护理管理人员对护患比配置现状体验的质性研究

目的了解军队中心医院护理管理人员对护患比配置现状的真实体验。方法 2014年1-6月,采用目的抽样法选取4所军队中心医院的13名护理管理人员为研究对象,采用半结构式的个人深入访谈法对其进行访谈,通过现场录音收集其对护患比配置现状的看法,并以内容分析法对资料进行归纳整理。结果提炼出四个主题,即:现有的人员配置不能满足工作需要;配置标准应考虑的因素;护患比配置具有合理性;抽组对护理人员配置的影响明显。结论护患比配置得到护理管理人员认可,具有合理性。护理人员配置主要根据临床工作需要决定,应综合考虑多方面因素。军队中心医院抽组对护理人员配置影响明显,应该建立机动护士队伍。     

Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) military mental health issues. Information on the wars' signature wounds: posttraumatic stress disorder and traumatic brain injury

This topic can be related to the nursing profession and the need to be better educated on military mental health. Since mood disorder, suicide, alcohol abuse, PTSD and TBI are evident in actively serving and returning service members, it is imperative to educate nurses and healthcare providers about these conditions, the available evidence-based treatments and referrals to programs for these signature OEF/OIF wounds. The authors encourage nurse educators to consider ways to include military mental health and other service-related health issues into nursing curricula and to use Veterans Administration and veterans-related healthcare facilities for clinical courses. As the wars in Afghanistan and Iraq continue into the foreseeable future, many veterans will be seen not only in VA facilities, but they will self-refer to academic and community hospitals, and psychiatric and rehabilitation centers. It is important for all nurses to be aware of the effects of PTSD, depression, suicide, substance abuse and TBI on our patients and to be effective advocates for quality care of veterans in all settings. Nurses need to advocate for screening and provision of mental health services in primary care settings. When such services are offered in primary care settings, it normalizes the care and the service member will more likely allow themselves to receive the care (Jones, 2004). All nurses must understand the price of war experienced by U.S. service members and their families, and in particular, the invisible wounds of war.     

Findings from the development of a nursing joint professional practice model for the U.S. military

BackgroundBy 2022 the Defense Health Agency became responsible for administration of all military treatment facilities (MTFs), which were previously managed by their respective military services. However, three different service-specific nursing professional practice models currently govern nursing practice in MTFs.PurposeTo describe the literature search, review, and synthesis of evidence which informed the JPPM and provide some of the most actionable findings.MethodsA team of tri-service nurses developed the JPPM by conducting six rigorous systematic reviews to synthesize evidence pertaining to relevant model components.DiscussionA total of 51,360 titles and abstracts were initially screened. Data were extracted from 540 included articles. The team then developed standards for five JPPM components: evidence-based practice, safety and quality, leadership development, healthy work environment, and operational readiness.ConclusionThe JPPM is a meaningful framework that will help create a mutual professional identity and shared vision to promote a unified nursing force in U.S. military settings.     

军队中心医院护理人员组成及工作满意度的调查

目的探讨军队中心级医院护理队伍组成及护理人员工作满意度现状。方法通过调查沈阳军区3家展开1000张床位的中心级军队三甲医院护理人员组成情况及工作满意度,对军队护理队伍的组成等现状进行分析。结果军队中心医院护理人员组成以聘用人员为主要力量占69．3％,年龄在18—27岁中所占比例最大93．6％,学历在中专及大专中所占比例最大,分别为94．6％及72．4％,在工龄4—6年中的比例最大79．5％,在临床和辅诊岗位上所占比例最高为75．2％及78．3％;现役军人护士只占全体护士的9．6％,甚至低于文职护士12．4％的比例,且在38～47岁组中占有最大比例,为85．5％,在医院的各级护理管理工作中所占比例最大为81．9％;文员护士工作年限在1～3年的阶段中所占比例最大98．8％,在人员组成比例中已经超过现役护士;返聘护士在48岁以上年龄组中所占比例最大86．7％,工龄在14年以上所占比例最高47．5％;卫生士官护士所占比例最少1％,工龄较短且都在临床一线工作。五类护理人员的总体工作满意度水平较低,现役军人得分最高为（3．18±1．02）分,差异有统计学意义（F=76;P〈0．01）。结论军队护理队伍组成更趋多元化、年轻化,骨干力量缺失,护理人员工作满意度普遍偏低,军队护理事业的发展机遇与挑战并存。针对军队多元化护理队伍的现状,应完善护理队伍管理,保持护理队伍的持续性、人才的层次性,同工同酬,多渠道聚拢护理人才,才能提高满意度、保证卫勤保障能力。     

Body Image Perceptions of Women Veterans With Military Sexual Trauma

The researchers were invited to a transitional home for homeless women veterans to help veterans with body image issues. Convenience sampling was used to recruit 12 veterans who perceived they had a physical difference due to military service. Data were obtained in focus groups where the veterans were invited to share stories. Ricoeur's hermeneutic phenomenology guided the study. The research team learned early in the data collection stage that 11 of the 12 participants suffered military sexual trauma (MST). Three structures emerged in the data: (a) to speak up or not to speak, (b) from military pride to shameful anguish, and (c) invisible scars versus visible scars. A phenomenological interpretation of these invisible scars uncovered that viewing self in a mirror was depicted as viewing a stranger. Being with others, including family, was described as wearing a fake face. The phrase I am broken defined intimate relationships which were non-existent or strained. Shame permeated all body image structures. As the veterans listened to each other, they began to see themes in their stories. There was a shared sense of identity and a movement toward greater self-understanding and resolving. In addition to the recommendations the participants had regarding prevention of MST and recovery care of those with MST, implications for research and practice are provided.     

Public health nursing: an autonomous career for World War II nurse veterans

The 1944 G.I. Bill increased accessibility of higher education to male veterans. Less is known about how its availability affected opportunities for female veterans. The purpose of this study was to examine nurse veterans' use of the G. I. Bill at one large public university. Primary sources included archival documents of one large public university as well as articles published in professional nursing and medical journals of the 1940s and 1950s. Secondary sources addressing nursing and nursing education history, and the history of the G. I. Bill provided further context. Historical research methodology was conducted. Findings demonstrate that nurse veterans desired more independence in practice following the war. Archival documents of one large public university show that nurse veterans used G. I. Bill funds to seek degrees in public health nursing. The specialty of public health provided increased independence and autonomy of practice not experienced in hospital based care. G.I. Bill educational funds provided these nurse veterans the means to attain degrees in public health nursing, providing them the opportunity for more autonomous practice.     

The postmodern heart: war veterans' experiences of invasive cardiac technology

Background. The consequences of war and medical discourse have historical connections to pacemaker technology. Understanding these consequences is important because war veterans, medicine and cardiac technology have a shared history that continues into the present. The incidence of Australian war veterans needing cardiac pacemakers has increased many‐fold in recent years, due to advancing age. This need was recognized by the Australian Department of Veteran Affairs and a cardiac programme was established in the veteran hospital that was the setting for this study. Aim. This paper reports on a study aimed at capturing the interest and sensitizing the practice of nurses involved in the care of war veterans and other health care consumers who have been diagnosed as requiring a cardiac pacemaker. The study sought to answer the question, ‘How does the war veteran experience his body in relation to invasive cardiac technology?’. Method. The research was guided by the principles of interpretive interactionism, and used unstructured interviews with eight male war veterans. The data were collected in 2000. Findings. Thematic and content analysis revealed five themes: emotional knowing; the medical encounter; belief in the myth of miracle; technological constraint; and the altered heart. The findings indicated that the human dimension was characterized by experiences of ambivalence, inner conflict, powerlessness and suffering. Conclusion. Nursing is at the interface of science and patient care, and this study contributes to nursing knowledge by focusing on a previously unresearched topic, namely embodied interactions between war veterans and invasive cardiac pacemakers. Within a highly technical area such as cardiology, nurses can still work around the technology and keep patients as their primary focus, thus promoting quality care. A humanistic rather than a technological focus locates nurses between patients and cardiac technology. In this in‐between location, nurses are not an extension of cardiac technology but a valuable source of information, education, and counselling.     

The proving grounds: combat nursing in Vietnam

PURPOSE: The profession of nursing has been greatly influenced by war, and the heroic nature of the work of nursing is often emphasized during war. The purpose of this research was to examine the stories of nurses' experiences during combat in Vietnam and identify themes that would corroborate, refute, or expand prior historical research. ORGANIZING CONSTRUCT AND METHODS: A content analysis to determine recurrent themes was performed on 18 oral histories of military nurses who served in Vietnam that were previously collected and published. Analysis of these collections of oral histories was conducted, and thick quotes contextualize and substantiate the thematic claims. FINDINGS AND CONCLUSIONS: This research confirms the analysis of prior historical research on nursing in Vietnam by finding similar experiences recorded in oral histories and further claims that an authentic professional identity is often forged during the hardships and heroic opportunities of war.     

Experiences of Japanese nurse scholars: insights for U.S. faculty

The purpose of this paper is to describe the international educational experiences of Japanese nurse scholars to develop more understanding within academic settings in the United States (U.S.). Based on Heideggerian phenomenology, interpretive methods were used to analyze 42 interviews. Participants of this study were 22 Japanese nurse scholars who had received or were in the process of receiving master or doctoral degrees from schools of nursing in the U.S., and three Japanese nurse consultants. To build trust and aid with self-disclosure, participants were interviewed up to three times. The analytic process used overlapping strategies, including early identification of principal themes, interpretive writing based on exemplars, and paradigm cases illustrative of major themes. Themes discussed in this paper include: changes in the sense of self; cultural differences in self-disclosure; the importance of the advisor; mental health issues; strategies for support; differences between practices in the U.S. and Japan; and experiences of returning to Japan.     

Nursing advocacy during a military operation

Advocacy is an essential component of the registered nurse's professional role, yet experts provide no consistent definition of advocacy. The purpose of this study was to explore the experiences of military nurses as they engage in advocating practices and to describe their shared practices and common meanings. Heideggerian hermeneutic phenomenology, provided the framework and method for this study. Twenty-four U.S. Army nurses were individually interviewed and the researcher kept interview observational notes. The constant comparative method of analysis was used. The stories of these nurses revealed one constitutive pattern--safeguarding--and four related themes. The themes were advocating as protecting, advocating as attending the whole person, advocating as being the patient's voice, and advocating as preserving personhood. One conclusion was that military nurses must be prepared for the important safe-guarding role. They must be coached in how to deal with other members of the health team on the patient's behalf.     

The leadership concept in Iranian nursing

Background:  Although greater emphasis has been placed on leadership skills in nursing management in the last decade, the concepts are often confused or used erroneously by Iranian nurses. At the same time we have observed that wide variations in nurses' clinical practice appeared to be related to the presence or absence of leadership skills among senior nurses.
Aim:  To begin to identify the concepts used for expressing leadership in nursing within the Iranian cultural context.
Methods:  A qualitative approach was adopted using content analysis of semi-structured interviews carried out with 10 nurse managers from hospitals in Teheran. The data were analysed using the constant comparative method.
Findings:  Fifty-five primary codes were identified from the respondents' experiences and from these three main themes were abstracted for describing the leadership concept. These were 'personality traits', 'being a model', and 'being a spiritual guide for the nursing profession'.
Conclusion:  Implementing the culture of patient safety and dignity needs leadership. From Iranian nurse managers' perspectives a leader as a spiritual guide should empower nurses spiritually; it means he/she has a vision for nursing; has clear and explicit objectives; and has a commitment to nursing. Nurses who are confident about the underlying concepts of leadership in their culture can help to adapt nursing to an ever-changing healthcare environment.     

Nurse Staffing Levels and Adverse Events Following Surgery in U.S. Hospitals

Purpose: To examine the relationship between nurse staffing and selected adverse events hypothesized to be sensitive to nursing care, while controlling for related hospital characteristics. Efforts in the United States to reduce hospital costs, resulting in strategies to use fewer nurses, have stimulated extensive debate but little evaluation.
Design: Survey using data from a 20% stratified probability sample to approximate U.S. community hospitals. The sample included 589 acute-care hospitals in 10 states.
Methods: Discharge data from 1993 for patients aged 18 years and over were used to create hospital-level adverse event indicators. These hospital-level data were matched to American Hospital Association data on community hospital characteristics, including nurse staffing, to examine the relationship between nurse staffing and adverse events.
Results: A large and significant inverse relationship was found between full-time-equivalent RNs per adjusted inpatient day (RNAPD) and urinary tract infections after major surgery (p<.0001) as well as pneumonia after major surgery (p<.001). A significant but less robust inverse relationship was found between RNAPD and thrombosis after major surgery (p<.01), as well as pulmonary compromise after major surgery (p<.05).
Conclusions: Inverse relationships between nurse staffing and these adverse events provide information for managers to use when redesigning and restructuring the clinical workforce employed in providing inpatient care.     

Barriers to nurse/nursing aide communication: the search for collegiality in a southeast Ohio nursing home

Aim  The aims of this study were: (1) to identify barriers to nurse/nursing aide communication and to discuss and provide solutions to some of these problems through a focus group; and (2) to determine the effectiveness of this focus group on job satisfaction-related outcomes.
Background  Numerous studies have attributed problems with nurse staffing and turnover to faulty communication between nursing supervisors and nursing aides.
Methods  Registered nurses (RNs) ( n  = 2), licensed practical nurses (LPNs) ( n  = 10) and nursing aides ( n  = 19) were interviewed; narrative themes from the interviews were then used to guide focus group discussions. A job satisfaction survey in a pre-test/post-test fashion was used to test the efficacy of the focus group.
Results  Qualitative data from the interviews highlighted: (1) anger and condescension in communication; and (2) lack of mentoring, empathy and respect. The job satisfaction survey data showed that the attitudes decreased significantly among participants in the focus group but not in the control group ( P  < 0.05).
Conclusion  Nurse supervisors, both RN and LPN, are key to educational reform and must be taught collegial methods when delegating authority.
Implications for nursing management  Findings from this study can be used to develop a multidisciplinary educational tool to foster communication and collegiality, thereby reducing job turnover in nursing homes.     

Integration of military and veteran health in a psychiatric mental health BSN curriculum: A mindful analysis

The military and veteran populations in the U. S. state of Hawaii have a strong presence in the local communities. It was this substantial presence that provided the impetus to integrate military and veteran health into a Bachelor's of Science in Nursing (BSN) curriculum. This exploratory study investigated the relationship between the integration of military and veteran health into a psychiatric mental health BSN curriculum and nursing students' understanding of the many facets of military veterans' health. The concepts related to military and veterans' health was infused in didactic, seminar, simulation and clinical instruction. Examples of approaches to teaching include guest speakers from military clinical partners, inclusion of military/military families in simulation, the reading of evidence-based articles focusing on the military and veteran population, use of identification of problem based learning and clinical placements in hospital(s) and community agencies specific to servicing military and veterans and their families. Students were encouraged to record their reflections which provided some insight on the value of integration of this important segment into the curriculum. Classroom discussions and reflections were analyzed using an exploratory method of inquiry by categorizing themes which revealed some biases about the military and veteran population and how working with this population helped students to understand their health needs. Although the data is limited, it an important foundation for further exploration into the significance of the integration of military and veterans' health in a psychiatric mental health BSN nursing curriculum. The recommendation is to further include military and veterans' health across the curriculum in order to help future nursing graduates understand and evaluate their role in working with this distinctive population, recognize challenges and opportunities in working with this population and identify available evidence-based resources to inform their practice.     

Protectionism or competition in managing British nursing research? Current debate among nurse and midwifery teachers

Aim   The intention is to highlight key issues related to research by nurse and midwifery teachers.
Background   The debate centres on the 'culture change' facing teachers from traditional colleges moving to universities where a more formal research requirement prevails.
Origins of information   Data were drawn from selected official reports and other literature informing the introductory discussion. Emerging themes were discussed by 25 nurse and midwife teachers at Forresterhill College, Aberdeen in March 1996 and their views were recorded and analysed.
Data analysis   Selected documents and discussion records were reviewed, using a thematic approach.
Key issues   Main themes concerned nursing as art and science, balance between multidisciplinary and unidisciplinary research and ring-fencing nursing research funds.
Conclusions   Anxieties among teachers centred on the increased research requirement in universities with possible neglect of teaching excellence.     

Teachers' stories: how faculty help and hinder students at risk

The purpose of this study was to examine how teachers help and hinder students who struggle academically. Thirty nurse educators from 18 different schools of nursing shared stories of how they helped and hindered their academically at-risk students. Hermeneutic analysis revealed several themes. This article addresses the pattern of attending and two themes: attending as understanding and attending as expecting.     

Shared governance as vertical alignment of nursing group power and nurse practice council effectiveness

Aim(s)  This study validates an instrument for measuring the effectiveness of nursing practice councils and offers a framework for measuring and understanding shared governance.
Background  Empowerment results from the vertical alignment of nursing group power with nursing unit power practices. The field lacks an instrument for measuring nurses' practice of power.
Method(s)  Two studies ( n 1 = 119; n 2 = 248) are used to validate the Nursing Practice Council effectiveness scale (NPCes).
Results  NPCes is a valid and reliable index of nursing practice council effectiveness. This study suggests specific diagnostic tools to understand two levels for actualized power, one at the group or departmental level and one at the unit level.
Conclusion(s)  NPCes and the Sieloff-King Assessment of Group Power within Organizations (SKAGPO) can be used together to improve examination of shared governance. Examining group power as well as unit-level practices may give a more complete view of barriers to nurse empowerment.
Implications for nursing management  Changing nursing power and practices in an organization may be made more effective by engaging and monitoring vertical alignment of strategies fostering power competencies among nurse leaders and simultaneously supporting nursing practice councils as a means of exercising nurse authority at the unit level.