Variations among nurses in behavioral intentions toward the dying.

The purposes of this study were to describe nurses' behavioral intentions toward the dying and to determine if they were related to selected characteristics of nurses caring for the dying. A questionnaire containing behavioral intention items and a characteristics profile was completed by 372 registered nurses working in a variety of settings in one midwestern state. Analyses of the data suggested that although nurses were very likely to provide general nursing care and to communicate openly with the dying, they were not likely to provide continuing care for bereaved family members. Major implications of the study were that the continuing care needs of bereaved family members are not being met by nurses in traditional health care settings, and that different groups of nurses have different approaches to care of the dying as well as different learning needs.     

Negotiation. A skill for nurses

As cutbacks and health care reform bring changes to nurses' roles and health care structures, conflict almost invariably arises. Clashes stem from unclear expectations about new roles, poor communication between management and staff, a lack of clear jurisdiction over changing responsibilities, personal differences in approaches to nursing and conflicting interests as different departments struggle to maintain their share of the health care dollar. The friction could be at the individual or the group level; it might exist between shifts of nurses, between nurses and their managers, or between nurse managers and other administration. In all cases, you, the nurse, are the one who must deal with it.     

Teamwork in primary care: the views and experiences of nurses, midwives and health visitors

This paper reports on findings from a study of teamwork in primary care in one family health services authority in England It is based on interviews using a semi-structured questionnaire with practice nurses, district nurses, health visitors and midwives in 20 practices Six topics emerged as important in relation to the views of nurses, midwives and health visitors and their experiences of teamwork team identity, leadership, access to general practitioners, philosophies of care, understanding of team members' roles and responsibilities, and, disagreement regarding roles and responsibilities Differences in the various views and experiences of teamwork were identified Midwives and health visitors emerged as the least integrated members of the primary health care team Recent changes to the organization of primary health care services, as well as professional changes, are seen as accounting for the different experiences of the nursing groups The potential for teamwork in the future is discussed     

Variations Among Nurses in Behavioral Intentions Toward the Dying

The purposes of this study were to describe nurses’ behavioral intentions toward the dying and to determine if they were related to selected characteristics of nurses caring for the dying. A questionnaire containing behavioral intention items and a characteristics profile was completed by 372 registered nurses working in a variety of settings in one midwestern state. Analyses of the data suggested that although nurses were very likely to provide general nursing care and to communicate openly with the dying, they were not likely to provide continuing care for bereaved family members. Major implications of the study were that the continuing care needs of bereaved family members are not being met by nurses in traditional health care settings, and that different groups of nurses have different approaches to care of the dying as well as different learning needs.     

Mental Health Nurses' Work with Family Caregivers of Older People with Depression: Review of the Literature

Australia, along with the rest of the world, is moving towards providing mental health services in the community rather than in hospital settings. This raises critical questions of what the impact of community-based care is on family members of people with mental illness, and how mental health care professionals, particularly mental health nurses, work with these family members to meet their needs. Considering the current trend of an increasingly aging population, the issue of late-life depression needs further attention, as it is known to be the most common mental illness in the elderly. The purpose of this article, therefore, is to paint a picture of family caregiving in the mental health arena, identify important roles that community mental health nurses play in this context, and address the significant gaps in the knowledge and nursing practice regarding community mental health nurses' work with families of older patients suffering from depression.     

Mental health nurses' work with family caregivers of older people with depression: review of the literature

Australia, along with the rest of the world, is moving towards providing mental health services in the community rather than in hospital settings. This raises critical questions of what the impact of community-based care is on family members of people with mental illness, and how mental health care professionals, particularly mental health nurses, work with these family members to meet their needs. Considering the current trend of an increasingly aging population, the issue of late-life depression needs further attention, as it is known to be the most common mental illness in the elderly. The purpose of this article, therefore, is to paint a picture of family caregiving in the mental health arena, identify important roles that community mental health nurses play in this context, and address the significant gaps in the knowledge and nursing practice regarding community mental health nurses' work with families of older patients suffering from depression.     

Registered Nurses working together with family members of older people

Aim. The aim of the study was to reach a more profound understanding, through looking at nurses’ working situation, of those factors that influence how nurses are able to work together with family members of older people living in nursing homes or similar facilities. Background. Working with the care of older people as a Registered Nurse provides a varied job with many challenges. Nurses have to co‐operate with family members of those in community health care. Co‐operation is important and necessary for all involved. Design. Nurses working in elder care in a geographically defined area received a questionnaire with three open‐ended questions, on the difficulties and/or problems involved with working together with family members, and the positive or negative aspects of this co‐operation. Methods. Analysis was carried out using the latent content analysis method. Results. Three themes, problems within the system, interaction with families and caring in nursing work, are presented with categories and their subcategories. The nurses wanted their superior to be a nurse so that their working situation would be better understood. Appreciation from their superior and family members was also a very important part of their work as nurses in community health care. The frequent changes and the lack of time in the work of elder care often put nurses under considerable psychological pressure. For the most part family members are a resource for the elder, but sometimes they will avoid contact, which will make co‐operating difficult. Conclusion. Registered Nurses and family members are dependent on each other in their care of the elder. Relevance to clinical practice. More attention should be paid to the working situation of Registered Nurses in community health care, and their ability to work together with family members of older people.     

Resource allocation decisions in critical care nursing

One of the major challenges for critical care nurses is to distribute their professional services in a manner that is consistent with the moral imperatives of nursing. The central values of respect for individual patients, patient-centered beneficence, full beneficence, and justice must be woven together into an ethical framework that assists nurses in allocating their skills. Professional organizations, such as the AACN, are actively trying to order this ethical disorder by proposing guidelines that, on the one hand, acknowledge societal interests in cost-effective utilization of health care resources, and on the other hand, safeguard the interests and well-being of individual patients. In addition to the guidance from professional organizations, health care institutions should address the inequities in health care by developing policies that guide the health care team through an ethical decision-making process. Nurses, as members of the multidisciplinary health care team and as members of an essential and scarce resource, should participate in formulating these directives. Not only is bedside and institutional involvement important, but participation at the local, state, and national levels will empower nurses to influence decisions of resource allocation at the micro and macro levels.     

Towards relational recovery: Nurses’ practices with consumers and families with dependent children in mental health inpatient units

Facilitating parent–child and family connections during parental hospitalization provides important opportunities for mental health services to support individual and family recovery. Nurses are often the primary point of contact for families in the inpatient context. They play an integral role in the care provision of consumers and families and in supporting consumers’ recovery. The aim of the present qualitative study was to explore nurses’ practice with families in inpatient mental health settings in the context of designated family rooms. Three themes were derived from the thematic analysis of semistructured interviews with 20 nurses from four mental health inpatient units. Nurses experienced tensions within their roles in balancing safety and risk, a lack of confidence in family‐focused practices in relation to role expectations, and challenges in juggling nursing care ideals with the contemporary realities of inpatient practice. A family‐centred relational recovery approach is recommended for mental health services, which is underpinned by family‐focused policies and processes, and supported at an organizational, managerial, and local‐unit level. At an individual level, nurses need professional development on the models of care they practice in, explicit role clarity on their practice with families, and education on evidence‐based brief family interventions.     

New opportunities for nurses as patient advocates

OBJECTIVES: To define the role of nurses as patient advocates and to explore new strategies for the future. DATA SOURCES: Review articles, research studies, education and communications materials, and personal experience with oncology professionals, patients, and family members. CONCLUSIONS: Cancer nurses' roles in patient advocacy have progressed and grown as the profession of oncology nursing has itself matured. As resources continue to diminish, nurses need to consider the power of their roles as change agents, coordinators, and directors as well as interventionists. IMPLICATIONS FOR NURSING PRACTICE: There are many needs for research in this area as well as new roles for nurses who care for patients. Nurses need to be aware of ongoing research in areas such as health communications and consider partnering with persons in these other disciplines to enhance productivity and to use their time most efficiently.     

History of the roles of nurses caring for persons with mental retardation

A historic examination of the major responsibilities of nurses in providing care to individuals with mental retardation indicates that the responsibilities have remained relatively constant, whereas the roles have shifted and expanded over time from nursing assistant activities to advanced practice roles. Regardless of the setting, nurses have been involved in primary and secondary prevention, case finding, health care management of the individual with mental retardation and their family across the life span, instruction about this care to other nurses, and referral. This specialty nursing practice has a long history. In recent years, the role of nurses in interdisciplinary care has waned with the continual trend of institutional closings and movement of the clients to small community group homes. As individuals with mental retardation achieve greater participation in their communities, the roles and responsibilities of nurses who specialize in the care of persons with mental retardation will also change, but much effort is needed today to enforce nursing's contribution in this field to the other disciplines involved in the care of these individuals and to society. The recent Surgeon General's report [57], Closing the Gap: A National Blueprint for Improving the Health of Individuals with Mental Retardation (2001), could serve as such a springboard for renewal of nursing action in this field.     

A family nursing educational intervention supports nurses and families in an adult intensive care unit

The family experience of critical illness is filled with distress that may have a lasting impact on family coping and family health. A nurse can become a source of comfort that helps the family endure. Yet, nurses often report a lack of confidence in communicating with families and families report troubling relationships with nurses. In spite of strong evidence supporting nursing practice focused on the family, family nursing interventions often not implemented in the critical care setting. This pilot study examined the influence of an educational intervention on nurses’ attitudes towards and confidence in providing family care, as well as families’ perceptions of support from nurses in an adult critical care setting. An academic–clinical practice partnership used digital storytelling as an educational strategy. A Knowledge to Action Process Framework guided this study. Results of pre-intervention data collection from families and nurses were used to inform the educational intervention. A convenience sample of family members completed the Iceland Family Perceived Support Questionnaire (ICE-FPSQ) to measure perception of support provided by nurses. Video, voice, and narrative stories of nurses describing their experiences caring for family members during a critical illness and family members’ experiences with a critically ill family member also guided education plans. When comparing the pre and post results of the Family Nurse Practice Scale (FNPS), nurses reported increased confidence, knowledge, and skill following the educational intervention. Qualitative data from nurses reported satisfaction with the educational intervention. Findings suggest that engaging nurses in educational opportunities focused on families while using storytelling methods encourages empathic understandings. Academic–clinician teams that drive directions show promise in supporting families and nurses in critical care settings. Plans are moving forward to use this study design and methods in other critical care settings.     

Public health nurses perception of clinical leadership in Ireland: narrative descriptions

Aim  The aim of the study was to identify how clinical leadership skills are perceived by Public Health Nurses' in the course of their everyday work and the effectiveness and consequences of such skills in primary care delivery.
Background  Public health nurses deliver primary care to children and adults as part of small teams or in individual situations. Leadership skills are needed to fulfil their many roles.
Method  Rigorous analysis of narrative interviews with public health nurses working in primary care environments in Ireland was undertaken. Narrative information was obtained by having conversations with 20 public health nurses relating to their perceptions on what clinical leadership meant to them and how their leadership skills influenced effective primary care delivery.
Results  Analysis of conversations identified the tensions existing between the various roles and responsibilities of the public health nurse and other primary care workers. This tension was perceived by the nurses as being the main barrier to effective primary care delivery from their perspective.
Conclusions  Clinical leadership is viewed narrowly by public health nurses as management skills rather than leadership skills were mainly identified. Education for the role was identified as a critical success factor.
Relevance to nurse managers  Public health nurses are well placed to shape and influence health service culture through effective clinical leadership.     

Family stresses, strengths, and outcomes after critical injury

Because critical injury occurs without warning, there is no time for families to prepare for this event. Stresses caused by critical injury vary in intensity and duration but certainly have the potential to create a heavy burden on family members. Prior family stress seems to be the salient indicator of the amount of assistance a family will need. The number of stresses not directly associated with the critical injury seems to be an important predictor of family adaptation outcomes. Therefore, it is important that nurses assess other stresses occurring in the family, not focusing solely on the stresses associated with critical injury. Interventions that help mobilize family strengths may be effective strategies for promoting family adaptation outcomes. Families using few coping strategies or reporting reduced resources, or both need referrals to other health care professionals or advanced practice nurses. Patient and family care conferences also may be helpful in the development of intervention plans to mobilize individual family strengths after critical injury.     

Nursing contribution to the rehabilitation of older patients: patient and family perspectives

tyrrell e.f., levack w.m., ritchie l.h. & keeling s.m. (2012)?Nursing contribution to the rehabilitation of older patients: patient and family perspectives. Journal of Advanced Nursing68(11), 2466-2476. ABSTRACT: Aims. This article reports a study of the perspective of older patients and their family members on the role of nurses in inpatient rehabilitation. Background. Rehabilitation services are used increasingly by older patients as life expectancy increases. The role of rehabilitation nurses in the multidisciplinary team has, however, yet to be clearly articulated. Previous research has focussed on the views of health professionals about nursing involvement in rehabilitation, but none has sought family members' perspectives. With the expectation of patient-centred care, it is important to consider what older patients and their families expect and require from nurses. Design. Grounded theory was used to collect and analyse data from interviews in an inpatient rehabilitation unit in New Zealand with seven patients, aged 72-89?years, and six family members, during 2009-2010. Findings. A substantive theory was developed which recognizes that the older patient values the relationship they build with nurses more than any specific role nurses perform. Participants acknowledged that rehabilitation nurses' roles included 'looking after', 'stepping in' and 'coaching independence' but 'best fit' nurses were identified by patients based on their 'nature', 'being available' and 'being attuned' to the patient's individual needs. If a 'connection' was formed, then this 'best fit relationship' maximized the older person's motivation to participate in his or her rehabilitation therapy. Conclusion. Patients and family members appreciate 'best fit relationships' where nurses seek to enter into the older person's world of disability to form a partnership which enhances their motivation to achieve independence.     

Oncology nursing: our past is the prologue ... can we author the future?

The development of the standards of care, roles in oncology nursing, and role competencies was an opportunity for Canadian nurses to revisit their professional roots, review and validate their present roles, and revise or reaffirm their future roles. The standards of care for individuals with cancer and their families affirmed the centrality of the individual and family in any nursing interaction and gave voice to the stated needs of Canadians at risk for, or living with cancer. For the first time in Canada, a specialty nursing organization has taken the lead to clearly define contemporary nursing roles and competencies. This new vision has captured the interest of oncology nurses. CANO, the nursing profession, other health care professionals, and health care decision-makers must now also consider how this enlightened view of oncology nursing can be operationalized. The presenters have had the opportunity to "hear" the stories of Canadian oncology nurses and their experiences in striving for excellence in their practice. These stories highlight the evidence supporting the standards of oncology nursing. In addition, the challenges and facilitators for achieving excellence in oncology nursing practice are identified. Through these stories, the future for the development of oncology practice and operationalization of the new standards of care emerges.