A ward without walls? District nurses’ perceptions of their workload management priorities and job satisfaction

Aim. To explore district nurses’ workload management, job satisfaction and the challenges they face. Background. This paper reports qualitative findings from a qualitative and quantitative study to identify a district nursing perspective on use of time, challenges and work satisfaction. District nursing is under increasing pressure because of the increasing shift to care in the community, early hospital discharge and changes in demography with an ageing population and more people with chronic illnesses. Design. Qualitive. Method. The study took place in one Scottish Health Board and data were collected in February and March 2005. The qualitative approach involved a total of 31 district nurses and senior managers in focus group discussions or individual interviews. Results. Three main themes were identified: (1) the priorities of district nurses and their views on work unrelated to ‘hands on’ clinical care, (2) aspects of district nursing considered stressful and (3) district nurses’ job satisfaction. Conclusion. District nurses and managers agree that caring work with patients is the priority for the service and provides job satisfaction. Many nurses feel overwhelmed by their workload and have little control over the admission of patients to their caseload; they are mainly demand led and therefore reactive care providers. A culture of long hours has developed as district nurses struggle to meet the needs of patients. Feeling devalued lowers satisfaction and Agenda for Change is perceived as de‐valuing the skills of community nurses. Relevance to clinical practice. More clerical support is required so district nurses can deliver care to patients. District nurses can better represent their workload and how it is managed through expressing the nature of assessing risk and caring for patients as opposed to defining patients care needs by medical diagnoses. Extending the hours of the full district nursing service would benefit patients and staff.     

Questions and answers: Some questions discussed at one of the round tables held at Chicago Institute with public health nurses

There were a number of issues confronting public health nurses in 1919, including the differentiation of practice between visiting nurses and public health nurses, use of community partnerships when developing a new nursing service in a community, and standards of nursing work. Other issues included the focus of nursing work at the community/population versus individual level, how to balance the work load where there was only one nurse in a community, and educating the public about the value of public health nursing to the community. In this excerpt from the original publication, Ella Phillips Crandall responded to questions raised at a round table session held in Chicago in 1919 as a part of a Public Health Nursing Forum, and then published in the October 1919 issue of The Public Health Nurse. While the social context in which PHNs worked in 1919 were significantly different from those nurses face today, these insights are prescient to the issues faced by PHNs today as the profession continues to address issues related to standards of practice, role development, and educational preparation for both entry level and advanced practice.     

Nursing, a bridge to peace in our region: Opinions on mutual co-operation between Israeli and Palestinian professional nurses and nurse educators

Raviv D, Bourgstein D, Kaplan R. International Journal of Nursing Practice 1997; 3: 159–165
Nursing: A bridge to peace in our region
The purpose of this study was to assess the activities and future direction of mutual co-operation of professional nurses from Israel and Judea and Samaria. Questionnaires were distributed to the participants, nurse educators and professional nurses from Judea and Samaria who were attending a workshop in clinical instruction at the Assaf HaRofeh School of Nursing, in Israel. Most of the nurses polled were interested in continued educational dialogue and expanded educational programmes in various nursing specialties both in education and service. The areas that received priority included: intensive care, operating room and emergency room nursing. Areas that received lower priorities included; midwifery, geriatrics and nephrology nursing. The participants expressed positive reactions to continued joint educational activities such as full length courses, workshops, day seminars and joint educational projects. The results showed an overwhelming interest for continued professional ties. Areas in the fields of clinical expertise and nursing education reflected the needs of their respective communities.     

The changing relationship between mental health nurses and psychiatrists in the United Kingdom

AIM: This paper illustrates key developments in the changing relationship between the two professions over the last 200 years. BACKGROUND: To understand the current relationship between mental health nurses and psychiatrists within the UK, it is necessary to understand the historical development of that relationship. METHODS: Information was sought from a range of primary documentary sources, including contemporary journals, asylum documents and official governmental and health service reports. Secondary sources, such as histories of medicine, nursing and individual asylums provided further supportive information. FINDINGS: Psychiatry emerged as a profession at the end of the 18th century and found a power base within county asylums from the middle of the 19th century. Medical superintendents, the doctors in charge of asylums, had strict control over the activities of attendants, the justification for which was the need to protect patients from cruelty and neglect. Superintendents' desire for their own enhanced professional status led to formalized training for attendants at the end of the 19th Century, in which training materials again reinforced the importance of obedience by nurses (as attendants had become known). During the 1920s, trade unions struggled for improved pay and conditions, whilst professionalizing mental health nursing was a secondary priority. Reorganization following creation of the National Health Service in 1948 lessened superintendents' authority, and ultimately the management of mental health nursing shifted from them. The move towards community care allowed mental health nurses to develop greater independence, which was supported by changes in nurse education. CONCLUSIONS: Psychiatrists in the UK remain highly influential, despite the move from their traditional power base in hospitals. Changes in mental health care, such as new nurse prescribing powers and the loss of psychiatrists' control over admission of patients to hospital, will continue to change the relationship between mental health nursing and psychiatry.     

Establecimiento de prioridades de investigación en enfermería en España: estudio Delphi

ObjectiveTo identify nursing research priorities in Spain as suggested by nurses and service users.MethodA Modified Delphi technique was used. The first round started off with a 24-item document for which consensus had been previously achieved. Experts participating in this modified (two rounds) Delphi technique were: nursing managers (community and hospital care settings), nursing school directors, scientific nursing association representatives, nursing researchers attending the National Nursing Research Conference, and service users.ResultsMain priorities identified for nursing research were: 1) evaluating the effectiveness of nursing interventions, 2) identifying strategies for health promotion empowering service users, 3) developing evidence-based care through implementing and evaluating results, and 4) evaluating the quality of nursing care.ConclusionsResults may help research managers and administrators identify and develop nursing research promotion strategies as well as more strongly sustained funding policies and decisions.     

Innovations in community health nursing: Examples from practice

Cusack L, Smith M, Byrnes T. International Journal of Nursing Practice 1997; 3: 133–136
Innovations in community health nursing: Examples from practice
The Ottawa Charter for Health Promotion is cited internationally as an appropriate conceptual framework for healthcare service delivery yet the literature reveals minimal evidence of nursing services interpreting and applying the Ottawa Charter strategies into nursing practice. Nurses with the community services of Noarlunga Health Services and the Drug and Alcohol Services Council of South Australia, however, do use the strategies to plan and implement their services. The Ottawa Charter strategies of developing personal skills; creating supportive environments; strengthening community action; building healthy public policy; and re-orienting services in the interest of health can be used as a tool to assist nurses to identify the purpose of their interventions and select a comprehensive range of nursing actions which address the needs of individuals while acknowledging the broader determinants of health. This article presents a nursing analysis of the Charter and provides examples of how the strategies are used to influence nursing practice in both organizations. The examples provided from the two different nursing services also demonstrate the adaptability and relevance of the strategies to diverse community nursing practice settings.     

上海社区老年护理工作内容调查

目的 了解上海市社区老年护理工作内容。方法 2000年对20家示范性社区卫生服务中心的卫生服务科的科长20人作社区护士工作内容的问卷调查;2001年对社区居民204人作社区护理需求的问卷调查以及对社区护士108人作工作内容的问卷调查;2002年社区护士55人以工作日记记录法作5d的记录,再经专家修正,确立工作内容。结果 2000年调查：上海已全面开展了“家庭病床”的对老年慢性病患者的护理操作;2001年调查：老年护理中的3项位居社区护理需求和提供各自33项中的前四位;2002年调查：社区老年护理的直接护理时问占总时问的29.82％,应包括3项职能、5项活动和45项任务,已实施32项。结论 上海社区老年护理是社区护理的重要部分,能以需求为导向、不断扩展服务对象和内容。     

上海市社区护士及慢病患者"互联网+护理服务"期望模式及服务项目的调查分析

目的调查上海市社区护士及慢病患者对"互联网+护理服务"模式及服务项目的期望情况,以期为完善上海市"互联网+护理服务"提供理论参考。方法采用便利抽样法,于2021年1—2月选取上海市静安区15家社区卫生服务中心的255名护士及150例慢病患者为研究对象,分别采用护士"互联网+护理服务"调查问卷和患者"互联网+护理服务"调查问卷对其进行调查。本研究共发放护士"互联网+护理服务"调查问卷255份,回收有效问卷250份,有效回收率为98.0%(250/255);共发放患者"互联网+护理服务"调查问卷150份,回收有效问卷148份,有效回收率为98.7%(148/150)。结果250名社区护士中有31.6%(79/250)的护士了解"互联网+护理服务";29.6%(74/250)的护士愿意参与"互联网+护理服务"。148例慢病患者中有50.0%(74/148)的患者不了解"互联网+护理服务";48.0%(71/148)的患者表示愿意参与"互联网+护理服务"。慢病患者需求较多的服务项目为血糖监测(27.0%,40/148)、皮下注射(25.0%,37/148)、肌内注射(23.6%,35/148);社区护士执行意愿较高的服务项目为血糖监测(42.0%,105/250)、静脉血采集(41.2%,103/250)、肌内注射(40.0%,100/250)。社区护士与慢病患者在期望的执业护士职称、期望的执业护士工作年限方面比较,差异均有统计学意义(P<0.05)。结论社区护士及慢病患者对"互联网+护理服务"的认知水平有待提高,有关部门应通过媒体、网络等手段提升"互联网+护理服务"知晓度,在完善"互联网+护理服务"规章制度时,应对护患供需双方进行充分调研,以数据导向作为政策的落脚点,切实满足患者需求,保障患者健康。     

社区护士对中医护理理论和技能的认知和需求现状

目的 了解社区护士对中医护理理论和技能的认知和需求情况.方法 采用便利抽样法抽取杭州市10所社区卫生服务中心184名社区护士进行问卷调查.结果 社区护士对中医养生保健的认知和需求度最高,而中医基础知识需求度最低.结论 应加强对社区护士中医护理理论和技能的系统培训,发挥中医护理特色与优势,促进中医护理在社区卫生保健服务中...     

培养社区护理人才的设想

为担负起社区内人们的健康保健工作，培养社区护士势在必行。可将已取得中专、大专文凭，并具有２年以上护理临床工作经验的护士，进行为期两年的社区护理理论学习和实践能力培养之后进入社区中心工作，以推动我国社区护理的发展。     

Confusing rhetoric with reality: achieving a balanced skill mix of nurses working with children

BACKGROUND AND RATIONALE: The option of separate registration in children's nursing has been a feature of nursing in the United Kingdom since 1919, but this is currently under review. The recently superseded governing body of nursing, the United Kingdom Central Council for Nursing, Midwifery and Health Visiting, has suggested that generic nurse registration with later specialization would be a more appropriate structure. Polarized views tend to dominate the debate over whether or not children's nursing should remain a discrete branch of nursing rather than simply another postregistration speciality. A long series of reports is often referred to in the debate, but the recommendations of these are often misconstrued and misrepresented. AIMS: First, to provide a factual historical overview of the significant reports on the provision of child health care over the past 50 years, identifying the key principles of each, and to develop from this analysis reasoned conclusions regarding the priorities in skill mix for nursing children. Second, to propose an alternative framework for nursing skill mix that will ensure that children receive care appropriate to their needs, and that nurses are appropriately prepared for the level of service to be offered. CONCLUSION: The problems associated with expectations of universal provision of registered children's nurses for all children requiring nursing intervention have resulted from misunderstandings of the recommendations of key historical reports. In the light of evidence presented for the drive for abolition of specialist registration, and the main arguments of the polar stances of genericism or specialization, it is vital that alternative strategies are developed and debated. The proposed framework, based on pragmatism and key principles established from major reports, is discussed in an attempt to address the real issues; namely that all children are cared for by nurses who have adequate preparation commensurate with their needs, and that there is a strong career trajectory for all nurses working in the field of child heath.     

Nursing students' career preferences: a Norwegian study

AIM: This paper is a report of a study to identify Norwegian undergraduate nursing students' career preferences at the beginning and end of their nursing education programme, together with their reasons for these preferences. BACKGROUND: International studies have shown that recruitment and retention of nurses in areas such as aged care and psychiatric nursing is difficult. It is important to know why some working areas are popular whilst others are not, so that nursing schools produce graduates who meet the needs of the community. METHODS: All students starting their nursing education programme in 2001/2002 in five Norwegian university colleges were invited to complete questionnaires at the beginning and end of their nursing education programme. In phase 1, 620 of 782 commencing students completed questionnaires (response rate 79.2%). In their third year, phase 2, 473 questionnaires were distributed (response rate 82.6%, n = 386). The questionnaire included closed questions about career preferences and open-ended questions seeking the reasons for the preferences. RESULTS: The study revealed changes in preferences between the beginning and the end of the nursing education programme. In phase 1, midwifery and paediatric nursing were ranked highest and in phase 2 working in medical/surgical ward, midwifery and psychiatric nursing were preferred. Working in aged care institutions remained unpopular throughout. Clinical experiences and professional challenges were often given as reasons for preferences. CONCLUSION: Nursing educators, clinical nurses and policymakers must reconsider their priorities and improve working conditions for nurses in aged care in order to meet society's need for nurses.     

社区护士社区护理知识掌握情况及需求的调查

目的：调查社区护士社区护理知识掌握及需求情况，为开展进一步的社区护士岗位培训提供依据。方法：采取自制问卷法于2006年12月对黑龙江省844名、社区护士社区护理知识掌握及需求进行调查。结果：社区护士对社区护理知识掌握“一般”。掌握相对较好的是：社区紧急救护，常见疾病的预防和护理、社区传染病的预防。知识需求排在前3位的是：常见疾病的预防与护理，社区护理概论和社区卫生服务概论，社区护理知识需求与第一学历、从事社区护理工作前工作年限、年龄有关。结论。社区护士社区护理知识水平有待进一步提高，应根据社区护士对社区护理知识的需求有针对性地开展岗位培训。     

吉林省社区护士岗位培训现状及发展方向

目的 了解吉林省社区护理人力资源现状及岗位培训状况,为构建社区护士岗位培训体系提供依据.方法 采用整群随机抽样法,对吉林省3个城市的社区卫生服务中心（站）共583名社区护士的社区知识掌握及需求进行问卷调查.结果 社区护士常见基础护理知识掌握率最好（63.8%）,科研方法 知识掌握率最不理想（13.6%）,年龄小,职位低以及工作时间在5～9年的社区护士知识掌握较差;42.9%的社区护士未参加过岗位培训,岗位培训存在最多的问题为培训时间太短（64.6%）,老年人常见疾病居家护理知识岗位培训需求率最高（99.7%）.结论 我省社区护士存在整体素质不稳定的现象,岗位培训工作落实不完善,进行岗位培训是提高社区护士整体素质的重要途径.     

重庆市社区护理人员综合素质情况调查分析

目的 了解重庆市社区护士综合素质情况,探讨社区护理教育的发展策略.方法 选取重庆市9个社区卫生中心、18个社区卫生站的104名社区护士,通过问卷调查,收集相关信息.结果 不同学历护士对各社区护理相关知识的掌握度不同(P＜0.05);不同职称护士对理论知识掌握度的总体评分差异有统计学意义(P＜0.05).80.0%以上的护士认为需培养各专科综合技能、应对社区紧急事件及获取新知识发展自身业务水平的能力,78.9%的护士认为要增强预见社区潜在问题、独立解决现存问题的能力.结论 需进一步强化社区护士工作理念,完善社区护理培训条件,优化课程内容,有针对性地培养护士综合能力.     

The pharmaceutical industry and the German National Socialist Regime: I.G. Farben and pharmacological research

Before the National Socialist party came to power, the German pharmaceutical industry constituted an international reference as far as the development of new medicines was concerned, having been responsible for synthetic analgesics (phenacetin, phenazones, acetylsalicylic acid), arsphenamine, barbiturates and sulfonamides. The year 1925 saw the founding of I.G. Farben ( Interessen-Gemeinschaft Farbenindustrie AG ), a conglomerate of companies that would monopolize the country's chemical production and come to own all its major pharmaceutical industries. During the World War II, I.G. Farben participated in numerous operations associated with the criminal activities of the Nazi executive, including the use of slave labour in plants built close to concentration camps, such as that at Auschwitz. With regard to medical and pharmacological research projects, I.G. Farben became involved in experimental programmes using patients from the Nazi regime's euthanasia programmes and healthy subjects recruited without their consent from concentration camps, on whom various pharmacological substances were tested, including sulfamide and arsenical derivatives and other preparations whose composition is not precisely known (B-1012, B-1034, 3382 or Rutenol, 3582 or Acridine), generally in relation to the treatment of infectious diseases, such as typhus, erysipelas, scarlet fever or paratyphoid diarrhoea. Furthermore, I.G. Farben played a decisive role in the German army's chemical warfare programme, contributing to the development of the first two neurotoxic substances, later known as 'nerve agents', tabun and sarin. Some of these activities came to light as a result of the one the famous Nuremberg Trials in 1947, which saw 24 executives and scientists from I.G. Farben brought to justice for, among other offences, the use of slave labour in the concentration camps and forced experimentation with drugs on prisoners.     

Nursing research priorities of the National Black Nurses Association.

The purpose of this article is to describe the nursing research priorities of the National Black Nurses Association (NBNA). The NBNA is a professional nursing association representing more than 150,000 black nurses throughout the United States and the Eastern Caribbean. This article describes knowledge gaps in nursing research and presents various findings from research studies aimed at defining research priorities in nursing. Recommended research priorities are discussed that are directed toward improving the health of African Americans and other vulnerable populations. The NBNA urges the National Institutes of Health to increase funding to support research initiatives with an emphasis on women's health, particularly the health of women from diverse cultures. Nursing research programs are steadily yielding results, which enable the nursing profession to meet the goal of using the programs include identification of research priorities, acknowledging the vast disparity in nursing research today.     

社区护士配置及老年人社区护理服务现状

目的:了解南昌市社区卫生服务机构护士配置及老年人社区护理服务现状。方法:抽取南昌市五大主城区社区卫生服务机构的护士201名进行调查。结果:南昌市社区护士配置基本达标;老年人社区护理服务情况总体较好,排名前五位的项目是定期健康体检、营养饮食指导、合理运动锻炼指导、健康咨询、行为安全指导;50%以上社区护士未提供的项目是免疫接种护理指导、心理咨询、家庭访视、家庭病床服务。结论:目前南昌市社区护士整体素质有待提高。需要对护士配置及老年人社区护理服务内容进行改进,更好地提高老年人社区护理服务的质量。     

Friday at Frontier Nursing Service

ABSTRACT The Frontier Nursing Service (FNS) was founded in 1925 in eastern Kentucky by Mary Breckinridge, a nurse whose interest in improving rural health and midwifery changed the course of rural public health nursing and improved health outcomes for some of the most isolated and poorest people in 20^th century America. The visual image of Breckinridge on horseback visiting her scattered rural patients is imprinted on the minds of most public health nurses in the United States and has, perhaps, been the wellspring of many nursing career aspirations. The daily life of FNS nurses was one of hardship, uncertainty and variey, as is evidenced in this tale of one day; nonetheless, the experiment of a rural nursing service combining midwifery and generalized nursing was ultimately a tremendous success. The following historical reprint recounts a singular day in the life of Anna January, a nurse midwife at the FNS in Confluence, Kentucky. She captures the dialect and earthiness of the region and the period in her story, but the events she relates also illustrate how interconnected life events can be in rural communities. The original article appeared in the December 1948 issue of Public Health Nursing [Volume 40 (12), 601–602].     

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.