Applying triangulation to the assessment of quality of nursing.

The claim that generic quality assessment instruments provide an objective assessment of quality of nursing care is questioned. Recent research suggests that most instruments are in need of extensive validity testing, particularly in relation to the concepts that they purport to assess. This paper outlines a research study designed to test the validity of the generic quality assessment instruments, Monitor, Senior Monitor and Qualpacs. In the absence of an independent criterion of quality against which to validate these instruments we propose a multiple triangulation research strategy in order to achieve the goals of 'confirmation' and 'completeness' within the same research design. The research incorporates approaches that purport to focus on quality of nursing care that are complementary to the generic instruments. We pay particular attention to the meanings of quality of nursing to those most closely involved and in positions of expertise--that is, nurses and patients. Comparisons between scores from the generic instruments and data generated by these complementary approaches will enable a more accurate picture of the validity of the generic instruments to emerge. The research should also increase our understanding of the meaning of quality in relation to nursing care.     

Caregiving in nursing homes. Views of licensed nurses and nursing assistants

This investigation is a qualitative study of the views held by 36 licensed nurses (25 registered nurses and 11 licensed practical nurses) and 40 nursing assistants regarding caregiving in nursing homes. Because these care providers are most directly involved in the delivery of care, their views are important as determinants of quality of care. Study findings focus on the extent to which nurses and nursing assistants agree on what contributes to good care and how they perceive the work that each does. Also reported are their perceptions regarding factors that make care delivery easy or difficult. Results suggest that nurses and nursing assistants share selected perceptions about the division of labor in the nursing home. Also evident are areas of less agreement among these members of different status sets. A discussion of how these caregivers can work together as effective team members is presented.     

Respondent‐generated quality of life measures: useful tools for nursing or more fool’s gold?

Within health services research the quest for better ways of measuring quality of life as an outcome variable continues apace. Recent developments in this area have seen increasing attempts to incorporate individually generated content and values into quality of life measures while retaining valid psychometric measurement properties. Following a brief overview of current conceptual approaches to quality of life measurement, this paper reviews the development of two leading Respondent-generated instruments: the Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and the Patient Generated Index (PGI). The relative strengths and weaknesses of these tools and their potential applications for nursing and nursing research are appraised. These measures both address and manifest a number of fundamental conceptual and methodological problems, and represent an innovative attempt to square the quantitative--qualitative circle. As such they offer challenging opportunities for nursing at a number of levels. Their elicitation and quantification of individual components of quality of life offer opportunities for nurses to plan care and goal set with patients. As yet, however, the validity, reliability, responsiveness and practicality of these instruments as outcome measures are debatable and require further testing. Nurse researchers could contribute to this process by using Respondent-generated measures as an adjunct to existing, established tools in outcome studies. Moreover, nursing is well placed to investigate and debate the validity of the conceptual assumptions underpinning these new instruments.     

Ethical challenges in the care of older people and risk of being burned out among male nurses

Aim. The aim of this study was to illuminate the meaning of being in ethically difficult situations when caring for older people, as experienced by male nurses. Background. Nurses and physicians are frequently faced with ethical issues and challenges in their work with older people in hospitals. Male nurses are a minority group in the nursing profession, thus it is important to listen to their lived experiences of the ethical challenges they are faced with in their work. Method. The study is part of a comprehensive investigation into the narratives of female and male physicians and nurses, concerning their experiences of being in ethically difficult care situations in the care of older people. Five male nurses working at gerontology wards at a university hospital in Norway participated in the study. A phenomenological hermeneutical method was applied. Results. The narratives revealed that the nurses were focusing on good nursing, emphasizing what meeting the patient entails. They highlighted what they perceived as barriers to good nursing. A third theme was ethical challenges, which lead to emotional and moral strain and a fear of becoming burned out. Conclusions. Continuous stress, little degree of autonomy and high expectations of oneself are causing the male nurses much moral strain. These factors place them at risk of being burned out. The nurses emphasized that burn out can be counteracted by clinical supervision. Relevance to clinical practice. It is suggested that the male nurses feeling of doing an important and rewarding job may be essential for protection against becoming burned out and why they can endure being in ethically difficult care situations. Other institutional support structures like ethics education and ethics rounds are suggested to reduce the level of moral strain.     

Quality assurance of nursing web sites: development and implications of the ALEU method

This article presents a study that evaluated the physical accessibility, readability, and usability of Spanish nursing Web sites and discusses the quality assurance issues raised, which are relevant to the wider nursing community. The Internet is recognized as an important source of health information for both nurses and the general public. Although it makes health-related information universally available, the wide variation in the overall quality of health Web sites is problematic. This raises many questions for the nursing profession: about what constitutes a good-quality Web site, about the nature of the information that nurses are finding and using to support their professional education, research, and clinical practice, and about the impact that Internet information ultimately has on health interactions and nursing care. The process of completing this small study showed that it is possible to usefully assess dimensions of Web site quality and suggested that it may be feasible to develop tools to help nurses evaluate national and international nursing Web sites. More research is needed to understand how nurses use the Internet to support their everyday professional practices, but the development and application of international Web site quality assurance tools may be important for maintaining professional nursing standards in the Internet age.     

Mentorship: a key to retention and recruitment.

Currently there is renewed interest in the selection of nursing as a career. As nursing education programs graduate more new nurses, the challenge is passed to the clinical agencies to provide an environment in which these novice nurses can flourish and remain engaged in providing quality nursing care. Mentorship programs are essential strategies to retain them in clinical practice as they begin their evolution as professional nurses.     

Responding to responsive behaviours: A clinical placement workshop for nursing students

As our population ages, it is important for the next generation of nurses to feel prepared to care for people with dementia. Communicating with a person with dementia who is experiencing responsive behaviours can be challenging. Furthermore, new graduate nurses may experience a phenomenon called reality shock when they do not feel prepared for the reality of nursing. Reality shock can lead to nurse turnover and poor retention rates. This study evaluated a workshop for first-year practical nursing students focusing on applying a person-centered communication framework when caring for people with dementia experiencing responsive behaviours. The results suggested that training students during their clinical placements on dementia communication may be effective in helping prepare nurses to care for this patient population.     

Nursing needs of acutely ill older people

BACKGROUND: Investigating older acutely ill hospitalized patients' nursing needs and quality of care is paramount, given the growing pressure on nurses to provide increasingly intensive levels of care to a growing older population while at the same time working with reduced staffing levels. AIMS: The aims of this study were to determine: (1) important aspects of nursing care as perceived by older patients, their family member/carer who observed care during hospitalization, and nurses; (2) satisfaction levels of patients, family/carers and nurses on nursing care received; and (3) mismatches between nursing care priorities and satisfaction with nursing care. METHODS: Two hundred and thirty-two acutely ill patients aged over 65 years, 99 carers/family members and 90 nurses completed the Caregiving Activities Survey, which measures importance of and satisfaction with various aspects of nursing care. Qualitative data, which qualified responses to survey items, were also obtained from participants. RESULTS: Patients, carers and nurses perceived that carrying out doctors' orders was the most important aspect of nursing care, followed by physical care, psychosocial care and discharge planning. Nurses and carers rated physical care, psychosocial care and discharge planning more highly than patients. Physical care was rated highly by patients in terms of importance, but rated moderately in terms of satisfaction. Carers' and patients' ratings of satisfaction with physical care were lower than nurses' ratings of opportunities to provide it. The importance of discharge planning was rated highly by nurses but all groups were only moderately satisfied with this aspect of care. STUDY LIMITATIONS: The findings do not apply to acutely ill older patients with confusion, mental illness or more than early stage dementia. CONCLUSIONS: Patients, nurses and family/carers were generally in agreement about the relative importance of particular aspects of nursing care. Nurses may need to communicate more effectively with older patients and their family carers about the particular roles they will play during the patient's hospital episode, the expectations they have of patients in the process of healing and recovery, and the reasons for the actions they take in aiding this process. The findings are useful in making nurses more aware of the expectations and needs of older hospital patients and their carers. They provide evidence for developing both new models of nursing care for this patient group, and nursing education programmes.     

A brief description of the methods of economic appraisal and the valuation of health states

The interest of nurses in methods of economic evaluation appears limited to cost-effectiveness analysis, with an apparent unawareness of other methods of economic appraisal and the types of efficiency they consider The main methods of economic appraisal are discussed, and linked to different kinds of efficiency Methods for the valuation of health states, an important accompaniment to the methods of economic appraisal, are briefly described along with some of the practical difficulties If skilled nursing care—alone or with other disciplines—changes health status then the measurement and valuation of such states may be used to inform resource allocation decisions involving nursing It could be argued that the main impact of nursing is on quality of life, and if so this suggests cost utility analysis, and not cost-effectiveness analysis, as the natural level of appraisal for nursing The use of these methods in research, and participation in their future development, are both suggested as valid targets for nurses to aim for     

Skills mix in Australian nursing homes

This study investigated the relationships between skills mix, resident dependency and the quality of care and life of residents in a stratified random sample of 200 non-government homes in four Australian states. The study considered various measures of skills mix including the qualifications of the staff (staffing mix), the exposure of staff to in-service training and the leadership style of the director of nursing. The only relationships found between staffing mix (that is, the proportion of qualified and unqualified staff) related to the positive effect of therapy staff on the variety of experience of residents. Significant relationships between a number of other components of skills mix and the outcomes of care were found. Specifically, exposure to in-service training of staff and the leadership style of the director of nursing affected quality of care. State enrolled nurses were found to be significantly less satisfied with their work than registered nurses or untrained nurse assistants. Further studies are suggested in these areas and a review of skills mix in relation to them is recommended.     

对护士家属关于护士从事临床基础护理认知的调查

目的了解护士家属对护士从事临床基础护理的认知情况,分析其影响因素并探讨干预对策。方法选取462名临床一线护士家属为研究对象,采用自设问卷调查家属对护士从事基础护理的认知情况,分析其影响因素。结果在对基础护理重要性认知各条目中,462名家属的最高了解率不足20％,仅有13．85％的家属了解基础护理是护士的重要职责,97．83％的家属不了解《住院患者基础护理服务项目》内容;93．07％的家属不赞同自己的亲人从事基础护理工作;95％以上的家属希望护士从事静脉输液、氧气吸入等治疗性护理操作,而100％的家属不希望护士做协助排泄与处理大小便的工作;男性家属对护士从事基础护理的认知程度得分（45．60±7．32）分高于女性家属（39．85±5．10）分,差异具有统计学意义（t=9．80,P〈0．01）;与护士不同关系的家属对护士从事基础护理的认知程度,差异具有统计学意义（F=7．82,P〈0．01）。结论护士家属对护士从事临床基础护理认知偏颇,态度消极。应加大宣传教育力度与广度,重视家庭对护士的教育与影响作用,关心护士家属的教育与修养,提高护士待遇,促使家属以积极的态度从正面去影响护士的职业态度,激发护士对从事基础护理的热情。     

Can nurses contribute to better end-of-life care?

In this article I will argue that futile medical and nursing care is not only inefficacious but that it may be harmful to the patient and also to health professionals, who may be diminished both as clinicians and as persons if they are not able to give appropriate care to dying patients and their families. I discuss futile care in intensive care units because the opportunities and the temptation to provide futile care in these settings is higher than, for instance, in internal medicine and nursing home care. I argue, following two nurse ethicists, Carol Taylor and Colleen Scanlon, that, even if nurses are not the initiators of futile care, they play an important role in its prevention because of their clinical expertise. They can do this by convening 'patient care conferences' when they recognize the need to bring together the various parties that have conflicting expectations. These conferences would then result in appropriate palliative care. The nurses providing this care would demonstrate their understanding of the process whereby living becomes the process of dying.     

Nurses' perceptions of parental involvement in hospital care

Parental involvement is an essential element of quality of care for children in hospital. However, there is often confusion in role perception between parents and nurses which may be affected by nurses' attitudes, their ability to provide information, their communication and interpersonal skills and willingness to relinquish control. AIM: This study examined nurses' perceptions of parental involvement and communication with parents of children in hospital and explored differences in perceptions of recent graduate nurses and more experienced nurses. METHOD: Two focus groups were carried out at a university paediatric hospital in Sweden, one with experienced paediatric nurses (n = 7) and one with recent nursing graduates (n = 6). FINDINGS: Analysis of the discussions identified five themes: clarifying roles, information, work environment, support and clinical competence. These nurses confirmed the belief that involving parents in the child's care is an important part of nursing in paediatric care and suggested that the nurses should play the role of being the communicator with the parents. CONCLUSION: Nurses need to be aware of the impact their communication has on parents and help them to clarify their role as parents in hospital.     

上海市临床护理人才结构的现状分析

目的 调查上海市临床护理人才的结构现状,旨在寻找目前临床护理人才结构的不良因素,并提出应对措施.方法 对上海市34所医院不同层次的护理人员发放5种调查问卷.结果 上海市临床护理人员仍以中专、初级职称为主,分别占总体的75.56%、87.51%;年龄以20～30 岁最多,占总体的52.34%;男性护理人员仅占0.18%;7.1%的护理人员对职业满意;5.55%的护理人员认为该职业的社会地位较高.结论 建议上海市相关政府部门采取相应的对策:优化护理人才配置结构,提升护理队伍整体素质;改善护理人员职业态度,稳定发展上海护理队伍.     

Finding professional fulfilment in caring for older people

This paper describes the findings of a phenomenological study of professional fulfilment in nurses who care for older people. The author sought to uncover what brings career satisfaction to nurses who care for older people and subsequently what motivates these caregivers to continue to care. The findings have implications for clinical nurses who may see reflections of their own approaches to care in the narratives presented. The examples of care reported may inspire nurses who work with older adults by affirming their own nursing interventions.     

Nurse perceptions of the impact of nursing care on patient outcomes: an exploratory study

The aim of this research was to explore registered nurses' perceptions of the relationship between nursing care and clinical outcomes. We conducted an exploratory survey using a convenience sample of nurses attending a 3 day nursing practice conference. Nurses with postgraduate degrees and those with a clinical main work role had higher mean scores for the impact of nursing care on patient outcomes. Nurses reported that pressure ulcers and surgical wound infection were most affected by nursing care. Falls, medication errors, pain management, and patient education were some of the clinical indicators suggested as additional appropriate measures of nursing care. Our results suggest that nurses' educational background and work role may influence their perception of the impact of nursing care on patient outcomes.     

Methodological issues in the development and use of instruments to assess patient nutritional status or the level of risk of nutritional compromise

This paper presents the results of an appraisal of the evidence for the effectiveness of methods of nutritional assessment currently in use by nurses and from this develops concepts which may be applied to many areas of nursing practice. The paper first shows how the approach to nutritional assessment by nurses has changed over time, producing the present search for methods which are relatively quick and easy to use. It then describes the limited nature of the evidence of effectiveness of these methods and considers the reasons for this situation. It suggests that the difficulty of validation is an important factor and describes the three most common approaches to validation, showing how problems arise from lack of clarity in the definition of terms and the assumption of a simple relationship between the level of risk of nutritional compromise and actual nutritional status. In conclusion, it is suggested that these difficulties illustrate principles applicable to many areas of nursing care, and a definition of 'segments' of care processes, each with well-defined purposes and outcome measures, is proposed. Such an approach will help to demonstrate the complexity and value of nursing activity.