Sociology and nursing: Role performance in a psychiatric setting

The role of sociology in nursing continues to cast new light on many aspects of health and illness. Over the last 20 years, nursing practice has seen sociological theory become a valuable clinical tool, both in the diagnosis and prognosis of a wide range of illnesses and long‐term conditions. Nevertheless, of these, the sociological examination of mental health problems and its impact upon nursing practitioners has received little coverage, simply because, as a discipline, mental health nursing has historically been wedded to a biomedical model, one which continues to embrace psychiatry/psychology as the driving force in the diagnosis and treatment of psychopathology. Adopting a sociological approach, this paper brings to light previously unexplored insights into the way nurses interact with patients experiencing mental health problems. Drawing on social interactionist methodology, this paper considers depression and other mental health problems in relation to current psychiatric nursing practice. Specifically, the paper focuses on aspects of role performance and interpersonal care in a psychiatric setting, and the impact the individual role may have on the wider aspects of institutional and official practices. The paper concludes by making a number of recommendations/observations for nursing practice.     

Advanced practice nursing roles: development, implementation and evaluation

AIM: The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based approaches to guide their development, implementation and evaluation. BACKGROUND: Health care restructuring in many countries has led to substantial increases in the different types and number of APN roles. The extent to which these roles truly reflect advanced nursing practice is often unclear. The misuse of APN terminology, inconsistent titling and educational preparation, and misguided interpretations regarding the purpose of these roles pose barriers to realizing their full potential and impact on health. Role conflict, role overload, and variable stakeholder acceptance are frequently reported problems associated with the introduction of APN roles. DISCUSSION: Challenges associated with the introduction of APN roles suggests that greater attention to and consistent use of the terms of the terms advanced nursing practice, advancement and advanced practice nursing is required. Advanced nursing practice refers to the work or what nurses do in the role and is important for defining the specific nature and goals for introducing new APN roles. The concept of advancement further defines the multi-dimensional scope and mandate of advanced nursing practice and distinguishes differences from other types of nursing roles. Advanced practice nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place. CONCLUSIONS: Recommendations for the future introduction of APN roles can be drawn from this paper. These include the need for a collaborative, systematic and evidence-based process designed to provide data to support the need and goals for a clearly defined APN role, support a nursing orientation to advanced practice, promote full utilization of all the role domains, create environments that support role development, and provide ongoing evaluation of these roles related to predetermined goals.     

Domains of practice and Advanced Practice Nursing in Australia

A key component of workforce reform is the international growth in Advanced Practice Nursing (APN) roles. This study evaluated one APN role in Australia, the Clinical Nurse Consultant (CNC). All 56 CNCs employed in a tertiary hospital in New South Wales took part in the study. Demographic and work activity data were collected by an online questionnaire. Face‐to‐face interviews included the administration of a 50‐point tool to score the level of practice of each CNC against five domains. The domains of practice did not appear to have played a central role in the design of these CNC roles despite being defined in the industrial legislation and linked to a pay structure. There was widespread variability in the level of practice both within and between the CNC grades as well as significant differences in job content. Few CNCs managed to achieve a moderate level of practice across all five domains. The findings suggest that the distinctive features of the CNC roles as articulated in the domains of practice are often not realized in practice.     

Professional responsibility and decision‐making in the context of a disease‐focused model of nursing care: The difficulties experienced by Spanish nurses

When, in 1977, nurse education in Spain was transferred to universities a more patient‐centred, the Anglo‐American philosophy of care was introduced into a context in which nurses had traditionally prioritised their technical skills. This paper examines the characteristics of the nurse's professional role in Spain, where the model of nursing practice has historically placed them in a position akin to that of physician assistants. The study design was qualitative and used the method of analytic induction. Participants were selected by means of theoretical sampling and then underwent in‐depth interviews. The resulting material was analysed using an approach based on the principles of grounded theory. Strategies were applied to ensure the credibility, transferability, dependability and confirmability of the findings. The main conclusion is that nurses in Spain continue to work within a disease‐focused model of care, making it difficult for them to take responsibility for decision‐making.     

Developing evidence-based nursing roles: lessons learned from the health care integrator role

PURPOSE: This study examined a unique nursing role in the United States Air Force to determine if it had been well institutionalized and to identify barriers and facilitators during the implementation process. SOURCE OF INFORMATION: Individuals functioning in the role were surveyed to measure time spent on specific job-related tasks, additional duties, and positive and negative experiences. CONCLUSIONS: Eighty-seven percent of the respondents (n = 45) indicated that the role had been well implemented, although wide variation existed in tasks performed and major organizational barriers identified. Findings of this study can be used to guide the development of other evidence-based positions.     

住院患者及家属对护士角色的认知

目的 深入了解住院患者及家属对护士角色的理解和认识.方法 对12例住院患者和10名家属进行访谈,运用类属分析法对资料进行整理和分析.结果 住院患者及家属认为护士角色包含执行医嘱角色、教育者角色、心理护理角色和照顾者角色.结论 住院患者和家属对于护士角色的认知有一定的局限性,应进一步加强护患沟通,优化护理人力资源使用,努...     

So what exactly is nursing knowledge?

This paper aims to present a discussion about intrinsic nursing knowledge. The paper stems from the author's study of knowledge claims enshrined in nursing journal articles, books and conference speeches. It is argued that claims by academic nurses have largely depended on principles drawn from continental and not Analytic (British-American) philosophy. Thus, claims are credible only insofar as they defer propositional logic. This is problematic inasmuch as nursing is a practice-based activity usually carried out in medical settings. Transpersonal nursing models are particularly criticizable in respect of their unworldly character as are also concepts based on shallow usages of physics or mathematics. I argue that sensible measurements of the 'real world' are possible--without endorsing positivism--and that nursing requires little recourse to logically unsustainable claims. The paper concludes with an analysis of a recent review of nursing knowledge, which analysis indicates the circularity that attends many discussions on the topic.     

角色定位理论在护理管理中的应用

目的观察角色定位理论在护理管理中的应用效果。方法根据角色定位理论,从确定角色、设计形象、特色服务和不断调整4方面对护理人员进行培训。结果引进角色定位理论前后护理服务质量比较,均P〈0.01,差异有统计学意义。病人满意度由93.6%上升为99.3%;护理投诉由0.2‰下降为0.03‰;护理纠纷率由0.07‰下降为0.01‰,经统计学分析,P〈0.01,差异有统计学血意义。结论角色定位理论在护理管理中的应用可使护理人员转变服务观念,提升护士整体形象,提高护理服务质量。     

角色扮演法在《护理学基础》实践教学中的应用

目的探讨角色扮演法在《护理学基础》实践教学中的应用方法与效果。方法对2005～2006年04、05级2个护士班的学生在《护理学基础》教学中实施角色扮演法，并对其效果进行调查。结果在《护理学基础》教学中实施角色扮演法有利于培养学生发现问题和解决问题的能力及对知识的理解和掌握；增强学生人际沟通能力和主动学习的意识。结论采用角色扮演法进行实践教学，培养了学生的主动参与意识和团队精神。提高了对《护理学基础》实践课的兴趣。     

从护士角色的延伸谈护理教育改革

随着护理模式的转变,护士工作的对象、地点、方式都发生着变化。护士从一个单纯的护理给予,变成了集教育、服务员、宣传、管理为一身的多角色的专业技术人员。为适应护士角色的变化,护理教育应该在教育思想、教学内容、教学方法等方面进行改革,使培养出的护士在知识结构和能力方面适应角色变化,更好地为社会为病人服务。     

Clinical formulation for mental health nursing practice

There are problems for mental health nurses in using psychiatric diagnoses as outcomes of their nursing assessments and nursing diagnoses present similar issues. However, there is a need in practice to link the assessment to nursing interventions in a meaningful way. This paper proposes that the clinical formulation can be regarded as central to providing this cohesion. The formulation does not merely organize the assessment findings but is also an interpretation or explanation, made in consultation with the client, of what meaning can be attributed to the issues explored in the assessment process. Because this interpretation is dependent on both the client's and the nurse's explanatory frameworks, there are multiple ways of developing the formulation. It is also an evolving and dynamic statement of understanding. A case example is provided in the paper to illustrate how the same case can be interpreted in different ways and the implications this has for the nursing interventions provided.