An integrative review on conflict management styles among nursing students: Implications for nurse education

ObjectivesNurse education plays a critical role in the achievement of conflict management skills in nursing students. However, a wider perspective on this concept has not been explored. This paper is a report of a review appraising and synthesizing existing empirical studies describing conflict management styles among nursing students.DesignAn integrative review method guided this review.Data SourcesFive (5) bibliographic databases (CINAHL, Medline, Psych Info, Embase and SCOPUS) were searched to locate relevant articles.Review MethodsAn electronic database search was performed in December 2016 to locate studies published from 2007 onwards. The search words included: ‘conflict’, ‘management resolution’, ‘management style’, ‘management strategy’, ‘nursing’, ‘student’. Thirteen (13) articles met the inclusion criteria.ResultsNursing students preferred ‘constructive/positive conflict management styles’ when handling conflicts. However, more studies are needed to identify factors that may affect their choice of styles. Further, this review emphasizes the need for empirical studies to identify appropriate interventions that would effectively enhance nursing students' skills in managing conflicts using rigorous methods.ConclusionsNursing faculty play a critical role in teaching, training, and modeling constructive conflict resolution styles in nursing students. Simulation scenarios, reflective exercises, and role playing may be useful to facilitate such learning in choosing constructive conflict management styles. Structured training programme on conflict management will assist nursing students develop positive conflict management styles.     

Teaching nursing in a situation of conflict: encounters between Palestinian‐Israeli and Jewish‐Israeli nursing students

ARIELI D. & HIRSCHFELD M.J. (2010) Teaching nursing in a situation of conflict: encounters between Palestinian‐Israeli and Jewish‐Israeli nursing students. International Nursing Review 57 , 312–320 Purpose: This research examines the ways Palestinian‐Israeli and Jewish‐Israeli nursing students, who study together in one group in an academic school of nursing situated in northern Israel, perceive each other and the relationships among them. Design: The study is based on semi‐structured interviews with undergraduate students. The cohort consists of 46 students, 20 of whom participated in the study. Findings: The students perceive themselves as divided into two separate groups according to nationality. Cooperation between the groups related to their study duties is described as generally satisfying, but little expressive communication and scarce social relations occur across these two groups. Students provided their perceptions of ‘the others’ to explain this social distance. Implications: We discuss the challenges of the situation for nursing educators and some strategies for coping with these challenges.     

Shifting supervision: implications for safe administration of medication by nursing students

Background. Medication errors made unintentionally by nurses continue to be a major concern in hospitals, medical centres and aged care facilities throughout Australia. While there is a plethora of literature available, which has identified factors that contribute to nurses making errors, few studies have reported on factors that may contribute to errors made by nursing students. Design. A grounded theory approach. Methods. In‐depth interviews with final‐year undergraduate nursing students (n = 28) to explore their experiences of administering medication. Constant comparative analysis was used to identify categories from the data. Results. The central category was identified as ‘shifting levels of supervision’. This describes the process of supervision students received when administering medication. Four levels were identified: ‘being with’, ‘being over’, ‘being near’ and ‘being absent’. The findings suggest that nursing students do not always receive the level of supervision that is legally required. Less than satisfactory levels of supervision were identified by participants as leading to medication errors or near misses. Conclusion. Apart from ‘Being with’, the levels of supervision described by participants have major implications for the safe administration of medication by nursing students and represent the actual or potential cause of error. Relevance to clinical practice. The potential for medication errors pose a major safety issue. Healthcare services have a responsibility to protect patient safety. Appropriate supervision of nursing students when administering education therefore requires urgent attention to ensure best practice is executed.     

Writing place: a comparison of nursing research and health geography

The concept of ‘place’, and general references to ‘geographies of …’ are making gradual incursions into nursing literature. Although the idea of place in nursing is not new, this recent spatial turn seems to be influenced by the increasing profile of the discipline of health geography, and the broadening of its scope to incorporate smaller and more intimate spatial scales. A wider emphasis within the social sciences on place from a social and cultural perspective, and a wider turn to ‘place’ across disciplines are probably equally important factors. This trend is raising some interesting questions for nurses, but at the same time contributes some confusion with regard to imputed meanings of ‘place’. While it is clear that most nurse clinicians and researchers certainly understand that place of care matters to their practices and patients, many diverse uses of ‘place’ are found within nursing literature, and contemporary understandings of the term ‘place’ within nursing are not immediately clear. It is in this context that this article plans to advance the discussion of place. More specifically, the aims of this paper are threefold: to critique ‘place’ as it appears in nursing literature, to explore the use of ‘place’ within health geography, whence notions of place and ‘geographies of’ have originated and, finally, to compare and contrast the use of ‘place’ in both disciplines. This critique intends to address a deficit in the literature, in this era of growing spatialization in nursing research. The specific questions of interest here are: ‘what is “place” in nursing?’ and ‘how do concepts of place in nursing compare to concepts of place in health geography?’     

Student nurses’ experiences of communication in cross‐cultural care encounters

Scand J Caring Sci; 2010; 24; 436–444
Student nurses’ experiences of communication in cross‐cultural care encounters Background: Communication is a fundamental component of cross‐cultural care encounters. Nurses experience communication difficulties in situations where they do not speak the same language as their patients. Communication difficulties are a major obstacle for immigrant patients and can lead to insufficient information and poor quality nursing care in contrast to the majority population. Aim: To explore student nurses’ experiences of communication in cross‐cultural care encounters. Methods: Semi‐structured interviews were undertaken a purposive sample of 10 final year students from one university in Sweden: five participants were from a Swedish background and five from an immigrant background. Interviews explored participant’s experiences of communication in cross‐cultural care encounters. Interviews were tape recorded, transcribed and analysed using ‘framework’ approach. Results: Four themes were identified: conceptualizing cross‐cultural care encounters, difficulties in communication, communication strategies and factors influencing communication. ‘Culture’ was equated with country of origin. Cross‐cultural care encounters involved patients from a different immigrant background to the nurse. Student nurses experienced particular difficulties communicating with patients with whom they did not share a common language. This led to care becoming mechanistic and impersonal. They were fearful of making mistakes and lacked skills and confidence in questioning patients. Various strategies were used to overcome communication barriers including the use of relatives to interpret, nonverbal communication, gestures and artefacts. Other factors which influenced communication included the student’s attitude, cultural knowledge acquired through education and life experience. Conclusion: Although student nurses seek creative ways to communicate with patients from different cultural backgrounds they lack skills and confidence in cross‐cultural communication. Nursing programmes need to address this deficit to ensure that nurses are equipped with the knowledge and skills to provide quality care to patients from different cultural backgrounds.     

The Italian economic crisis and its impact on nursing services and education: hard and challenging times

Bortoluzzi G. & Palese A. (2010) Journal of Nursing Management 18 , 515–519
The Italian economic crisis and its impact on nursing services and education: hard and challenging times Aims Three levels of impact are reported and discussed in this commentary: the ‘macro’ level, which corresponds to policy(ies); the ‘meso’ level, which corresponds to nursing services and nursing education; and the ‘micro’ level, which deals with clinical practice and education, where interactions between patients and nurses and/or students take place. Background The Italian economy is showing some signs of recovery after the worst economic crisis of past decades. However, these signs are still quite weak and insufficient to declare that the country is finally coming out of it. Key issues Several negative impacts of the economic crisis on nursing services and nursing education are documented. Reports have started to document initial signs of the economical crisis impact on patients too. Present and future issues related to nursing services, education and clinical practice are commented both from national data and from nurses’ daily perceptions. Implications for nursing management The Italian economic crisis will leave a heavy burden on the shoulders of future generations. Nurses’ leaders are coping with these challenges, innovating the nursing system and preparing a sustainable future for generations of patients and nurses.     

The ‘mindless’ relationship between nursing homes and emergency departments: what do Bourdieu and Freire have to offer?

McCLOSKEY R. Nursing Inquiry 2011; 18 : 154–164
The ‘mindless’ relationship between nursing homes and emergency departments: what do Bourdieu and Freire have to offer? This paper explicates the long‐standing and largely unquestioned adversarial relationship between nurses working in the nursing home (NH) and the emergency department (ED). Drawing on the author’s own research on resident ED transfers, this paper reports on the conflict and tension that can arise when residents transfer between the two settings. The theoretical concepts of mindlessness, habitus, social capital and oppression are deployed to understand the contextual nature of the social relations that exist between NH and ED practitioners and between practitioners and residents. This theoretical discussion offers the potential to uncover the social relations that give rise to problematic transfers which may lead to alternative and more productive NH to ED transfers.     

Nursing students' perceptions of the importance of caring behaviors

Title. Nursing students’ perceptions of the importance of caring behaviours Aim. This paper is a report of a study to determine the nursing students’ perceptions of the importance of caring behaviours. Background. Caring has been considered as the essence of nursing. It is believed that caring enhances patients’ health and well‐being and facilitates health promotion. Nursing education has an important role in educating the nurses with adequate caring abilities. Method. Ninety nursing students (response rate 75%) responded to a questionnaire consisting of 55 caring behaviours adapted from items on Caring Assessment Questionnaire (Care‐Q). Behaviours were ranked on a 5‐point Likert‐type scale. The caring behaviours were categorized in seven subscales: ‘accessibles’, ‘monitors and follows through’, ‘explains and facilitates’, ‘comforts’, ‘anticipates’, ‘trusting relationship’ and ‘spiritual care’. Data were collected in Iran in 2003. Findings. The students perceived ‘monitors and follows through’ (mean = 4·33, SD = 0·60) as the most and ‘trusting relationship’ (mean = 3·70, SD = 0·62) as the least important subscales. ‘To give patient’s treatments and medications on time’ and ‘to do voluntarily little things…’ were the most and least important caring behaviours, respectively. ‘Explains and facilitates’ statistically and significantly correlated with age (r = 0·31, P = 0·003) and programme year (r = 0·28, P = 0·025). Gender had no statistically significant influence on students’ perceptions of caring behaviours. Conclusion. Further research is needed, using longitudinal designs, to explore nursing students’ perceptions of caring behaviours in different cultures, as well as evaluation studies of innovations in curriculum and teaching methods to improve learning in relation to cultural competence and caring concepts.     

From diagnosis to health: a cross‐cultural interview study with immigrants from Somalia

Scand J Caring Sci; 2010; 24; 357–365
From diagnosis to health: a cross‐cultural interview study with immigrants from Somalia Objective: Being diagnosed as having a chronic disease gives rise to emotions. Beliefs about health are culturally constructed and affect people’s decisions regarding treatment. No studies have been reported that focus on the health beliefs of immigrants of Somalian origin with diabetes and how these people experiences the diagnosis. Therefore the aim of the present study was to investigate how immigrants from Somalia living in Sweden experienced receiving the diagnosis and describe their beliefs about health. Method: The sample consisted of 19 adults with diabetes born in Somalia and now living in Sweden who were interviewed with the aid of an interpreter. The interviews were subjected to qualitative content analysis. Results: From the analysis of what the participants said about their experiences of the diagnosis there emerged three themes: ‘Existential brooding’, ‘Avoiding the diagnosis’ and ‘Accepting what is fated’. Three themes also emerged from the analysis of what they said about beliefs about health: ‘Health as absence of disease’, ‘Health as general well‐being’ and ‘Fated by a higher power’. A major finding was that women when they communicated their experiences regarding the diagnosis and health beliefs made more use of supernatural beliefs than men did. The participants, irrespective of gender, did not immediately respond with shock or other strong emotion when they received the diagnosis. Conclusions: The study provides health‐care staff with knowledge concerning a minority group’s experiences of being diagnosed as having diabetes and their beliefs about health. The findings indicate that men and women differ in how they experiences the diagnosis and how they described their health beliefs. The quality improvement of health education and nursing for patients with diabetes calls for consideration of the variation of beliefs related to cultural background and gender.     

Critical Care nurses' understanding of the NHS Knowledge and Skills Framework. An Interpretative Phenomenological Analysis

Aims: This small‐scale research study aimed to explore Critical Care nurses' understanding of the National Health Service (NHS) Knowledge and Skills Framework (KSF) in relationship to its challenges and their nursing role. Background: The NHS KSF is central to the professional development of nurses in Critical Care and supports the effective delivery of health care in the UK. KSF was implemented in 2004 yet engagement seems lacking with challenges often identified. Design: This qualitative study adopted an Interpretative Phenomenological Analysis framework. Method: Data were collected from five Critical Care nurses using semi‐structured interviews that were transcribed for analysis. Results: Two super‐ordinate themes of ‘engagement’ and ‘theory‐practice gap’ were identified. Six subthemes of ‘fluency’, ‘transparency’, ‘self‐assessment', ‘achieving for whom’, ‘reflection’ and ‘the nursing role’ further explained the super‐ordinate themes. Critical Care nurses demonstrated layers of understanding about KSF. Challenges identified were primarily concerned with complex language, an unclear process and the use of reflective and self‐assessment skills. Conclusions: Two theory‐practice gaps were found. Critical Care nurses understood the principles of KSF but they either did not apply or did not realize they applied these principles. They struggled to relate KSF to Critical Care practice and felt it did not capture the ‘essence’ of their nursing role in Critical Care. Relevance to clinical practice: Recommendations were made for embedding KSF into Critical Care practice, using education and taking a flexible approach to KSF to support the development and care delivery of Critical Care nurses.     

Structuring Moral Meaning in Psychiatric Nursing Practice

Comparatively little is known about the experiential aspect of moral decision making in psychiatric nursing. Earlier research in this area has mainly focused on the cognitive aspects of moral reasoning, using hypothetical cases. The purpose of this study was to examine the experience of moral decision making in psychiatric nursing practice. In-depth interviews with fourteen nurses, purposively selected for their reputed competency and long experience in psychiatric care, were conducted. By using the strategy of ‘constant comparative analysis’, the grounded theory, ‘structuring moral meaning’ was derived, which consists of three interrelated processes, perceiving, knowing and judging. This process identifies the nurse's manner of making sense of a perceived moral conflict and justifiying ‘good’ actions within the nurse-patient framework.     

Nursing students' self-reported experiences and attitudes regarding patient safety: A cross-sectional study comparing the classroom and clinical settings

BackgroundPatient safety education varies in nursing schools and therefore it is crucial to identify the educational needs of students by determining their skills, attitudes, and competencies regarding patient safety and medical errors.AimThis study was conducted to determine nursing students’ patient safety education competencies in the classroom and clinical settings, their attitudes towards medical errors, and the relationship between them.MethodsThis was a cross-sectional questionnaire study conducted with 204 nursing students. The participation rate was 96%. Data were collected using the Health Professional Education in Patient Safety Survey (H-PEPSS_TR), and the Medical Errors Attitude Scale (MEAS). A STROBE checklist was used to report findings.FindingsStudents’ patient safety knowledge and competence scores obtained from the H-PEPSS_TR were the highest for the ‘communicating effectively’ subscale in the classroom and for the ‘culture of safety’ subscale in the clinics while their ‘understanding human and environmental factors’ subscale scores were the lowest. The total H-PEPSS_TR scores in the classroom, ‘working in teams with other health professionals,’ ‘communicating effectively,’ ‘managing safety risks,’ and ‘understanding human and environmental factors’ subscales scores of the students who had positive attitudes according to MEAS were higher (p < 0.05).DiscussionStudents with positive attitudes towards medical errors had higher patient safety knowledge in the classroom; however, it did not affect patient safety competence in the clinical setting.ConclusionNursing students had positive attitudes towards medical errors. Their patient safety knowledge and competencies gained in the classroom were more than that developed in the clinical settings.     

The challenge of caring for patients in pain: from the nurse’s perspective

Aim. To increase understanding of what it is like for nurses to care for patients in pain. Background. Hospitalised patients are still suffering from pain despite increased knowledge, new technology and a wealth of research. Since nurses are key figures in successful pain management and research findings indicate that caring for suffering patients is a stressful and demanding experience where conflict often arises in nurses’ relations with patients and doctors, it may be fruitful to study nurses’ experience of caring for patients in pain to increase understanding of the above problem. Design. A phenomenological study involved 20 dialogues with 10 experienced nurses. Results. The findings indicate that caring for a patient in pain is a ‘challenging journey’ for the nurse. The nurse seems to have a ‘strong motivation to ease the pain’ through moral obligation, knowledge, personal experience and conviction. The main challenges that face the nurse are ‘reading the patient’, ‘dealing with inner conflict of moral dilemmas’, ‘dealing with gatekeepers’ (physicians) and ‘organisational hindrances’. Depending upon the outcome, pain management can have positive or negative effects on the patient and the nurse. Conclusions. Nurses need various coexisting patterns of knowledge, as well as a favourable organisational environment, if they are to be capable of performing in accord with their moral and professional obligations regarding pain relief. Nurses’ knowledge in this respect may hitherto have been too narrowly defined. Relevance to clinical practice. The findings can stimulate nurses to reflect critically on their current pain management practice. By identifying their strengths as well as their limitations, they can improve their knowledge and performance on their own, or else request more education, training and support. Since nurses’ clinical decisions are constantly moulded and stimulated by multiple patterns of knowledge, educators in pain management should focus not only on theoretical but also on personal and ethical knowledge.     

Capacity development for community health nurses in Pakistan: the assistant manager role

GULZAR S.A., MISTRY R. & UPVALL M.J. (2011) Capacity development for Community Health Nurses in Pakistan: the assistant manager role. International Nursing Review 58 , 386–391 Background: Community health nurses (CHNs), as leaders in developing countries, can promote successful outcomes in meeting the targets of the Millennium Development Goals. A community‐based organization in Pakistan is striving to achieve the goals of maternal and child health through the development of the assistant manager role for community health nursing. Purpose: The purpose of this study was to assess the perception of the role of the CHN assistant manager, with the goal of strengthening that role. Methods: This interpretive, qualitative study included 13 participants already familiar with CHNs in Pakistan. Interviewing was utilized to explore perceptions of the assistant manager role and to uncover challenges currently existing within this new role. Findings: Content analysis revealed the following themes: ‘role perceptions’, ‘expectations of the role’ and ‘collaboration with other community healthcare providers’. Conclusion: Changes to the role are necessary including increased education of the assistant manager CHNs and preparing administration to work with the assistant mangers for effective leadership.     

实习对本科护生患者安全知识影响的调查研究

目的调查本科护生实习前后的患者安全知识、态度和技能现状,为更好地开展护生患者安全教育提供依据。方法以皖南医学院护理学院实习前后本科护生为研究对象,进行"患者安全知识、态度、技能"问卷的匿名调查。采用EpiData 3.0软件录入数据,SPSS 17.0软件进行统计分析。结果实习前共发放问卷451份,收回有效问卷435份(96.45%)。实习后共发放问卷418份,收回有效问卷412份(98.56%)。与实习前相比,实习后女护生"医疗差错相关知识"和"医疗差错发生后我应该怎么做"两个维度的得分显著增高(P<0.000),"医疗差错发生后的情感"(P=0.002)和"有关患者安全你的意向/打算"得分显著降低(P=0.006);而男护生仅在"医疗差错发生后我应该怎么做"方面得分显著增高(P=0.046)。结论实习能显著提升护生的患者安全知识,减轻护生发生医疗差错后的负面情感反应。     

The skills gap in nursing management in South Africa: a sectoral analysis: a research paper

pillay r . (2010) Journal of Nursing Management  18, 134–144
The skills gap in nursing management in South Africa: a sectoral analysis: a research paper Aim To identify competencies important for effective nursing management and to assess managers’ proficiency therein. Background A lack of management capacity has been identified as the key stumbling block to health delivery in South Africa. Despite nursing managers being central to overcoming the challenges facing health care, there has been a paucity of research that empirically evaluates their skill levels. Methods A survey was conducted among 171 senior nursing managers in South Africa using a self-administered questionnaire. Results Public sector managers assessed themselves as being relatively less competent than private sector managers. The largest skill gaps for public sector managers were for ‘ethico–legal’, ‘task-related’ and ‘controlling’ skills whereas those for private sector managers were for ‘ethico–legal’, ‘health-related ‘ and ‘task-related’ skills. Conclusions This research confirmed the lack of management capacity within the health sector and identified areas in which the skills deficit was most significant for both the public and private sectors. Implications for nursing management These findings reflect the needs of nursing managers and will be useful in the conceptualization, design and delivery of health management programmes aimed at enhancing management and leadership capacity in the health sector in South Africa.     

Education and role conflict in the health visitor profession, 1918–39

BROOKS J and RAFFERTY AM. Nursing Inquiry 2010; 17 : 142–150
Education and role conflict in the health visitor profession, 1918–39 Health visiting was the public health profession in the UK, which arose during the Victorian period to support and supervise the mothers of the nation. The health visitor was expected to teach the new mothers hygiene, infant feeding and diet, help them in the home when necessary and then report back to the Medical Officer for Health. Her role therefore was multifaceted and required education and training from a number of differing bodies. She needed nursing skills to help with the practicalities of observation and home care, sanitary knowledge to ensure that the buildings were safe and training in law and epidemiology. In order to fulfil these professional requirements, by the middle of the twentieth century the health visitor was expected to be a nurse by background, be educated for health visiting in a university and understand community medicine. These differing and sometimes opposing requirements meant that the health visitor was often caught in‐between conflicting ideologies. It is this idea of ‘in‐betweenness’ from the work of the anthropologist Marilyn Strathern and its relation to the work and education of the health visitor that this article will focus.     

How to prepare Chinese-born nurses to care for patients at the end-of-life in Western settings: A discussion paper

BackgroundAs a result of globalisation, many Chinese-born nurses choose to work outside China. They are expected to be competent in providing end-of-life care and dealing with dying and death within the new country, where cultural beliefs, attitudes, and values towards dying and death may differ from their own. It is essential to consider the influence of Chinese culture on nurses’ confidence and preparedness for end-of-life care, especially for dealing with dying and death.PurposeTo discuss Chinese perspectives on dying and death, and death education and training in mainland China, from which we propose recommendations for nurse educators, clinical mentors and researchers in Western settings on how to prepare Chinese-born nurses to care for patients at end-of-life.DiscussionChinese-born nurses likely encounter significant cultural challenges when providing end-of-life care to dying patients in Western settings. Chinese-born nurses’ perspectives, attitudes and values toward dying and death are shaped by Chinese cultural and social beliefs, practices and expectations, which contrast with those of Western settings. Nurse educators, clinical mentors and researchers in Western settings are encouraged to support and guide Chinese-born nurses in building their cross-cultural understanding and world view to an international view of nursing; essential foundations to the provision of end-of-life care, and nurse coping with dying and death in Western settings.ConclusionThe development of death education programs and training to support Chinese-born nurses to attain their cultural competence is a priority in Western countries, to better promote these nurses’ competency in providing high-quality end-of-life care.