Parent-nurse interactions: care of hospitalized children

BACKGROUND: An essential component of quality nursing care is nurses' ability to work with parents in the hospital care of their children. However, changes in the health care environment have presented nurses with many new challenges, including meeting family-centred care expectations. AIM OF THE PAPER: To report a research study examining the experiences of parents who interacted with nurses in a hospital setting regarding the care of their children. METHODS: A qualitative approach was employed for this study. In-depth audiotaped interviews were conducted with eight parents representing seven families. Data collection was completed over a 7-month period in 2001. FINDINGS: Parents characterized their experiences with nurses caring for their children as interactions, and identified the elements of establishing rapport and sharing children's care as key to a positive perception of the interactions. These elements were influenced by parental expectations of nurses. Changes in nurses' approach were reported by parents as the children's conditions changed. CONCLUSION: Nurses were able to work with families in the hospital care of their children in ways that parents perceived as positive. However, in parents' views, their interactions with nurses did not constitute collaborative relationships. A deeper understanding of these interactions may provoke new thinking about how to promote an agency's philosophy, and how nurses enact this philosophy in practice.     

Caring for adults with intellectual disabilities: perceived challenges for nurses in accident and emergency units

AIM: This paper reports a study exploring the experiences of nurses in accident and emergency units caring for people with intellectual disabilities. BACKGROUND: People with intellectual disabilities are increasingly in contact with healthcare professionals in accident and emergency units. Often this contact occurs within the accident and emergency service, an area in which staff care for a diverse range of people. The experiences of people with intellectual disabilities within acute general hospitals in the United Kingdom and internationally has largely been reported as quite negative. Conversely, little is known about the experiences of nurses working in acute general hospitals, nor the exact nature of any challenges they encounter, in providing care to people with intellectual disabilities. This lack of understanding weakens opportunities for nurses to reduce barriers to providing an equitable service for people with intellectual disabilities. METHOD: Five focus groups were conducted with 27 accident and emergency nurses from five hospitals in Northern Ireland in the spring of 2004. The data were then coded and recurring themes identified. FINDINGS: This paper focuses on two themes: lack of knowledge of the nature of intellectual disability and dependence on carers. Whilst these themes have been acknowledged in the existing literature, they have received limited attention and exploration. The experience of fear and vulnerability was considered by participants to be a consequence of their lack of knowledge. The experience of these emotions is viewed as a key factor in nurses' over-dependence on patients' informal carers. CONCLUSION: Increased awareness is needed among professionals in accident and emergency units of the abilities and needs of people with intellectual disabilities.     

The experience of general nurses in rural Australian emergency departments

Australia is a geographically unique country with large areas classed as rural. Nurses providing emergency care in rural hospitals face a number of challenges, with rural communities expecting multi-skilled nurses, prepared for a wide range of unannounced situations. Using a mixed method approach, involving questionnaires and focus groups, the study was undertaken in two rural health services in Victoria, Australia. The aim was to explore the experiences of general nurses working in rural hospital settings, with regards to their emergency department responsibilities. The findings indicate that nurses lacked confidence, which they attributed to the sporadic nature of working in the area and the diversity of people who presented. A resultant ‘skills rusting’ was described and nurses identified the need to be a diverse ‘specialist’. Some lack of confidence, particularly in the mental health area, was related to feelings of isolation and lack of context specific education and training. While some excellent emergency specific education and training is available for rural nurses, access is limited by a multitude of constraints. This study found there is an urgent need for local emergency education and training; with nurses showing a strong preference for ongoing professional development incorporating scenario based and context specific education.     

Kicking Eeyore into touch:'living-strong','nursing-strong' and being appreciative and solution-focused

The potential benefits of moving away from a problem/needs oriented approach to a solution-focused, appreciative way of working with children and their families are explored in this paper. It aims to acknowledge and celebrate the expertise of children and their families and the nurses who care for and with them. I draw on both Appreciative Inquiry - a dynamic, dialogic framework for appreciative thinking with people about situations and settings - and Solution-Focused Nursing as means of underpinning my proposal to further shift the way that children's nurses think and work with children and their families and genuinely consider the families' expertise and knowledge. This requires us to be attuned to the diverse ways of experiencing things and multiple ways in which nurses can care with families. It requires us to carefully consider not only what we say but how we say it and the impact that our dialogue with children has on them. Equally it requires children's nurses to acknowledge and celebrate what they do well and embrace and engage with the energy and creativity that underpins strong, resourceful, innovative and expert practice. I propose a manifesto for children's nurses that acknowledges these attributes and encourages us to 'think solutions', to be nurses that children will remember who help children and families to live well and live-strong with their illness.     

Exploring Spanish emergency nurses' lived experience of the care provided for suddenly bereaved families

AIM OF THE STUDY: To investigate the experience of emergency nurses caring for suddenly bereaved family members in the clinical setting, particularly after they are informed about the loss of a loved one. DESIGN/METHODS: Data was obtained from semi-structured interviews with seven emergency nurses drawn from emergency nursing staff working in a Spanish Hospital. Interviews were tape recorded, and hermeneutic-phenomenological analysis was applied to gain understanding from the emergency nurses' experiences. SETTING: The Accident and Emergency department in the Hospital Universitario Insular de Gran Canaria (Spain). Study undertaken in partial fulfillment of the main author's MSc (Department of Nursing and Community Health) at Glasgow Caledonian University. RESULTS: Several themes emerged from those interviews, which appeared to form the basis of the emergency nurses' reality: knowing, relationships, culture and reality. They showed the need to reflect on personal and professional experiences to facilitate personal growth, discover meaning for emergency nurses and examine the possible implications for clinical care. CONCLUSIONS: This study enabled both participants and the researcher to evaluate critically what was troublesome from their perspective and to identify sources of innovation and liberation within everyday practices.     

Keeping experience at the bedside: the emergency consultant nurse role

The consultant nurse concept has not yet been transferred to the military setting. The motivation for developing the role in the NHS was to improve the quality of patient care by strengthening professional leadership and extending the clinical career ladder. The consultant nurse may be defined as an expert in their clinical field, possessing expert leadership and visionary skills. The role is based on four domains: expert practice, professional leadership, education and research. Typically, the emergency consultant nurse spends 50% of their time working clinically, thereby providing senior clinical expertise and adding value to the clinical role. In a military context the consultant nurse role could be perceived as the coming together of the senior command and administrative role and the clinical role. The military has the opportunity to develop a senior clinical emergency nurse role encompassing elements of the civilian consultant nurse model, which may strengthen leadership, provide a central resource of expertise and raise the profile of military nursing. This has the added potential to provide inspiration for junior nurses and retain experienced emergency nurses in the clinical arena.     

Negotiating the boundaries: the experience of the mental health nurse at the interface with the criminal justice system

Community mental health nurses working within the criminal justice system undertake an important function with regard to the strategic intent that wherever possible, mentally disordered persons should receive care and treatment from health and social services. Their precise role, and the particular function of court diversion/assessment schemes, is still being defined. This takes place within a broader context of reorientation of mental health nursing within the move to community care and exposure to the complexity of multidisciplinary working. Examining the experience of mental health nurses in court diversion schemes reveals the intensity of the experience of working in an inter-professional setting without the benefit of preparation or training, and without the frame of reference of a structured health environment. Adaptation of the language of mental health nursing was necessary to effect mutual understanding with other professional groups, and there was a recognition that the competences needed to operate in this environment had not previously been identified as part of their skills base. The result was to bring into question their professional practice and identity as mental health nurses. The handling of patient information in the context of an inter-professional setting remains an issue requiring clarification.     

Nurses' experience in clinical encounters with children experiencing abuse and their parents

Aim and objectives. The aim of this study was to identify nurse’s experiences in the clinical care of children experiencing abuse. The objective was to assess how nurses remain professional especially when the suspected perpetrator is a parent. Background. The diagnosis of child abuse is a difficult one, yet essential because of the high morbidity and significant mortality rates. Young children may be unable to give a clear history; parents may be unwilling to be truthful, and the signs and symptoms of abuse are often not conclusive. A contributing factor to the challenges of providing nursing care to children in a context of abuse is the lack of education in this field. Nurses working in the care of paediatric patients may not be familiar with situations in which they cannot rely on histories provided by parents. Design. A qualitative study. Methods. Investigators used a qualitative design with a critical incident technique. Eleven nurses who cared for abused children and their parents at a tertiary care children’s hospital were interviewed. Results. We highlighted three areas in the analysis of the interviews: Feelings of ambivalence, nurses’ professionalism and the nurses’ care strategies. Participants expressed difficulties in maintaining a professional role in clinical encounters with the parents. The nurses were unhappy in their conflicting roles of both policing (a judging function) and nursing (a caring function). Conclusions. The nurses expressed that they had devised strategies to remain professional in the clinical encounter with abused children and their parents. To remain professional, education, counselling and experience was essential. Relevance to clinical practice. By identifying nurses’ experiences in clinical encounters with children experiencing abuse and their parents, nurses can assess what kind of specific interventions should be used to improve the caring situation.     

Client-centred empowering partnering in nursing

AIM: This paper explores nurses' experiences 1 year after an organization's commitment to providing a client-centred and client-empowering partnering approach to care. BACKGROUND: Historically, nurses' approach to providing care in all nursing contexts has been one of doing for clients, and previous studies have focused more on in-hospital care than on home care. However, the isolation inherent in in-home nursing and nurses' limited professional autonomy and power associated with physician control over patients in home care have been reported, as has their difficulty in finding the meaning and satisfaction of human connectedness and mutuality in nurse-client relationships. Overall, research to date does not inform us about how nurses might make a change toward a more client-centred and client-empowering approach to nursing. METHODS: An interpretive phenomenological design was used to elicit in-depth understanding about Registered Nurses' experiences of providing care using this innovative empowerment model. A purposefully selected sample of eight Registered Nurses participated in in-depth interviews. Data were generated during 2002. Hermeneutic analysis was used to elicit themes and patterns emerging from the data. FINDINGS: Caring, client-centredness and the context of in-home care were important in implementing the new partnering approach. Barriers encountered at system, organizational and personal levels distracted nurses from fully comprehending and enacting the approach. After a year, they had begun to contemplate potential strategies for partnering with clients, but had not yet explored the power of their professional autonomy. CONCLUSION: Nurses are inclined to practise within the expert model of service delivery. They need to work through issues of professional autonomy and rise to the challenge of exercising their autonomy within the current healthcare context if they are to attend more consistently to client-centred empowering partnering. The home care setting offers an excellent environment for achieving these aims.     

Mothers in postdivorce families caring for a child with cystic fibrosis

This study explored the experiences of mothers of children with cystic fibrosis (CF) in postdivorce family structures. In-depth interviews of mothers were conducted by registered nurses with expertise in CF. Interviews focused on responsibility for care of the CF child within the context of postdivorce families (e.g., extent of nonresidential fathers' involvement in children's care, communication between households). Interviews were audiotaped and transcribed verbatim. The constant comparison method was used for analyzing interview data. Marital transitions contributed to the closeness between mothers and children with CF, but they also added to the mothers' sense of being overwhelmed with responsibilities. It is likely that children and mothers are more at risk for stress-related problems when mothers are overburdened by the demands of caregiving, earning a living, and other responsibilities.     

Caring connections with older persons with dementia in an acute hospital setting - a hermeneutic interpretation of the staff nurse's experience

Background: The literature highlights the challenges inherent in caring for older persons with dementia in the acute care context. However despite concerns relating to the quality of care available to persons with dementia in this setting, there is a paucity of research with which to guide practice. Specifically the existing literature lacks in-depth knowledge on nurses' experiences. Aim: The aim of this paper is to report the findings of a study exploring nurses' experiences of caring for older persons with dementia in an acute hospital setting. Methods: Using a hermeneutic approach, a purposive sample of seven nurses was interviewed regarding the research phenomenon. Interview texts were subjected to thematic content analysis. Multiple data sources were employed to expand the horizon of understanding including: the textual data, personal and professional understandings, reflective journal data and conceptual frameworks derived from theoretical and research literature. The data were collected in 2002. Results: The findings reported here relate to the theme 'Meeting the patient as a person'. Meaningful care for the older person with dementia in the acute context required a respectful connection with the patient as person, which required establishing a bond with the person. The meaning of the caring experience was found to relate to the personhood of both the nurse and the patient, experienced within the context of relationship. To make this connection it was necessary to work with those who knew the patient best i.e. relatives/carers. Conclusions: Despite the contextual limitations of the acute setting, the importance of knowing and respecting the person with dementia and the centrality of relationship as the medium within which caring is experienced is demonstrated. However, nurses lack specific knowledge on which to base care. Further research is therefore recommended to identify how care which promotes the integrity of the person with dementia may be effectively operationalized across the acute care setting.     

Relationships between nurses and older people within the home: exploring the boundaries of care

mcgarry J. (2009) Relationships between nurses and older people within the home: exploring the boundaries of care. International Journal of Older People Nursing 5 , 265–273
doi: 10.1111/j.1748-3743.2009.00192.x Aim. To explore the nature of relationships between nurses and older people within the home and to illuminate the nature and quality of caring boundaries within this setting. Background. Older people are increasingly receiving nursing care in the home. There has been little exploration of the nature of the nurse–older patient relationship within this setting. Methods. An ethnographic approach using semi-structured interviews with 16 community nurses and 13 older patients (aged 65 years and over), were undertaken to explore the nature of care relationships within the home setting. Findings. The study has highlighted the centrality of the location of care and the concept of ‘the home’ in terms of geographical and metaphorical meanings. Moreover, the study has clearly illuminated the complex nature of relationships and boundary construction from a number of perspectives. Conclusion. As the location of care for older people continues to move closer to home it is crucial that the implicit qualities that are valued within nurse–patient relationships within this context of care, and which contribute to the quality of care, are recognized and made more explicit at the organizational and policy level. Practice implications. For nurses working within the home there is a clear impetus to clearly define and articulate the full breadth of their role, the nature of relationships and issues surrounding professional boundary construction within this environment. There is also a need for the core qualities that underpin the receipt of care within the home and the facets of the nurse–patient relationship valued by older people to be fully recognized and accounted for.     

The experiences of providing children's palliative care education in undergraduate nursing programmes--a discussion of some practical issues

Despite recent proliferation of palliative care services for children, and the fact that the needs of these children and their families are enshrined in current policy directives, the challenges of providing education for nurses within this area of practice is largely underexplored. This paper examines some of the key issues facing nurse educators who are involved in the delivery of palliative care content in undergraduate children's nursing programmes. Drawing on the extensive experiences of two nurse educators in children's palliative care education, research and practice, key issues which should be considered by those involved in curriculum development and delivery will be outlined. Such issues include ambiguity in terminology and resultant lack of conceptual clarity, the limited evidence base to underpin practice and education, the complexities of teaching sensitive topics to large groups and limited teaching expertise to deliver the content. Suggestions for addressing such issues will be outlined.     

Navigating stroke care: the experiences of younger stroke survivors

Abstract

Purpose: Although stroke is associated with ageing, a significant proportion of strokes occur in younger people. Younger stroke survivors have experienced care available as inappropriate to their needs. However, insufficient attention has been paid to how the social context shapes their experiences of care. We investigated this question with younger stroke survivors in Greater London, UK. Method: We conducted in-depth interviews with individuals aged between 24 and 62 years. Interviews were analysed thematically, with interpretation informed by Bourdieu’s concepts of field, capital and habitus. Results: In the acute care setting it was implicit for participants that expertise and guidance was to be prioritised and largely this was reported as what was received. Individuals’ cultural capital shaped expectations to access information, but health care professionals’ symbolic capital meant they controlled its provision. After discharge, professional guidance was still looked for, but many felt it was limited or unavailable. It was here that participants’ social, cultural and economic capital became more important in experiences of care. Conclusions: The field of stroke shaped younger stroke survivors’ experiences of care. Navigating stroke care was contingent on accessing different forms of capital. Differences in access to these resources influenced longer term adjustment after stroke.

• Implications for Rehabilitation

• Stroke care can be conceptualised as a temporal field of social activity and relationships which shapes variations in experiences of care among younger stroke survivors, and differences in expectations of support at different time points after stroke.

• On entering the field of stroke participants reported needing health care professional guidance and expertise to manage the acute event, yet difficulties accessing information in hospital limited the agency of some individuals wanting to take an active role in their recovery.

• After discharge from hospital variations in experiences of care among participants were more evident, with a number still seeking professional guidance, and requiring the capital and agency to navigate the field of stroke.

• Despite international efforts to improve the quality of acute care, effective models of community stroke care still need to be developed.

     

Role of a paediatric nurse in primary care 1: research issues

This study, which looked at the potential for the role of a paediatric nurse in primary care, was a tripartite partnership arrangement with Community Health Sheffield NHS Trust, the University of Sheffield and the Children's Hospital Sheffield. The study focused on the role and function of two qualified children's nurses each working within a different primary healthcare team (PHCT). It was important to allow the role to evolve without undue pressure, so that members of the PHCT could work with the nurses to establish what would be the most useful and relevant tasks to be carried out by the team. The methodological problems posed in this type of study where little was known about how a children's nurse would work in a PHCT resulted in exploring the concept of a formative evaluation process. The major data source and contribution to the evaluation were the nurses' reflective accounts of their role and function as members of the PHCT. Case studies written in the form of reflective diaries provided a self-critical approach to the record of tasks undertaken and explained why the service was taken up. Five constructions emerged: duplication and perceived threats to established nursing roles within the PHCT; improved care of children in PHCT settings; the nature of support for children and families; working as a nurse practitioner; and meeting unmet need. A clear need was demonstrated for a qualified children's nurse working in a community setting to raise the overall support and quality of care for a whole range of conditions which are currently low profile. There was evidence that these nurses met unmet need and were, at times, functioning as nurse practitioners and at times as advanced practitioners. This article, the first of two parts, focuses on the methods used and the associated problems. The second part will present the findings and discussions of the research.     

Registered children's nurses in emergency departments in England: an exploratory survey

Recent reports suggest that emergency departments in England are some way from achieving universal provision of specific facilities for children and young people staffed by practitioners with appropriate qualifications. In 1998, 74 per cent of emergency departments employed children's nurses, but only 8 per cent employed them in sufficient numbers to provide 24-hour cover (Smith 1998). AIM: To establish whether there has been an increase in the number of children's nurses employed within emergency departments and to identify their specific roles and responsibilities. METHOD: A postal questionnaire was sent to senior managers of 99 general emergency departments in England with annual new attendance figures of between 45,000 and 100,000. Specific paediatric emergency departments and general departments in the London region were excluded. RESULTS: Analysis of data from the 52 valid responses suggest that although children comprise around 25 per cent of workload, registered children's nurses make up 10 per cent of the workforce in general emergency departments. The number employed in each department varied from one to 13 whole time equivalents (WTEs), and three departments did not employ any at all. In 11 of the 52 departments children's nurses were employed to specifically care for children; in other departments their main responsibilities were training other staff and developing and implementing policies and protocols. Fifty one of the 52 departments employed emergency nurse practitioners (ENPs). Children's nurses were employed as ENPs in 30 of the departments (total 46), a mean of 1.5 WTE per department. A quarter of the ENPs who were not registered children's nurses were reported to have received no additional training before being deemed competent to assess and treat children. CONCLUSION: There has been an increase in the numbers of children's nurses employed in general emergency departments but the numbers are still too low to comply with policy requirements. Managers should ensure that the skills of children's nurses are used to the full, and ENPs need to consider legal and accountability issues if they are asked to assess and treat children without having accessed appropriate training.     

Children visiting family and friends on adult intensive care units: the nurses' perspective

Recent surveys show that children are still restricted from visiting their critically ill family and friends on many adult intensive care units throughout the country. The purpose of this small-scale exploratory pilot study was to examine and describe the experiences and perceptions of trained nurses towards children visiting within this setting. The aim of the study was to gain greater insight and understanding into the reason why, despite evidence to support the benefits to children of visiting their critically ill family and friends, they remain discouraged and restricted. It is hoped that the study will act as an initial enquiry to generate themes and further research questions. A qualitative research approach was adopted and in-depth focused interviews used as a method of data collection. The participants of the study were trained nurses working on an adult intensive care unit in a district general hospital in England. A total of 12 individual interviews were conducted which were audiotaped in full and analysed using a method of thematic content analysis. The value of the research is to promote family-centred care within an adult intensive care environment to meet the neglected needs of the well children of the critically ill person. The findings suggest that the participants in the study attempted to offer valuable support to children visiting their critically ill family and friends, but, despite an open visiting policy, children rarely visited within this setting. The desire of the well parent to protect and shield the child from the crisis of critical illness was perceived by the participants to be the main reason why they did not visit. To provide family-centred care within an adult intensive care setting has many implications for practice and several of these important issues are discussed. These include the educational and training needs of nursing staff and the importance of adopting a collaborative team approach to providing care for the critically ill person and their family. The need to generate research and literature from within the United Kingdom's health care system has also been identified and recommendations for further studies are proposed.     

Evidence-Based vs Informal Suicide Training: Nurse Confidence and Comfort With Suicidal Patient Care

IntroductionEmergency nurses are on the front line of patient care for suicidal persons, yet many nurses report feeling unprepared to effectively manage suicidal patients owing to a lack of suicide-specific training. The purpose of this study was to examine the suicide-specific training experiences of emergency nurses and evaluate how training relates to burnout, confidence, and comfort working with suicidal patients.MethodsEmergency nurses at critical access and community hospitals completed an anonymous online survey during work hours. The survey included questions about training experiences, burnout, confidence, and comfort working with suicidal patients, perceptions of the quality and interactive nature of training, and desires for future suicide-specific intervention training.ResultsGroup comparisons among the 117 emergency nurses revealed that those who received evidence-based/expert-delivered training reported greater confidence, comfort, and perceived ability to treat suicidal patients and lower burnout than those who received informal or no training. Those with informal training reported greater confidence and ability to treat suicidal patients, but similar levels of comfort and burnout as those with no training. Mediation analyses showed that training was associated with greater comfort working with suicidal patients through its effect on increased confidence. A majority desired additional suicide-specific training.DiscussionEvidence-based/expert-delivered professional training in suicide intervention is associated with improved confidence, comfort, and perceived ability to care for suicidal patients and lower burnout. Providing evidence-based suicide intervention training may improve quality of care for suicidal patients by improving emergency nurse confidence and comfort for treating these high-risk patients.     

Nurses experiences in chemical emergency departments: Iran–Iraq war, 1980–1988

BackgroundNurses have played a major role in taking care of the wounded across the centuries. One of the most important roles of Iranian nurses in wartime has been working in chemical emergency departments. This study investigated the nature of nursing practice in chemical emergency departments created in the context of the Iran–Iraq War fought during 1980–1988.MethodThis is a history methodology design with oral history and in-depth interview to detect nurses ‘actual experiences in chemical emergency departments while taking care of the chemically injured military forces.FindingsToday’s nurses emphasize finding new ways to fulfill the present nursing needs and to combine theory and practice in an appropriate framework.Having a retrospective approach to utilize nurses’ experience can well clarify the future way to achieve this goal.ConclusionThis study revealed the way the nurses prepared to take care of the chemically injured in miserable situations and their practice in chemical emergency departments. It highlighted their awareness of wartime nursing and the challenging experiences it brings.     

Nurse prescribing by children’s nurses: views of doctors and clinical leads in one specialist children’s hospital

Aim. To explore the views of doctors and clinical leads (CLs), who care for children and young people, on nurse prescribing in one specialist children’s hospital. Background. Nearly 14,000 nurses in the UK have virtually the same prescribing rights as doctors. Benefits of nurses adopting this role have been reported, but doctors do have some concerns. Increasing numbers of specialist nurses involved in the care of children in the hospital setting are undertaking prescribing training. No research has explored the views of health care professionals on nurse prescribing in this setting. Design. A subset of qualitative data taken from a larger study that adopted an intrinsic case study design. Method. Interviews were conducted between October 2006–July 2007 with 11 doctors and three clinical leads in one specialist children’s hospital. A thematic analysis was conducted on the interview data. Results. Nurse prescribing improved access to medicines and continuity of care. Concerns included the need for doctors to have confidence in the ability of the nurse who wanted to become a prescriber, the selection of nurses for prescribing training, the effects of nurse prescribing on the individual roles and responsibilities of doctors and nurses’ clinical skills. Conclusion. Doctors and clinical leads working in a specialist children’s hospital in the UK recognise that nurse prescribing makes a positive contribution to the delivery of services. However, it is important that nurses have the appropriate clinical skills and doctors understand nurse prescribing. This will only take place if there is good communication across professional boundaries. Relevance to clinical practice. Selection processes for the prescribing programmes must ensure that students have the necessary course prerequisites. Communication across professional boundaries is crucial to the successful implementation of nurse prescribing in the care of children and young people in the hospital setting.