures to overcome certain barriers present in emergency services, such as lack of time, lack of training and misconceptions that make it difficult to approach emergency services these needs.     

The nurse apprentice and fundamental bedside care: An historical perspective

This historical study aims to explain how the transition from student nurse service to fully qualified “graduate nurse” service in the United States in the 20th century affected assumptions about fundamental patient care in hospital wards and provide historical context for current apprenticeship programs. Through analysis of documents from 1920 when student nurse service, a nurse apprentice model, was the norm to 1960 when the nurse apprentice model was waning in favor of registered nurse service, this study found that the replacement of student nurses with registered nurses led to weakened standardization of fundamental bedside care and the introduction of large numbers of unlicensed nursing assistants. While student nurses could perform all the functions of fully qualified graduate nurses, nursing assistants could not, resulting in a separation of fundamental nursing care from the professional nurse role and changes in assumptions and attitudes toward fundamental care. These changes had a negative effect on fundamental nursing care. New apprenticeship programs provide opportunities for improvement.     

Nursing care process for releasing psychiatric inpatients from long‐term seclusion in Japan: Modified grounded theory approach

Based on a modified grounded theory approach, in this study, we sought to elucidate the nursing care process used to guide psychiatric inpatients in long‐term seclusion towards release from seclusion. Participant observations and interviews were conducted with a total of 18 nurses from three long‐term psychiatric wards at two institutions from September 2011 to November 2012, to collect data on the nursing care they provided for psychiatric patients in long‐term seclusion. Consequently, four categories and 15 concepts were extracted. The nurses viewed “a mature therapeutic environment that utilizes flexible apportionment of care” as the foundation (i.e. the core category) in guiding psychiatric inpatients towards release from long‐term seclusion. The results revealed a care structure in which nurses in such a treatment environment provided care by flexible apportionment of three types of care: care aimed at avoiding mental and physical exhaustion, standardized care that does not confer a disadvantage to patients, and immediately responding to prevent problematic behaviors.     

Workplace aggression as cause and effect: Emergency nurses’ experiences of working fatigued

IntroductionEmergency nursing requires acute attention to detail to provide safe and effective care to potentially unstable or critically ill patients; this requirement may be significantly impaired by physical and mental fatigue. There is a lack of evidence regarding the effects of fatigue caused by factors other than a sleep deficit (e.g., emotional exhaustion). Fatigue affects nurses’ ability to work safely in the emergency care setting and potentially impacts their health and quality of life outside of work.MethodsThis was the qualitative arm of a mixed methods study; we used a qualitative exploratory design with focus group data from a sample of 16 emergency nurses. Themes were identified using an inductive approach to content analysis.Results/discussionThe following themes were identified: “It’s a weight on your back;” “Competitive nursing;” “It’s never enough;” “You have to get away;” and “Engagement as a solution.”ConclusionsOur participants reported high levels of fatigue, which compromised patient care, had a negative effect on their personal lives, and created a toxic unit environment. They reported lateral violence as both the cause and effect of mental and emotional fatigue, suggesting that unit culture affects nurses and the patients they care for.     

分级管理模式病房和普通病房护士工作满意度对照分析

目的:探讨分级管理模式病房与普通病房护士工作满意度水平及影响因素。方法:采用MuellerMccloskey满意度量表(MMSS)对三级甲等医院3个模式病房护士和3个普通病房护士发放调查问卷,数据采用t检验进行统计学分析。结果:分级管理模式病房的护士总体满意度与普通病房有显著差异,在自主性和胜任感方面有高度显著性差异,其中,模式病房与普通病房执行护士的满意度差异尤为显著。降低了陪床率(包括护工的使用率)。结论:分级管理模式明确了护理专业性定位,体现出护士工作的知识性、技术性。因此,有效应用护理人力资源管理的方法,能够确保病人生活质量及护士对病人病情的及时观察和护理,提高整体护理质量。     

Qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards

This study tested the theoretical proposition that qualified nurses lack adequate knowledge related to oral health, resulting in inadequate oral care of patients on medical wards The research was undertaken in a local district general hospital during January 1995 The project aimed to look at local practices of qualified nurses related to oral care of patients hospitalized in medical wards Extent of knowledge and current practice of care was examined using a questionnaire Open and closed style questions were used The sample comprised nurses on one elderly care ward and three general medical wards and the sample size was 34 The results revealed gaps in knowledge of oral care procedures In particular, a lack of assessment and documentation was highlighted However, the nurses indicated a high level of interest at updating themselves in this area of nursing The limitations of this study are discussed     

Physical restraints practice in adult intensive care units in Egypt

Physical restraints are commonly used in intensive care units to reduce the risk of injury and ensure patient safety. However, there is still controversy regarding the practice of physical restraints in such units. The purpose of this study was to investigate the practices of physical restraints among critical care nurses in El‐Mansoura City, Egypt. The study involved a convenience sample of 275 critically ill adult patients, and 153 nurses. Data were collected from 11 intensive care units using a “physical restraint observation form” and a “structured questionnaire.” The results revealed that physical restraint was commonly used to ensure patient safety. Assessment of physical restraint was mainly restricted to peripheral circulation. The most commonly reported physically restrained site complications included: redness, bruising, swelling, and edema. The results illustrated a lack of documentation on physical restraint and a lack of education of patients and their families about the rationale of physical restraint usage. The study shed light on the need for standard guidelines and policies for physical restraint practices in Egyptian intensive care units.     

Nurses in municipal care of the elderly act as pharmacovigilant intermediaries: a qualitative study of medication management

Objective: To explore registered nurses’ experience of medication management in municipal care of the elderly in Sweden, with a focus on their pharmacovigilant activities. Design: A qualitative approach using focus-group discussions was chosen in order to provide in-depth information. Data were analysed by qualitative content analysis. Setting: Five focus groups in five different long-term care settings in two regions in Sweden. Subject: A total of 21 registered nurses (RNs), four men and 17 women, aged 27–65 years, with 4–34 years of nursing experience. Results: The findings reveal that RNs in municipal long-term care settings can be regarded as “vigilant intermediaries” in the patients’ drug treatments. They continuously control the work of staff and physicians and mediate between them, and also compensate for existing shortcomings, both organizational and in the work of health care professionals. RNs depend on other health care professionals to be able to monitor drug treatments and ensure medication safety. They assume expanded responsibilities, sometimes exceeding their formal competence, and try to cover for deficiencies in competence, experience, accessibility, and responsibility-taking. Conclusion: The RNs play a central but also complex role as “vigilant intermediaries” in the medication monitoring process, including the issue of responsibility. Improving RNs’ possibility to monitor their patients’ drug treatments would enable them to prevent adverse drug events in their daily practice. New strategies are justified to facilitate RNs’ pharmacovigilant activities.

• Key points

• This study contributes to the understanding of registered nurses’ (RNs’) role in medication management in municipal care of the elderly (i.e. detecting, assessing, and preventing adverse drug events or any drug-related problems).

  • RNs can be considered to be “vigilant intermediaries” in elderly patients’ drug treatments, working at a distance from staff, physicians, and patients.

  • RNs occasionally take on responsibilities that exceed their formal competence, with the patients’ best interests in mind.

  • In order to prevent adverse drug events in municipal care of the elderly, new strategies are justified to facilitate RNs’ pharmacovigilant activities.