The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care

Mcsherry R., pearce P., Grimwood K. & Mcsherry W. (2012) Journal of Nursing Management 20, 7–19
The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care Aim The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. Background The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. Key issues Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. Conclusions Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. Implications for nursing management The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.     

Creating conditions for good nursing by attending to the spiritual

biro a.l. (2012) Journal of Nursing Management  20, 1002–1011
Creating conditions for good nursing by attending to the spiritual Aim To note similarities, differences, and gaps in the literature on good nursing and spiritual care. Background Good nursing care is essential for meeting patient health needs. With growing recognition of the role of spirituality in health, understanding spiritual care as it relates to good nursing is important, especially as spiritual care has been recognized as the most neglected area of nursing care. Methods Nursing research, reports and discussion articles from a variety of countries were reviewed on the topics of good nursing, spiritual care and spirituality. Key issues A nurse’s spirituality and the nurse–patient relationship are integral to spiritual care and good nursing. Conclusions There are many commonalities between good nursing and spiritual care. Personal attributes of the nurse are described in similar terms in research on spiritual care and good nursing. Professional attributes common to good nursing and spiritual care are the nurse–patient relationship, assessment skills and communication skills. Implications for nursing management Good nursing through spiritual care is facilitated by personal spirituality, training in spiritual care and a culture that implements changes supportive of spiritual care. Further research is needed to address limitations in the scope of literature.     

整体护理实际效果分析与探讨

整体护理是以病人为中心的一种先进的护理模式,摒弃了功能制护理只注重治病,而不注重身心护理的弊端。但在实施整体护理工作中仍有一些影响实际效果的因素存在,如：制定的护理计划难以付诸实践;工作方法还停留在功能制护理的模式上;护理人员的自身素质还不能完全适应整体护理的需要。结合我院的实际情况对此进行分析,并提出相应改进措施：(1)以病人为中心,制定新的护理表格;(2)制定新的工作程序和有效的质量评估标准;(3)提高护理人员多方面素质,以提高整体护理的实际效果。     

Integrating health care for women diagnosed with HIV infection, substance abuse, and mental illness in Detroit, Michigan.

This article describes the evolution of Personalized Nursing, a comprehensive nursing practice model of care. Findings from several nursing research studies contributed to the development of Personalized Nursing. The model includes a practice model of the art of nursing care based on nursing theory and a specific nursing process that directs nursing care delivery. The process of care delivery includes location of hard-to-reach clients; linkage to health care providers; integration of care among providers for clients diagnosed with HIV, mental illness, and substance abuse; and strategies to promote retention in health care. Use of Personalized Nursing is designed to assist clients to improve their well-being and increase positive health-related behaviors. Personalized Nursing has been used in urban landscapes to serve multiply diagnosed clients at risk for HIV infection. The model is currently being used in a study targeting multiply diagnosed women who are lost to follow-up from medical care.     

Research in intensive care nursing

• • The results of a questionnaire study about intensive care nursing in Finland indicate that the chief problems in intensive care nursing are concerned with staff coping resources, quality development and patient experiences.
• • Questions on staff stress and coping have been researched quite extensively. Earlier studies have described intensive care nursing as highly stressful and pointed to numerous problems related to coping.
• • It is clear that intensive care nursing warrants closer attention in research.

     

What are nurses doing to patients? A review of theories of nursing past and present

• ? This paper looks critically at the nature of nursing theory from three perspectives.
• ? Firstly, it examines the current state of nursing theory with a particular focus on Patricia Benner's work. This examination concludes that nursing theory is currently beset by the problems of scientific and moral relativism and philosophical incoherence because it has abandoned a traditional realist approach to the care of patients.
• ? Secondly, the roots of this contemporary nursing position are analysed and the conclusion is reached that nursing theorists are implicitly presuming this traditional ‘common sense’ view of nursing, although their own philosophical assumptions do not support it and indeed are removing the ground from beneath it.
• ? The traditional theory underpinning the quality of the nurse's care, and hence the ethos of nursing, is rearticulated.
• ? In conclusion it is suggested that nursing needs to debate the modernist views that are now holding sway in nursing and rediscover a theory for the care of patients that holds together the personal, the pastoral, the scientific and the technological aspects of patient care.

     

Achieving Equilibrium within a Culture of Stability—Cultural Knowing in Nursing Care on Psychiatric Intensive Care Units

This article presents intensive psychiatric nurses' work and nursing care. The aim of the study was to describe expressions of cultural knowing in nursing care in psychiatric intensive care units (PICU). Spradley's ethnographic methodology was applied. Six themes emerged as frames for nursing care in psychiatric intensive care: providing surveillance, soothing, being present, trading information, maintaining security and reducing. These themes are used to strike a balance between turbulence and stability and to achieve equilibrium. As the nursing care intervenes when turbulence emerges, the PICU becomes a sanctuary that offers tranquility, peace and rest.     

A concept analysis of holistic nursing care in paediatric nursing

Holistic nursing care is widely advocated and is espoused in the philosophy of the South African Nursing Council. This concept is unclear, variously interpreted and poorly understood in paediatric nursing. This study was undertaken to examine the meaning of holistic nursing care and to develop a framework for holistic nursing care, which can be utilised in nurse education settings and in clinical nursing practice in the context of paediatric nursing. A qualitative, interpretive, explorative and contextual research design was used. An evolutionary concept analysis was undertaken to clarify the concept "holistic nursing care" in paediatric nursing in three Johannesburg hospitals. Rodgers' (1989, 2000) evolutionary method was utilised to analyse the concept. The study objectives were formulated in two phases to: --Conduct an analysis of the concept "holistic nursing care" --Obtain an emic viewpoint of holistic nursing care from paediatric nurses working in the academic hospitals. --Identify the characteristics and dimensions of "holistic nursing care" and develop a framework of holistic nursing care for paediatric nurses working in the academic hospitals. Attributes of holistic nursing care yielded two dimensions; whole person and mind-body-Spirit dimension. The decriptors of whole-person include physical, mental, emotional, spirit and spitual being. Spirituality is the predominant antecedent. Holistic nursing care is initiated by the recognition of the individual as a spiritual being with a mind-body-spirit dimension. Spirituality is an ever-present force pervading all human experience. Complimentary alternative medicine (CAM) was identified as a surrogate term. The connection of CAM with holistic nursing care is the focus of therapeutic interventions that are directed to the mind-body-spirit dimension. Therapeutic interventions are designed to meet the needs of the whole-person. Caution is advocated in the use of CAM therapies in child nursing, as CAM efficacy has not been sufficiently investigated in child health care.     

The challenge of providing palliative care in the nursing home part II: internal factors

Nursing homes are increasingly becoming the place of care and site of death for growing numbers of frail older people dying of chronic progressive illnesses. Despite this increase, empirical evidence suggests that providing palliative care in nursing homes is replete with challenges. In a previous publication, the authors examined challenges external to the nursing home that influence the provision of palliative care, and which may be beyond the nursing home's control (Wowchuk et al, 2006). This paper reviews the primary internal factors identified in the literature that affect the provision of palliative care and are, to some extent, under the nursing home's control. The internal factors include: i) lack of care provider knowledge about the principles and practices of palliative care; ii) care provider attitudes and beliefs about death and dying; iii) staffing levels and lack of available time for dying residents; iv) lack of physician support; v) lack of privacy for residents and families; vi) families' expectations regarding residents' care; vii) hospitalisation of dying residents. Suggestions for practice, education and research are provided.     

Nursing interventions in palliative care in the intensive care unit: A systematic review

ContextPatients in palliative care are found in different places where care is provided, including the intensive care environment with important role of the nursing staff.ObjectiveThe aim of this systematic review was to answer the following question: which nursing interventions are aimed to the palliative care patients who are in the intensive care unit (ICU).Data sourcesUS National Library of Medicine (PUBMED), Virtual Health Library (BVS), SciELO, The Cochrane Library (Cochrane) and Lilacs databases were used.Data extractionAfter applying inclusion and exclusion criteria in accordance with the PRISMA method, a total of 36 entries published between 2010 and 2020 were used.Data analysisThe records extracted were analyzed from a qualitative approach, so no statistical analysis was carried out.ResultsThe findings demonstrated that the interventions that focus on promoting the patient's autonomy and respect their needs on ICU involves effective communication, promoting shared decision with patient and family, individualize care for each patient including the family on the daily care and decisions, maintaining basic nursing care as hygiene and comfort and encouraging self-care, as well as the involvement of nursing palliative care specialists the care is important. Other interventions included promoting a continuing education program for the nursing staff and other professionals involved in caring for patients in palliative care at ICU.ConclusionThis review highlighted the need for specific nursing interventions aimed at palliative care patients at ICU to promote patient autonomy and the focus on patient needs, always sharing decisions with the patient and family. However, it showed that there is a need for the continuous training of the nursing staff because factors such as the nurses’ lack of technical-scientific knowledge and, concomitantly, the absence of a standardized and specific intervention model linked to a bureaucratic system, make it difficult to carry out a specialized care for this type of patient.     

Missed nursing care in Australia: Exploring the contributing factors

BackgroundNurses are increasingly ending their shifts with outstanding tasks and missing vital aspects of patient care. Research has indicated that this could have a detrimental effect on both nurse and patient outcomes. The connection between inadequate staffing levels and missed nursing care is well documented in the research. However, other contributing factors leading to missed nursing care remain uncertain. This scoping review seeks to identify the contributing factors to missed nursing care in an Australian context.AimTo determine the contributing factors to missed nursing care by registered nurses in Australian hospitals.MethodsMEDLINE, CINAHL, and PubMed were searched for primary and secondary research articles. A scoping review was conducted using the Joanna Briggs Institute methodology for scoping reviews. Data from the studies was analysed by two independent reviewers and presented with a narrative synthesis of the findings.FindingsSeventeen studies were conducted in Australia. The main contributing factors to missed nursing care were: Inadequate staffing, environmental factors, and urgent situations. Nurses’ poor insight into personal and professional accountability was also found to contribute to missed nursing care.DiscussionThis review adds an important perspective to the impact of staffing on missed nursing care due to the mandated nurse-to-patient ratios in Australia, which has not been investigated in other countries. It found that mandated nurse-to-patient ratios can lead to a reduction in missed nursing care.ConclusionFurther research is required into mandated nurse-to-patient ratios and a nurse's personal and professional accountability and missed nursing care.     

Las taxonomías enfermeras NANDA,NOC y NIC en la práctica asistencial hospitalaria

IntroductionThe use of taxonomies originally developed in contexts other than our own means that a preliminary validation is required to adjust them to our healthcare system.ObjectivesTo improve the management of nursing care in hospitalization units and to develop working systems for nursing staff with coherent and efficient records.Material and methodThe project will be performed in two phases: 1) Instruction of staff members who will act as project leaders. 2) Design and implementation of standardized care plans by discussion groups composed of 4 to 7 experts in the care of the most prevalent diseases in the units collaborating in the study.ConclusionsThe design of standardized care plans by the consensus technique and the use of nursing taxonomies are valid tools for the homogenization of nursing care and the development of the discipline of nursing.     

Retention of nurses in the primary and community care workforce after the age of 50 years: database analysis and literature review

Title.  Retention of nurses in the primary and community care workforce after theage of 50 years: database analysis and literature review.
Aim.  This paper is a report of a study conducted to explore strategies for retaining nurses and their implications for the primary and community care nursing workforce.
Background.  An ageing nursing workforce has forced the need for recruitment and retention of nurses to be an important feature of workforce planning in many countries. However, whilst there is a growing awareness of the factors that influence the retention of nurses within secondary care services, little is known about those that influence retention of nurses in primary and community care. Little is known about the age profile of such nurses or the impact of the ageing nursing workforce on individual nursing specialities in the England.
Methods.  Nursing databases were analysed to explore the impact of age on nursing specialities in primary and community care. The nurse retention literature was reviewed from 1995 to 2006.
Findings.  Workforce statistics reveal that primary and community care nurses have a higher age profile than the National Health Service nursing workforce as a whole. However, there are important gaps in the literature in relation to the factors influencing retention of older primary and community care nurses. Specific factors exist for older nurses within primary care that are unique. Implications for their retention are suggested.
Conclusion.  Particular attention needs to be paid to factors influencing retention of older nurses in primary and community care. These factors need to be incorporated into local and national policy planning and development.     

我国肺癌护理研究的知识图谱分析

目的 了解我国肺癌护理的研究热点及前沿主题，为今后开展肺癌护理研究提供参考。 方法 以“肺癌护理”为检索词，检索自中国知网建库至2022年3月7日的核心数据库文献。运用Citespace软件对文献进行可视化分析。 结果 我国肺癌护理核心文献为289篇，研究热点主要集中在①对肺癌患者化疗药物相关不良反应的护理；②肺癌患者围手术期的护理；③对肺癌患者生活质量的干预和护理。研究的前沿领域总结为四类：①研究内容为肺癌患者的化疗护理、免疫抑制剂护理、睡眠相关护理、并发症的护理、优质护理、呼吸道的护理；②研究对象为肺癌危重患者、肺癌后肺切除患者；③研究方法为横断面调查、个案护理、干预研究、方案构建；④重点应用领域为晚期肺癌患者生活质量的改善相关问题。 结论 肺癌护理涉及面广，应制定肺癌化疗患者护理团体标准，以提高晚期肺癌患者的生活质量。     

A comparison of nurse-related behaviour, philosophy of care and job satisfaction in team and primary nursing

The study compares team and primary nursing modes of organization of nursing care on three related variables, namely: nurse-related behaviour and quality of care, philosophy of care and job satisfaction for nurses. The historical dimension and evolution of modes of care, quality of care, philosophy of care and theories of job satisfaction are discussed within the context of the study. The literature and previous research studies conducted on team and primary nursing are reviewed and comparisons of the two are made. Analysis of data collected yielded results which are compared for differences and benefits between team and primary nursing. The results of the study suggest that when compared to team nursing mode of organization of care, primary nursing affords increased quality of care, a more coherent philosophy of nursing and increased job satisfaction for nurses. Methodological problems are examined and implications for policy explored.     

Management of technology and its influence on nursing care

Currently, much nursing care adheres to a specific biomedical paradigm within the positivist framework. However, sometimes nursing care cannot be adapted to numerous human or vital conditions affecting our patients, their families or the environment in which nurses work. An specific example of these nursing interventions are those applied in intensive care units (ICU) where there is a large amount of technology and nursing care is specialized. Several questions that arise are whether the above-mentioned specialization is inherent to nurse care, whether technology management forms part of nursing care, whether this care has a non-nursing origin, and what is the source of nursing knowledge. The present article aims to provide basic knowledge to distinguish the nursing care performed in the ICU within the 2 predominant paradigms in current nursing: the biomedical and the holistic paradigms. The characteristics of nursing care in both paradigms are described and an integrated vision of these 2 paradigms and of nursing care with and without the use of technology is provided.     

Usefulness,feasibility and face validity of the interRAI Palliative Care instrument according to care professionals in nursing homes: A qualitative study

BackgroundNursing homes are important locations for palliative care. High quality palliative care requires an evaluation of the different care needs of the nursing home residents. The interRAI Palliative Care instrument is a comprehensive assessment that evaluates the needs and preferences of adults receiving palliative care.ObjectivesThis study aims to evaluate the usefulness, feasibility and face validity of the interRAI Palliative Care instrument.DesignA qualitative study was conducted, based on the abductive reasoning approach.SettingFifteen nursing homes in Flanders (Belgium).ParticipantsCalls for participation were sent out by four umbrella organizations of Flemish nursing homes (Belgium) and at a national conference for nursing home staff. Nineteen care professionals (nurses, certified nursing assistants, psychologists, physiotherapists, quality coordinators and directors) of 15 nursing homes voluntarily agreed to participate in the study.MethodsDuring one year, care professionals evaluated the needs and preferences of all nursing home residents receiving palliative care by means of the interRAI Palliative Care instrument. Data on the usefulness, feasibility and face validity of the interRAI Palliative Care instrument were derived from notes, semi-structured interviews and focus groups with participating care professionals and were thematically analyzed and synthesized. Data were gathered between December 2013 and March 2015.ResultsIn general, the interRAI Palliative Care (interRAI PC instrument) is a useful instrument according to care professionals in nursing homes. However, care professionals made a series of recommendations in order to optimize the usefulness of the instrument. The interRAI PC instrument is not always feasible to complete because of organizational reasons. Furthermore, the face validity of the instrument could be improved since certain items are incomplete, lacking, redundant or too complex.ConclusionsFindings highlight the importance of adapting the content of the interRAI Palliative Care instrument for use in nursing homes. Furthermore, the use of the instrument should be integrated in the organization of daily care routines in the nursing homes. Tackling the critical remarks of care professionals will help to optimize the interRAI Palliative Care instrument and hence support palliative care of high quality in nursing homes.     

The Zebra index: one method for comparing units in terms of nursing care

levenstam a.-k. & bergbom i. (2011) Journal of Nursing Management 19, 260–268
The Zebra index: one method for comparing units in terms of nursing care Aim To describe an approach for developing a nursing index that is based on the patients’ needs of nursing care and enables nursing costs to be calculated. Background Usually staffing resources are calculated as the ratio between the number of staff and the number of occupied beds per unit. Method The index was developed from two parts of the Zebra method. The index factor per patient category of care was calculated first. The patient days per category of care was multiplied next with the index factor for the category, which gives the same value in terms of nursing care given for all the patient days. The third step was the calculation of the Zebra index (ZI). Results The ZI shows ‘the intensity of nursing care’ given. The index makes it possible to follow changes in the nursing care given over a period of time and it can also explain why two similar units with the same number of staff per patient can have a totally different workload situation. Conclusion The ZI obtains reliable information about the changing nursing situations over a period of time. Implications for nursing management The approach described can be used in different settings and is not bound to Sweden but can be looked upon as a general method. The index is useful for comparing different units and clinics in terms of nursing care and staffing.