Interaction between adult patients' family members and nursing staff on a hospital ward

The purpose of this study was to generate knowledge of the interaction between an adult patient's family members and nursing staff from the staff's perspective. Data were collected from nursing staff (n = 155) working on the wards and out-patient departments for pulmonary, rheumatic, neurological and gastroenterological diseases at a university hospital by using a new questionnaire based on earlier research and the literature. The questions explored the staff's views of interaction with the adult patient's family members. In this study, interaction is seen as an umbrella concept which encompasses giving information to relatives, discussion, contacts between staff and significant others and working together. The instrument included questions about personal and telephone discussions, the provision of written instructions and factors facilitating and complicating interaction. The response rate was 55%. The data were analysed using SPSS software and examined using frequency and percentage distributions and cross-tabulation. The open-ended questions were analysed using qualitative content analysis by reducing, grouping and abstracting the data inductively. Discussions with relatives while they visited the patient in hospital were the commonest form of interaction. The majority of respondents perceived the interaction with the patient and knowing his or her family members as important. Less than one-fourth of the respondents started discussion with family members, while the majority expected family members to initiate interaction. The majority of respondents perceived the patient's presence in discussion as important, but sometimes they thought it was necessary to discuss with family members without the patient. The staff discussed with family members mainly in the ward office or in patient rooms, which were, however, not perceived as peaceful. Discussions primarily pertained to the patient's condition, discharge from hospital and planning of continued treatment. The majority of respondents reported that the opportunity for discussion offered by staff, the patient's positive attitude towards discussion with the family and family members' own interest facilitated interaction. The staff's haste and shift-work, family members' shyness of approaching the staff and the absence of a peaceful place for discussion serve to complicate interaction. Family members are primarily seen as informants and recipients of information. The staff's ability to recognize the importance of family members to successful patient care is relatively adequate. However, insufficient attention is paid to family members and their need for support.     

Culturally diverse patient--nurse interactions on acute care wards

The nurse-patient interaction is central to providing nursing care. This qualitative study explores nurses' and culturally diverse patients' experiences within nurse-patient relationships in acute care wards. Eight nurses and their respective patients volunteered to join the study and were interviewed. The three themes identified in relationships between nurses and culturally diverse patients were shared tension, perceived difference and held awareness. It is concluded from the study that relationships between nurses and culturally diverse patients in acute care wards during short episodes of hospitalization are not easy for nurses and need to receive deeper consideration as to how they can be developed more effectively. It is recommended that educational support be provided to develop more effective interactions between nurses and patients with research being carried out to investigate factors that can strengthen culturally diverse patient-nurse interactions in acute care settings.     

A communication intervention for nursing staff in chronic care

Title.  A communication intervention for nursing staff in chronic care.
Aim.  The paper is a report of a study conducted to evaluate the effect of a brief, focused educational intervention on the quality of verbal interactions between nursing staff and patients in a chronic care facility.
Background.  Positive nurse–patient communication in chronic care is crucial to the quality of life and well-being of patients. Despite this, patients are dissatisfied with these interactions and nursing staff indicate the need for additional training.
Method.  A repeated-measures design was used to collect data between April 2003 and February 2004, by audiotaping verbal interactions between nursing staff and patients during morning care. Baseline data were analysed and an educational intervention was developed based on the results of the pretest. Five months after the educational intervention, interactions between the same nursing staff and patients were audiotaped. Twenty-seven randomly chosen patients and selected nursing staff participated in the study. Data were analysed using a qualitative comparative method, and a quantification technique was developed to compare the quality of the interactions before and after the intervention.
Findings.  Preintervention interactions were task-oriented, superficial and dominated by nursing staff. Results statistically significantly improved after the intervention was implemented. Nursing staff were less authoritative, used more solution-focused communication and interactions had a statistically significantly higher positive ratio.
Conclusion.  Brief interventions can change nursing staff's communication practice and they realized the importance of effective communication as a fundamental component to deliver patient-focused care.     

Power in telephone-advice nursing

LEPPÄNEN V. Nursing Inquiry 2010; 17 : 15–26
Power in telephone-advice nursing
Power is a central aspect of nursing, especially in telephone-advice nursing, where nurses assess callers' medical problems and decide what measures that need to be taken. This article presents a framework for understanding how power operates in social interaction between nurses and callers in telephone-advice nursing in primary care in Sweden. Power is analysed as the result of nurses and callers being oriented to five social structures that are relevant to their actions in this context, namely the organization of telephone-advice nursing, the social stock of medical knowledge, the professional division of labour between nurses and doctors, structures of social interaction and structures of emotions. While structural constraints govern some actions to a high degree, calls take place in an organizational free room that give nurses more leeway for acting more creatively. The discussion focuses on the introduction of new technologies of control, for instance computerized decision support systems and audio recording of calls, and on how they reduce the free room. Empirical data consist of 276 audio-recorded telephone calls to 13 nurses at six primary-care centres and of qualitative interviews with 18 nurses.     

'Something always comes up': nurse-patient interaction in an acute psychiatric setting

In this study, 10 nurses and 10 patients were interviewed to explore factors influencing nurse-patient interactions in an acute psychiatric inpatient facility. The six themes that emerged from the nursing interviews were; environment, something always comes up, nurses' attributes, patient factors, instrumental support and focus of nursing. The four themes from the patient interviews were; nurses' attributes, role perceptions, clinical care, and time. These findings have implications for clinical practice, the nurses' role and nursing education.     

Patients' and nurses' perceptions of nursing problems in an acute care setting

AIM: This paper reports a study to determine the degree of agreement or disagreement between nurses and patients in their perceptions of the presence, severity, and importance of nursing problems. BACKGROUND: Patient experiences, values and preferences are increasingly acknowledged as important factors underpinning healthcare decision-making. The ability to identify patient problems accurately is an important prerequisite for planning and implementing individualized high quality care. METHODS: A convenience sample of patients (n = 80) and Registered Nurses (n = 30) in an acute care setting responded to a 43-item questionnaire. Findings. Nurses identified patients' problems with a sensitivity of 0.53 and a positive predictive value of 0.50. Patients identified several severe problems that were not identified by nurses, particularly problems with nutrition, sleep, pain, and emotions/spirituality. Nurses underestimated the severity in 47% of mutually-identified problems. An overall level of agreement of 44% was found on the importance of patient problems. Low levels of agreement on severity and importance were related more to individual differences than to systematic differences. CONCLUSIONS: Nurses need to be more aware that patients and nurses often hold disparate views of the priorities in nursing care. To plan individualized nursing care effectively, nurses need to elicit and use individual patients' preferences more systematically in care planning.     

Verbal and social interactions in the nurse-patient relationship in forensic psychiatric nursing care: a model and its philosophical and theoretical foundation

The present paper focuses on the nurse-patient relationship in forensic psychiatric care. From research in the field six categories of nurse-patient interactions are identified: 'building and sustaining relationships', 'supportive/encouraging interactions', 'social skills training', 'reality orientation', 'reflective interactions' and 'practical skills training'. The content of each category of interaction in the context of forensic psychiatric care is described. A conceptual model is presented together with an empirical, philosophical and theoretical foundation for the use of verbal and social interactions in nurse-patient interactions in forensic psychiatric nursing care. The implications and possible uses of the model in the practical field of forensic psychiatric care are discussed.     

Bourdieu's theory of practice and its potential in nursing research

AIMS: This paper seeks to consider the utility of Bourdieu's "Theory of Practice" in nursing, and considers specifically its use as a framework for research exploring nurses' conceptualizations of illness and the patients in their care. Bourdieu's work uses the concepts of field, capital and habitus to explain interactions within the social world. This paper describes these concepts and their relationship with nursing is discussed using dementia care as an example. BACKGROUND: The work of French scholar Pierre Bourdieu has contributed to debates throughout the social sciences, but has had relatively little attention in the nursing literature. Pierre Bourdieu's work developed against a backdrop of change in the academic world. The emergence of the social sciences and the debate around objective and subjective styles of research were influential in the development of his "Theory of Practice". DISCUSSION: The importance of the conceptualization process is discussed, and the considerable potential influence of conceptualization on patient care is highlighted. Reflexivity is a cornerstone of Bourdieu's work, and is an important feature of nursing research. Examples of health care research using his work as a framework are discussed, and some of the challenges of the approach are outlined. CONCLUSIONS: The use of Bourdieu's "Theory of Practice" as a research framework could allow nurse researchers to explore the interactions of nurses with the structures, agents and symbols of illness within the field of care. This work could enhance understanding of how nurses view and react to patients in their care, and promote the development of practice innovations and policy change. The theory may, therefore, have much to offer future nursing research.     

Dying at home: nursing of the critically and terminally ill in private care in Germany around 1900

Over the last twenty years, 'palliative care' has evolved as a special nursing field in Germany. Its historic roots are seen in the hospices of the Middle Ages or in the hospice movement of the twentieth century. Actually, there are numerous everyday sources to be found about this subject from the nineteenth century. The article at hand deals with the history of nursing the terminally ill and dying in domestic care in the nineteenth century. Taking care of and nursing the dying was part of everyday routine in the nursing care as practiced by the deaconesses and sisters in those days. Mit der Seelenpflege bei den unheilbar Kranken und Sterbenden schufen die Kaiserswerther Diakonissen sich einen von Ärzten unabhängigen Kompetenzbereich. Meine Analysen zur Privatpflege zeigen jedoch darüber hinaus, dass die in ihrer Aufmerksamkeit auf das Mutterhaus ausgerichteten Diakonissen auch in Leibespflege sehr viel unabhängiger von den Ärzten zu agieren schienen als die freien Krankenschwestern. The article takes a look not only at the actual nursing activities but also at the relationship between the sisters and their patients and their relatives and the family doctor. On the basis of the recorded letters which the nurses wrote to the deaconess motherhouse in Kaiserswerth, it is also possible to analyze how the deaconesses communicated and reflected their actions at the deathbed.     

精神病人社会支持状况测评及护理对策

目的:了解住院精神病人的社会支持情况。方法:应用社会支持评定量表对113例住院精神病人进行测评。结果:113例住院精神病人SSRS评分显著低于内科住院病人(P<0.01),且家庭次要地位者其主观支持、对支持的利用度和支持总分均显著低于家庭主导地位者(P<0.05),男、女性别之间无统计学意义(P>0.05)。结论:精神病人的社会支持明显不足,且家庭地位次要者获得的社会支持更少。因此,要加大精神卫生知识的宣传力度,充分发挥家庭和社会的支持作用,促进病人早日康复。     

Utilization of patient classification systems in Swedish hospitals and the degree of satisfaction among nursing staff

BACKGROUND: Although patient classification tools have been used in Sweden since the 1980s, few studies have examined how they are utilized and monitored. AIM: This paper investigates the patient classification systems implemented in hospitals in the country as well as the level of satisfaction of nurses with the implemented instrument. METHOD: A postal survey method was used in which a total of 128 questionnaires were sent to nurse managers. Twenty-three hospitals were identified with patient classification systems currently in operation. RESULTS AND CONCLUSION: The Zebra and Beakta systems are the most commonly used instruments. Nurse managers appear to be satisfied with the patient classification systems in use on their wards as a whole except for their inability to measure the quality of care provided, the time spent to use the instruments and the fact that the administration do not estimate nursing staff requirements using the system.     

Verbal and social interactions in Swedish forensic psychiatric nursing care as perceived by the patients and nurses

Patients and nurses in a Swedish forensic psychiatric unit filled in a questionnaire Verbal and Social Interactions designed to survey patients' and nurses' views on the frequency and importance of nursing interactions in forensic psychiatric care. The patients perceived the 'supportive/encouraging interactions' and the 'reality orientation interactions' as the most frequent interactions and the 'supportive/encouraging interactions' and the 'social skills training' as the most important interactions. The nurses perceived the 'supportive/encouraging interactions' and the 'practical skills training' as the most frequent and the 'supportive/encouraging interactions', 'interpretative interactions' and the 'practical skills training' as the most important interactions. There were significant differences between patients' and nurses' perceptions about the frequency of all the different groups of interactions, but greater agreement as to the importance. In general, the patients perceived that the interactions occurred less frequently than the nurses. The differences between patients' and nurses' perceptions on the interactions as well as the clinical implications of these differences are discussed.     

The multidimensionality of caring: a confirmatory factor analysis of the Caring Nurse-Patient Interaction Short Scale

Title. The multidimensionality of caring: a confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale Aim. This paper is a report of a study to evaluate the construct validity of the four‐dimensional Caring Nurse–Patient Interaction–Short Scale using confirmatory factor analysis. Background. Validating theoretical structures of caring is an ongoing challenge in the discipline of nursing. Our previous work has contributed to this literature by the exploration of the dimensionality of the Caring Nurse–Patient Interaction Short Scale via an exploratory factor analysis. The Caring Nurse–Patient Interaction Short Scale comprises 23 items reflecting four caring domains: humanistic care, relational care, clinical care and comforting care. Method. A methodological study was conducted involving a convenience sample of 531 nursing students in a baccalaureate nursing programme (20% were already Registered Nurses). Data were collected in 2002 and 2004. Confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale was performed. Findings. As expected with large samples and models, the chi‐squared‐associated P‐value was statistically significant (χ² = 811·43, d.f. = 224, P < 0·01). However, the other indices reached acceptable levels with 0·054 for the standardized root mean‐squared residuals, 0·070 for the root mean‐square error of approximation, 0·88 for the goodness of fit index, 0·98 for the comparative fit index and 0·97 for the normal fit index. The factor loadings for all items with their hypothesized factor were ≥0·48 and statistically significant at the 0·01 level. Conclusion. The Caring Nurse–Patient Interaction Short Scale model was judged to fit the data adequately. Although further testing of the scale with different samples of patients is warranted, our model emerged as a middle‐range theory during the construct validity process and still reflects Watson’s theory while offering a structure that is testable in clinical research.     

The professional development of nursing through different aspects of the caring practices of nurses: nursing the patient person in a geriatric assessment unit

The caring component of nursing practice has become an increasingly visible activity of nursing. Consequently, a growing amount of research has explored the role caring plays in nurse practice. Research often explores the activities of caring or its moral agenda, rather than motivation. This study broadens the discussion about nurses and caring practice by examining nurses approaches to different aspects of the caring practices of nurses for the aged in a Geriatric Assessment Unit (GAU). Data collection involved semi-structured interviews and participant observation within the GAU. Four categories of themes emerged as different aspects of the caring practices of nurses. Three fit within the professional development of nursing: physical caring, negotiative caring and relational caring. A fourth, motivated caring, however, provides an additional aspect of caring located within and beyond professional development.     

住院精神病患者拒药行为分析与护理对策

目的 探讨住院精神病患者拒绝药物治疗的原因及护理对策.方法 对526例住院精神病患者中拒药患者的资料进行调查,并对其进行护理干预.结果 出现拒药行为178例(33.8%),其中直接拒药142例(79.8%),藏药36例(20.2%);首次住院患者106例(59.6%);拒药患者中主要原因是对疾病缺乏自知力,认为自己没有病,不需要治疗(57.3%).结论 护理干预能消除或缓解患者的拒药心理和行为,提高患者对药物治疗的依从性,缩短住院时间.     

The impact of ward design on the behaviour,occupational satisfaction and well-being of psychiatric nurses

Studies have shown that modifications to the physical environment of psychiatric institutions are associated with positive changes in patients' behaviour, attitudes and perceptions. However, little attention has been paid to the impact such modifications to the physical environment have on the nursing staff. The building of two completely new wards at a rural psychiatric hospital provided an opportunity to examine this issue. Measures of the nursing staffs' observed behaviour and self-ratings of burnout and job satisfaction were obtained in both the old and the new wards. The results showed that the new wards were associated with largely positive changes in behaviour and increased burnout, but there was no change in job satisfaction. However, it was clear that a vital component in the success of any environmental manipulation is an appropriate, corresponding change in the organizational climate .     

Ward safety perceived by ward managers in Britain, Germany and Switzerland: identifying factors that improve ability to deal with violence

Little is known about how safe nurses feel on psychiatric wards across different European countries. This paper is aim to evaluate how ward safety is perceived by ward managers in Great Britain, Germany and Switzerland. We replicated a Swiss questionnaire study in Germany and Britain, which asked ward managers on adult psychiatric wards to give details about their ward including data on the management of aggression, staffing levels, staff training, standards and type of restraint used, alarm devices, treatment and management of aggression and the existence and perceived efficacy of standards (protocols, guidelines). The British sample had by far the highest staffing levels per psychiatric bed, followed by Switzerland and Germany. The British ward managers by far perceived violence and aggression least as a problem on their wards, followed by Germany and then Switzerland. British ward managers are most satisfied with risk management and current practice dealing with violence. German managers were most likely to use fixation and most likely to have specific documentation for coercive measures. Swiss wards were most likely to use non-specific bedrooms for seclusion and carry alarm devices. British wards were far more likely to have protocols and training for the treatment and management of violence, followed by Switzerland and Germany. British ward managers by far perceived violence and aggression to be a small problem on their wards compared with Swiss and German ward managers. This was associated with the availability of control and restraint teams, regular training, clear protocols and a lesser degree risk assessments, but not staffing levels.