The courage to care: nurses facing the moral extreme

Many European nurses were caught up in the horror of what happened to Jewish people during the Second World War, trapped in ghettoes and concentration camps. The advanced age of the nurses, however, decreases the number of firsthand accounts available. This paper reports on the experience of nurses in one camp, Westerbork, in the Netherlands, highlighting their work and relating their stories. Facing extreme suffering, they chose to care about others when it would have been easier to distance themselves. Until recently, historians' interest in medical practices in the transit and concentration camps has centered on medicine and sanitation. Utilisation of a nursing framework allows new material that has previously been overlooked to provide a broader understanding of the context of health care within the camps. Westerbork is an ideal camp to study since it had a genuine hospital with medicines and equipment available and a number of wards that provided care. Data collection was through oral interviews, archival documents and literature. The conclusion is that these nurses provide powerful role models of care that are as significant today as they were then.     

Promoting practical clinical management learning: the current situation about Information and Communications Technology capability development in student nurses

AIM: This paper is about work-based learning in information management for student nurses. It seeks, through a literature review, to make a case for and promote Information and Communications Technology capability development in student nurses within their clinical environment. BACKGROUND: The profession of nursing, like many other jobs, is facing the increasing usage of information technology in day-to-day operations. Admission and discharges of patients have been held on computer databases since at least the 1980s. With the new Labour Government in 1997, increasing focus was placed on the effectiveness of the National Health Service and using computers as one way to assist in achieving greater effectiveness. Nurse education therefore needed to reflect this need and support trainee nurses to acquire skills in Information and Communications Technology. This paper is part of an ongoing professional doctorate inquiry into Information and Communications Technology capability development in student nurses. EVALUATION: A literature search was conducted on teaching information and technology skills via Cumulative Index to Nursing and Allied Health Literature. Most of the available studies were neither based on the UK nor were they about student nurses. As there is a dearth of published work in this specific area, relevant, related and tangential literature was reviewed. KEY ISSUES: It is argued that current practice and published work on Information and Communications Technology capability development by student nurses hardly exists. The literature confirmed that success in this area requires sound change management, an understanding of National Health Service culture, and effective people leadership skills. Nurse educators and managers need to pay more attention to understand how organizations work, particularly organizations where student nurses carry out their work. CONCLUSIONS: As the search revealed a significant gap in the literature in this area, a practical conceptual framework to fully analyse, develop and implement sustained Information and Communications Technology capability in student nurses is proposed.     

Exploring the effect of sound and music on health in hospital settings: A narrative review

BackgroundSound in hospital space has traditionally been considered in negative terms as both intrusive and unwanted, and based mainly on sound levels. However, sound level is only one aspect of the soundscape. There is strong evidence that exploring the positive aspect of sound in a hospital context can evoke positive feelings in both patients and nurses. Music psychology studies have also shown that music intervention in health care can have a positive effect on patient's emotions and recuperating processes. In this way, hospital spaces have the potential to reduce anxiety and stress, and make patients feel comfortable and secure. This paper describes a review of the literature exploring sound perception and its effect on health care.Data sources and review methodsThis review sorted the literature and main issues into themes concerning sound in health care spaces; sound, stress and health; positive soundscape; psychological perspective of music and emotion; music as a complementary medicine for improving health care; contradicting arguments concerning the use of music in health care; and implications for clinical practice. Using Web of Science, PubMed, Scopus, ProQuest Central, MEDLINE, and Google, a literature search on sound levels, sound sources and the impression of a soundscape was conducted. The review focused on the role and use of music on health care in clinical environments. In addition, other pertinent related materials in shaping the understanding of the field were retrieved, scanned and added into this review.ResultsThe result indicated that not all noises give a negative impression within healthcare soundscapes. Listening to soothing music was shown to reduce stress, blood pressure and post-operative trauma when compared to silence. Much of the sound conveys meaningful information that is positive for both patients and nurses, in terms of soft wind, bird twitter, and ocean sounds.ConclusionsMusic perception was demonstrated to bring about positive change in patient-reported outcomes such as eliciting positive emotion, and decreasing the levels of stressful conditions. Whilst sound holds both negative and positive aspects of the hospital ecosystem and may be stressful, it also possesses a soothing quality that induces positive feelings in patients. Conceptualizing the nature of sound in the hospital context as a soundscape, rather than merely noise can permit a subtler and socially useful understanding of the role of sound and music in the hospital setting, thereby creating a means for improving the hospital experience for patients and nurses.     

Cross-infection and the use and decontamination of placebo inhalers

Historically, inhaled placebos have been provided by pharmaceutical companies and have been widely used by nurses both in primary and secondary care to teach respiratory patients how to use prescribed inhaled therapy. Over recent years, the author of this article has had concerns about the potential risk of cross-infection as a result of reusing placebos with disposable mouthpieces. This concern has been heightened by the lack of verbal and written guidance from the pharmaceutical companies that provide these placebos. There are no recognized protocols or guidelines on the most effective cleaning methods that would minimize or prevent cross-infection. The cleaning of large volume spacers, which are used to enhance a patient's inhaler technique, are particularly problematic as it is not possible to use a disposable mouthpiece with this device. In response to this problem, a cross-sectional, multicentre, regional audit was designed to identify the decontamination process adopted by nurses working in the fields of respiratory care and infection control. The audit outcome confirmed that nurses were using a number of different cleaning methods, with no sound evidence base to support their chosen methods of decontamination. This is an issue that requires further investigation and clarification if nurses are to continue assessing patients' techniques with inhaled devices.     

Does breastfeeding reduce risk for breast cancer? A short lesson in evidence-based practice

Breastfeeding has been promoted by some healthcare providers and childbirth educators as having a protective effect against breast cancer. In an effort to use the best evidence available for teaching patients, this article was written to summarize the literature about the protective effects of breastfeeding. The studies examined consistently demonstrated a mild to moderate protective effect from breast cancer; however, many variables including age, medication use, smoking, and family history affected the risk. While nurses and childbirth educators are in key positions to disseminate information to women concerning their choice in feeding their newborns and how that choice affects their health in general, it is essential that the information they impart is based on evidence.     

Intramuscular injections: a review of best practice for mental health nurses

This paper reviews practice in the area of intramuscular (IM) injection administration, an everyday activity for many nurses in clinical practice. The authors address administration of neuroleptic depot drugs within the adult mental health environment and examine the evidence base for this practice. A historical overview of injection practices and use of the dorsogluteal site is given, followed by more contemporary evidence on the benefits of using the ventrogluteal, deltoid and thigh sites. The authors point out that despite being a very commonplace nursing activity, there is a dearth of research-based guidelines for nurses in this area. A quantity of published papers and nursing texts on injection sites and techniques were assessed to evaluate their quality and relevance and their overall benefit to improving clinical practice. Much of the literature available was in the form of opinion pieces without a sound research/evidence base. There appears, however, to be enough consensual evidence to form an evidence-based clinical guideline for the administration of IM injections. The review of the available evidence, albeit at times contradictory, is presented along with a discussion of the implications for nurses.     

The Challenge of Accountability in Nursing

The authors examine the literature on accountability in nursing and analyze the following questions: What is meant by accountability in nursing? To whom are nurses accountable? For what should nurses be held accountable? Finally, the implications of accountability for the nursing profession are explored. In order for nursing to grow and develop as a profession based on sound theoretical foundations, nurses need to examine what it means to be truly accountable. The authors point out that accountability is a complex issue that requires nurses to examine their practice relative to the needs of healthcare consumers, their relationships with other healthcare professionals, and the increasingly critical role of nursing in the healthcare system.     

Introduction of novice oncology nurses to end-of-life care

Dying patients and their families often have unique physical, psychosocial, social, and spiritual needs that require special ized end-of-life (EOL) skills. EOL preparation of nurses has been inconsistent. Novice nurses need guidance to develop the knowledge, clinical skills, and coping strategies to provide high-quality and compassionate EOL care. Inadequate preparation for providing EOL care can lead to anxiety, stress, and burnout. Barriers that prevent adequate preparation and support of novice nurses in EOL care include lack of education, financial constraints, poor staffing, and major life changes. However, opportunities are available to support novice oncology nurses as they develop the skills necessary to provide competent EOL care. Nurse extern programs and individually tailored orientation plans that include EOL care should be developed. Careful selection of mentors and preceptors is an important aspect in planning orientation for novice oncology nurses. The presence of peers experienced in EOL care is crucial. Educational materials, standards of practice, and continuing education on EOL care should be available to novice nurses as well. EOL competencies may provide a blueprint to help with performance evaluations. Adequate preparation of novice oncology nurses for EOL care will improve patient outcomes, increase job satisfaction, and promote longevity in the specialty.     

Factors contributing to the shortage of nurse faculty: a review of the literature

There is an abundance of literature documenting the shortage of nurse faculty, both in Australia and internationally. This shortage has repercussions for the next generation of nurses, contributes to the overall nursing workforce shortage, and holds implications for the development of nursing research and continued practice development. The literature suggests a multitude of factors contributing to the shortage, including the ageing of current nurse faculty, and an undersupply of doctorally prepared nurses to take their place. To date, most nurse academics come from a clinical background with little preparation for the complex faculty role; despite this there is little exploration of their experiences transitioning to academia. The limited available evidence suggests that this new role may be accompanied by feelings of uncertainty, anxiety and isolation associated with changed responsibilities, an emphasis on scholarly activities and teaching, and the unique culture of the academic environment. The aim of this paper is to provide a critical review of the literature, identify issues relevant to the nurse faculty shortage and provide direction for further research.     

Supportive nursing: a critical review of the literature.

Nurses have long thought that providing support was a part, if not a central part, of their nursing practice. In the literature, nurses have described their ability to provide support and have discussed their inability as well as their reasons why they have been unable to give support. Support for nurses has at least three parameters: physical, social, and emotional. The emotional parameter has received the most attention by nurses. The meaning of support in nursing needs to be clearer and more precise. Although several nurses, either through theoretical discussions or exploratory research studies, have begun to further define support, this construct warrants more thought and investigation by nurses. Once an operational definition is determined and supportive behaviors identified, nurses can further investigate the influence of support to the promotion of health.     

Internet-based education for enrolled nurses: could it be e-ffective?

There has been an extraordinary growth of technology-mediated learning in the higher education system over the last 10 years (IHEP 2000, p.1), predominantly in the area of distance education. These technological advances provide exciting opportunities for the delivery of education to those who have not previously been able to access on-campus learning, usually because of barriers of distance and cost. While there are a growing number of studies supporting the implementation of distance education programs in nursing education, the use of Internet-based learning as a sole means of education delivery is relatively new. This paper investigates the current literature available regarding the use of Internet-based education delivery for registered and enrolled nurses in undergraduate and postgraduate programs, and reviews contemporary education trends in Victoria, Australia, for enrolled nurses (ENs). The challenge in nursing education currently is to design curricula that will address the health care needs of the future. This is not easy with the rapidly changing environment health care professionals, especially nurses, face in their daily work. To prepare graduates who can function successfully as professional nurses in this new century, nurse educators must examine the dominant trends in health care and education, and analyse whether the processes used to prepare students for practice will result in the desired outcome (Jorgensen et al 1998, p.109). The current growth and impact of web-based and online learning courses has been proposed by some as a major revolution for education, and has been firmly embraced by many tertiary institutions as the way of the future (Sims 1998, p. 21).     

Integrative nursing research — an important strategy to further the development of nursing science and nursing practice

In this paper it is argued that integrative nursing research has a great potential for clarifying the theoretical perspective and substance of the nursing discipline as well as making research-based knowledge more accessible to clinical nurses. Two general kinds of integrative research are introduced and illustration provided of how these have been practiced with in nursing. Significant strengths and weaknesses in current practice is highlighted. It is argues that nursing should pay more attention to this kind of research, specifically in terms of developing sound methodological approaches and overcoming the traditional schism between empirical and theoretical research. Sound integrative nursing research promises to improve the development of nursing science as well as making the products of nursing research more easily available for clinical nurses.     

Ambient sound levels in a state psychiatric hospital.

High environmental and psychosocial stress contribute to the onset and relapse of major psychiatric disorders. High sound levels in general hospitals are common and may be indirectly associated with negative physical effects because of increased physiological stress on the body. Excessive sound also interferes with cognitive functioning, especially affecting prefrontal cortical processes, but no information about sound levels in psychiatric hospitals was available. This study critically examines literature on sound stress and reports findings from an exploratory study of sound levels in a tertiary care psychiatric hospital. An overall mean sound level of 75.68 dB was found, with peak sound levels as high as 85 to 90 dB, in the range that causes hearing loss. These levels, higher than sound levels on medical, surgical, and intensive care units, suggest the need for more attention to the effect that environmental sound has on the behavior of patients hospitalized with acute psychiatric symptoms.     

Pain assessment in critical care: what have we learnt from research.

Despite an ongoing acknowledgement in the literature that pain is a significant problem within the critical care environment, this issue has not been adequately addressed by critical care nurses. This paper examines strategies for changing pain management practices in critical care, including reviewing documentation practices, the utilisation of guidelines and algorithms to augment clinical decision making, and increasing educational opportunities available to critical care nurses. It is recommended that pain assessment be given a higher priority within the clinical context, particularly as inadequate pain assessment and management has been linked to increased morbidity and mortality within critical care. Importantly, critical care nurses need to not only be aware of research-based pain management practices, but also lead the way in implementation and continuous evaluation as a measure of decreasing patient pain in the future.     

Nurse migration: the effects on nursing education

This paper is an opinion piece based on experience and supported where possible with literature, which addresses an issue of both national and international interest. It focuses on one aspect of the multifaceted social phenomenon of nurse migration, i.e. nurse education.
Background:  Much has been written about the direct effects of nurse migration on the nurse migrant, the delivery of health care in the countries that supply the nurses, and the countries that receive them. However, there is little information regarding the direct effects of migration on nurse education within the literature.
Aim:  The aim of this paper is to raise awareness of the positive and negative effects of nurse migration on nurse education both in the countries that supply nurses and those which receive them.
Methods:  Both scholarly and 'grey' literature is used to support the discussion on the 'real' challenges faced by nurse educators and clinical nurses in those countries that supply or receive nurses. In addition, practical recommendations for nurse educators are presented. Furthermore, the nursing profession is challenged to become politically active, to become involved and to take responsibility for the decisions made about nurse education in order to protect the integrity of nurse education and patient safety.
Conclusion:  The quality of nurse education in many countries has been undermined as a result of rapid, mass migration. There is an urgent need to take practical steps to maintain the integrity of nurse education and the nurse's preparation for practice in order to protect patients' safety.     

Implantable cardioverter defibrillators: developing evidence-based care

BACKGROUND: In the UK, access to psychological support for people with implantable cardioverter defibrillators (ICDs) is arbitrary, despite the fact that the National Institute for Clinical Excellence (NICE) recognises that the provision of adequate support can positively affect recovery. The author evaluates the available literature. CONCLUSION: This review identifies that, although a lot of information is available about the effects of ICD technology on patients, there have been few systematic evaluations of care interventions that aid adjustment to living with an ICD. Equally, it has not yet been established whether nurses are equipped to effectively assess and meet the complex care needs of this patient population. The development and evaluation of national standards of care, in association with ICD patients and their families, is recommended.     

Is the professional code still the cornerstone of clinical nursing practice?*

Although codes of practice for those concerned with the health care of others have always been inherent in the structure of societies, they have been institutionalized within the nursing discipline since the end of the last century Up until the early 1970s they promulgated subservience to the medical discipline As a result of the processes of emancipation and professionalization, the philosophy of the nurse has come to contain concepts of autonomy, accountability and patient-advocacy, based on a personal and individualized care system Research in recent years has shown that nurses are making morally sound and ethically acceptable choices based on their own decision-making abilities, whilst having little or no active knowledge of the existing professional codes Based on the literature, the author discusses ethical codes in relation to their perception by nurses in the clinical situation The influence of the code in the areas of moral decision making, administration and management, and education are likewise discussed and the conclusion is reached that codes remain the cornerstone of nursing practice     

Measuring the impact of nursing interventions in the community: a selective review of the literature

In a resource conscious environment, it is imperative that nurses use their skills and knowledge to provide an optimum service It is suggested that nurses working in the community must measure the impact of their nursing interventions to guide their own role development and to inform the purchasing process This literature review has revealed, however, that little progress has been made in this area by nurses within the community setting Indeed, it is suggested that research is needed to test reliable and valid methods of outcome measurement