Cohesion among nurses: a comparison of bedside vs. charge nurses' perceptions in Australian hospitals

AIM: This study examines the extent to which hospital nurses view their working environment in a positive sense, working as a cohesive group. BACKGROUND: Despite the fact that nursing in Australia is now considered a profession, it has been claimed that nurses are an oppressed group who use horizontal violence, bullying and aggression in their interactions with one and other. METHODS: After ethical approval, a random sample of 666 nurses working directly with patients and all 333 critical care nurses employed in three large tertiary Australian hospitals were invited to participate in the study in the late 1990s. A mailed survey examined the perceptions of interaction nurses had with each other. The hypothesis, that level of employment (either Level I bedside nurses or Level II/III clinical leaders) and area of work (either critical care or noncritical care) would influence perceptions of cohesion, as measured by the cohesion amongst nurses scale (CANS) was tested. RESULTS: In total 555 (56%) surveys were returned. Of these, 413 were returned by Level I and 142 by Level II/III nurses. Of this sample, 189 were critical care and 355 noncritical care nurses. There was no difference between Level I and II/III nurses in mean CANS scores. It is interesting to note that the item rated most positively was "nurses on the units worked well together", however, the item rated least positive was "staff can be really bitchy towards each other" for both Level I and II/III nurses. There was no difference in CANS scores between critical care and noncritical care nurses. CONCLUSIONS: Nurses working in Australian hospitals perceived themselves to be moderately cohesive but, as would be expected in other work settings, some negative perceptions existed.     

Preventing increased intracranial pressure: nursing care can make the difference

Recent studies show that critical care nurses are instrumental in reducing increased intracranial pressure in patients after pathologic neurologic events. The nursing literature addresses the absence of adequate nursing diagnoses to document the scope of critical care nursing practice and the impact of nursing care on the patient's ultimate outcome. In this article several basic pathophysiologic responses to increased intracranial pressure are reviewed and a comprehensive list of nursing interventions is presented to be used by nurses caring for the patient with this potentially catastrophic illness. Two new nursing diagnoses are proposed: (1) alteration in intracranial pressure: increased: potential, and (2) alteration in intracranial pressure: increased: actual. Use of the diagnoses will aid in the critical care nurse's documentation of nursing's unique contribution to the complex care of these patients.     

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.     

Factors Associated With Nursing Diagnosis Utilization in Canada

PURPOSE. To investigate factors associated with nursing diagnosis utilization.
METHODS. A retrospective chart audit was conducted on four hospital units over a 5-month period and linked to the nurses (N = 65) who participated in a survey on attitudes toward nursing diagnosis.
FINDINGS. Computer-generated nursing care plans resulted in the greatest frequency of nursing diagnosis documentation. Nurses who did not document nursing diagnoses, and nurses employed in hospitals without nursing diagnosis implementation programs, had more positive attitudes toward the value of nursing diagnosis in practice compared with nurses who documented nursing diagnoses and nurses employed in hospitals with implementation programs.
CONCLUSIONS. Nurses have a greater tendency to document nursing diagnoses when institutions have formal educational programs and computer-generated care plans.     

Standardized Nursing Diagnoses in an Electronic Health Record: Nursing Survey Results

PURPOSE. A survey was conducted to obtain feedback from registered nurses as end‐users of standardized nursing terminology for care planning in an electronic health record. Revisions to the care plan terminology were completed as part of an evidence‐based project by nurses at one facility. METHODS. The survey was conducted pre‐, post‐, and 2‐year post‐implementation to obtain feedback from the acute care registered nurses (RNs). FINDINGS. Nurses reported a more positive agreement with the changes at 6 months compared with baseline, which generally was found to be sustained in the 2‐year survey. Overall, the standardized terminology provided the nurses greater ease in their selection of nursing diagnoses and interventions in planning patient care, yet their reported satisfaction did not change. The survey identified several problematic areas related to nurses and care planning. Nurses reported less agreement with the statement about the care plans offering them the ability to determine the status of their patient's nursing care needs. They noted less agreement with statements of the care plan offering information on assessment of patient outcomes of nursing care. CONCLUSIONS. The patient plan of care in the electronic record is expected to offer nurses the ability to communicate the needs of the patient and assess outcomes of care. The survey findings indicate weaknesses warranting further exploration to identify changes needed to improve care planning documentation.     

Consensus‐Validation Study Identifies Relevant Nursing Diagnoses,Nursing Interventions,and Health Outcomes for People with Traumatic Brain Injuries

A consensus‐validation study used action research methods to identify relevant nursing diagnoses, nursing interventions, and patient outcomes for a population of adults with traumatic brain injury (TBI) in long‐term care. In meetings totaling 159 hours to reach 100% consensus through group discussions, the three classifications of NANDA International's (NANDA‐I's) approved nursing diagnoses, the Nursing Interventions Classification (NIC), and the Nursing Outcomes Classification (NOC) were used as the basis for three nurses experienced in working with adults with TBI to select the elements of nursing care. Among almost 200 NANDA‐I nursing diagnoses, 29 were identified as relevant for comprehensive nursing care of this population. Each nursing diagnosis was associated with 3–11 of the more than 500 NIC interventions and 1–13 of more than 300 NOC outcomes. The nurses became aware of the complexity and the need for critical thinking. The findings were used to refine the facility's nursing standards of care, which were to be combined with the interdisciplinary plan of care and included in future electronic health records.     

Critical clinical competencies in undergraduate psychiatric-mental health nursing

Clinical competencies in nursing education provide the foundation for the development of competencies in nursing practice. Literature pertaining to clinical competencies in psychiatric-mental health nursing is extremely sparse. The purpose of this study was to explore nurses' perceptions of undergraduate students' critical clinical competencies. A purposive sample of 18 nurses with experience in psychiatric care and nursing education completed a 198-item survey, which included eight criterion-referenced critical clinical competencies. The results, in which 80% of items were rated strongly agree or agree, have implications for nursing education, practice, and research. The results support the use of the items in the instrument as a pedagogical tool, as a guide in assessing and evaluating students' clinical performance, and as a guide for novice faculty and practitioners. Further research about critical clinical competencies in psychiatric-mental health nursing is needed.     

Content Validation of Impaired Skin Integrity and Urinary Incontinence in the Home Health Setting

The purpose of this study was to examine content validity of two nursing diagnoses in the home health setting: impaired skin integrity and altered urinary elimination: total incontinence. Eighty-two home health nurses rated the importance of each of the defining characteristics for the two nursing diagnoses. Diagnostic content validity scores (DCV) were calculated for each defining characteristic for both diagnoses using the method described by Fehring (1986). Four characteristics for each diagnosis had DCV scores greater than .75, indicating characteristics were critical indicators for the diagnosis. Erythema, denuded skin, disruptions of dermal and epidermal tissue, and lesions were critical indicators for impaired skin integrity. Lack of awareness of incontinence, constant flow of urine, lack of awareness of bladder cues to void, and incontinence refractory to other treatments were critical indicators for alteration in urinary elimination: total incontinence.     

Survey of the degree to which critical care nurses are performing current procedural terminology-coded services.

PURPOSE: To identify the degree to which current procedural terminology-coded services are provided by critical care nurses. Current procedural terminology codes are used by government and private insurers for reimbursement for office, home, hospital, nursing home and emergency department services. METHOD: Out of 100 randomly selected registered nurses invited to participate in this national survey, 43 completed the survey questionnaire. The majority of respondents were 18 to 40 years old, had a bachelor's degree, had practiced nursing between 5 and 10 years, and were employed as staff or charge nurses in an intensive care or emergency room setting. RESULTS: More than 70% of the group were found to perform 28 codes. The codes performed by the greatest number (42) were blood or blood component transfusion and cardiopulmonary resuscitation. One-way analysis of variance applied to the amount of supervision the nurses received while performing the codes and the educational level of the nurses revealed a significant difference between the groups. Post hoc analysis of all possible group comparisons showed that diploma-prepared nurses reported significantly more supervision than nurses having a bachelor's or master's degree. CONCLUSION: This exploratory study indicates that critical care nurses frequently perform selected codes with little or no supervision by a physician.     

Competence of newly-graduated nurses--a comparison of the perceptions of qualified nurses and students

AIM: This paper reports a study that compares opinions of final year nursing students, rating their own competence, with the opinions of experienced nurses on the competence of newly-graduated nurses. BACKGROUND: The transition of nursing preparation into higher education is regarded as positive, although it has led to differences in opinion about the competence of newly-graduated nurses and their readiness to enter the nursing profession. There are studies showing that newly-graduated nurses perceive themselves as holistically focused, professional practitioners, while other nurses are concerned that newly-graduated nurses do not have necessary skills. METHODS: A convenience sample of 106 nursing students in the final week of their course and 136 nurses who had experience of supervising nursing students completed a questionnaire. The data were collected in 2002. RESULTS: Own competence, in the form of ability to perform nursing care, was rated by nursing students to be good or strongly developed in most of the investigated areas of nursing care. Experienced nurses also estimated newly-graduated nurses' competence to be good or strongly developed, although to a lesser extent. Nurses qualified within the previous 5 years rated newly-graduated nurses' competence to be higher in comparison with those with less recent education. CONCLUSIONS: Further studies are needed to broaden our understanding of why some areas of nursing care, such as ethical awareness, were rated very highly, while others, like informing and teaching of co-workers and planning and prioritizing interventions had the lowest rating.     

Discrepant attitudes about teamwork among critical care nurses and physicians

OBJECTIVE: To measure and compare critical care physicians' and nurses' attitudes about teamwork. DESIGN: Cross-sectional surveys. SETTING: Eight nonsurgical intensive care units in two teaching and four nonteaching hospitals in the Houston, TX, metropolitan area. SUBJECTS: Physicians and nurses who worked in the intensive care units. MEASUREMENTS AND MAIN RESULTS: Three hundred twenty subjects (90 physicians and 230 nurses) responded to the survey. The response rate was 58% (40% for physicians and 71% for nurses). Only 33% of nurses rated the quality of collaboration and communication with the physicians as high or very high. In contrast, 73% of physicians rated collaboration and communication with nurses as high or very high. By using factor analysis, we developed a seven-item teamwork scale. Multivariate analysis of variance of the items yielded an omnibus ( [7, 163] = 8.37; p <.001), indicating that physicians and nurses perceive their teamwork climate differently. Analysis of individual items revealed that relative to physicians, nurses reported that it is difficult to speak up, disagreements are not appropriately resolved, more input into decision making is needed, and nurse input is not well received. CONCLUSIONS: Critical care physicians and nurses have discrepant attitudes about the teamwork they experience with each other. As evidenced by individual item content, this discrepancy includes suboptimal conflict resolution and interpersonal communication skills. These findings may be the result of the differences in status/authority, responsibilities, gender, training, and nursing and physician cultures.     

Nursing practice environment,quality of care,and morale of hospital nurses in Japan

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse‐reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross‐sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.     

Classification of nursing interventions for care of the integument

The Classification of Nursing Interventions research team at The University of Iowa, College of Nursing is building a taxonomy of nursing interventions that will include all of the direct care treatment activities that nurses perform on behalf of patients. This report describes the study in which 12 nursing interventions and their associated activities for care of the integument were extracted from a large database and validated through a two-round Delphi survey. Using an adaptation of Fehring's model for determining diagnostic content validity of nursing diagnoses, a definition, critical activities, and supporting activities were developed for each of the following interventions: Bathing, Bedrest Care, Hair Care, Nail Care, Oral Health Maintenance, Oral Health Promotion, Oral Health Restoration, Positioning, Pressure Management, Skin Care--Topical Treatments, Skin Surveillance, and Wound Care. Further research is needed to validate supporting activities and to continue classifying interventions and activities that nurses use in treating impaired skin integrity (potential and actual) and altered oral mucous membrane integrity (potential and actual).