South African student nurses' experiences of professional nurses' role-modelling of caring

BackgroundStudent nurses are expected to implement a caring practice in order to become professional nurses. Caring has remained the art and science of nursing, which student nurses learn from professional nurses during clinical practice. The South African Nursing Council mandates professional nurses to teach and supervise student nurses to master the art of caring during clinical practice. Caring is taught through role-modelling of daily nursing activities.Research purposeThis study was performed to gain an understanding of South African student nurses' experiences of professional nurses' role-modelling of caring.MethodsPhenomenological, qualitative research. Purposive sampling of fourth-year student nurses. Data collection: focus groups, observations and field notes. The data were analysed using Giorgi's modified Husserlian five-step method. Ethical principles were respected.ResultsThree themes were identified. Theme 1: inconsistency in the clinical environment; Theme 2: effective and ineffective role-modelling of caring and Theme 3: carelessness cascading.ConclusionsThe study facilitated an understanding of student nurses' experiences of professional nurses' role-modelling of caring. Recommendations to facilitate professional nurses' role-modelling of caring in a public hospital were formulated: Mentorship training, recognition system for professional nurses, clinical support for student nurses, open channels of communication, random nurse leader rounds, employee wellness program, workshops and positive learning environment promotion.     

An exploratory study about meaningful work in acute care nursing

OBJECTIVE. To develop deeper understandings about nurses' perceptions of meaningful work and the contextual factors that impact finding meaning in work. BACKGROUND. Much has been written about nurses' job satisfaction and the impact on quality of health care. However, scant qualitative evidence exists regarding nurses' perceptions of meaningful work and how factors in the work environment influence their perceptions. The literature reveals links among work satisfaction, retention, quality of care, and meaningfulness in work. METHODS. Using a narrative design, researchers interviewed 13 public health nurses and 13 acute care nurses. Categorical‐content analysis with Atlas.ti data management software was conducted separately for each group of nurses. This article reports results for acute care nurses. RESULTS. Twenty‐four stories of meaningful moments were analyzed and categorized. Three primary themes of meaningful work emerged: connections, contributions, and recognition. Participants described learning‐focused environment, teamwork, constructive management, and time with patients as facilitators of meaningfulness and task‐focused environment, stressful relationships, and divisive management as barriers. Meaningful nursing roles were advocate, catalyst and guide, and caring presence. CONCLUSIONS. Nurse administrators are the key to improving quality of care by nurturing opportunities for nurses to find meaning and satisfaction in their work. Study findings provide nurse leaders with new avenues for improving work environments and job satisfaction to potentially enhance healthcare outcomes.     

Nursing practice environment,quality of care,and morale of hospital nurses in Japan

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse‐reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross‐sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan.     

Jordanian perspectives on advanced nursing practice: an ethnography

Zahran Z., Curtis P., Lloyd‐Jones M. & Blackett T. (2012) Jordanian perspectives on advanced nursing practice: an ethnography. International Nursing Review 59 , 222–229 Aim: This study aimed to explore how different groups of participants perceived the concept of advanced nursing practice in Jordan. Background: In Jordan, there are postgraduate educational programmes offering a Master's degree in clinical nursing for registered nurses. Intended to prepare nurses to practise at an advanced level as potential clinical nurse specialists in critical care, community health nursing and maternal newborn nursing, little was known prior to this study about the development of advanced nursing roles for nurses in Jordan and the drivers behind their establishment. Methods: Using ethnographic design, narratives from semi‐structured interviews and non‐participant observation with participants from five Jordanian hospitals and two public universities were collected and analysed according to thematic analysis. Findings and discussion: Four themes emerged from the data: core competencies, specific practice area vs. generic practice, beneficiaries of advanced nursing practice and drivers for educational change. The findings are similar to those found in other countries and highlight the need for a consensual understanding between nurse educationalists, professional bodies and employers about what advanced nursing practice in Jordan should be, so that a common framework can be identified. Conclusion: Paralleling the lack of consistency in understanding of advanced nursing practice in the broader literature, participants described a number of different elements of advanced practice that are relevant to the specific context of contemporary Jordanian nursing.     

How nurse practitioners make decisions regarding coronary heart disease risk: a social judgment analysis

PURPOSE: Understanding how nurse practitioners use clinical decision skills in practice has the potential to guide education programs to ensure safe, competent, and high quality advanced nursing practice. This study used the lens of social judgment theory to examine the clinical decision making of 60 nurse practitioners. METHODS: A three‐group pretest–posttest comparison design was used to evaluate how much insight nurse practitioners had into their clinical decision‐making process. FINDINGS: Nurse practitioners had modest insight into their clinical decision‐making process. CONCLUSION: Self‐insight has implications for enhancing nurses' decision making, improving education, and fostering agreement among advanced practice nurses. IMPLICATIONS FOR NURSING PRACTICE: Self‐insight has implications for developing professional decision making and promoting appropriate educational opportunities for advanced practice nurses.     

Transcultural Adaptation of NANDA Taxonomy II to a Brazilian Context

PURPOSE To orient nurses caring for critically ill emergency patients to a standardized nursing language–based protocol system in the field. METHODS An experimental learning program was developed and conducted by a nurse consultant. Nursing process–oriented, theoretical‐practical classes focused on the analysis of real clinical situations with the purpose of generating a reflective process in the nurses' conceptual schemes and incorporating standardized nursing language in their clinical practice. FINDINGS The expansion of nursing process–oriented clinical sessions and the retrospective clinical analysis of individualized patients has occurred in 7 of the 8 leading cities of the region (in one of them the teaching program has not been performed yet). Nine courses have been taught to a total of 185 RNs. The mean satisfaction rate reported was 90%, and one externally funded research project was initiated in regard to implementing nursing process in emergency prehospital care and taught to 75 nurses. A qualitative‐quantitative research project funded by the health department of the Andalusian government was initiated by one of these nurses with respect to nursing process implementation in emergency services. The Quality and Accreditation Center developed an evaluation system that included nurse perfomance. Two of 11 nurses participating as educators were designated as members of the evaluation board. The evaluation described impediments in determining the specific contribution of nurses to the overall process. The 2 nurses proposed that incorporating standardized nursing language was the best way to evaluate nursing performance. As a consequence, a nursing record based on the initial one designed in the research project was implemented. This record is divided into assessment, diagnosis, outcomes, and interventions based on Henderson's 14 needs, NANDA, NIC, and NOC. The electronic record will set the standards for evaluating the dimensions of the nursing data set established by the Nursing Information and Data Set Evaluation Center: nomenclature, clinical context, clinical data repository, and general system characteristics. The electronic record has been implemented in all the main cities of Andalusia and will be a main component of the Critical Patient Clinical Dossier that integrates both medical and nursing records. DISCUSSION Implementation of standardized nursing language requires an adequate orientation program with defined objectives. The simple addition of nursing terminology to clinical areas or guidelines development not only offers some difficulties in their usage, but also creates a conceptual conflict among nurses with a biomedical paradigm orientation. Using standardized nursing language presupposes a paradigm shift among nurses and managers. Nursing process and standardized nursing language are not always the primary focus of healthcare systems; it is necessary to demonstrate the lack of sensitivity present in information systems regarding nursing practice, nursing resources evaluation, and competency design. This situation cannot be modified piecemeal, and collaboration between nurses and administration is critical. CONCLUSIONS A nursing information system is not only a recordkeeping system and a software application; it needs also a qualitative transformation of the nurses' conceptual point of view and adequate linkage between theory and clinical practice. A patient‐centered, longterm evaluation of the nursing process implementation is needed to assess the effectiveness of this reorientation of nurses' clinical practice.     

Interacting with relatives in intensive care unit. Nurses' perceptions of a challenging task

Aims: To describe how Danish intensive care unit (ICU)‐nurses perceive personal knowledge and skills (self‐efficacy) and outcome expectations to interacting with relatives. Moreover, to explore relationships between self‐efficacy and outcome expectations and the nurses' attitude towards involving relatives in care‐related tasks and allowing relatives to be with the patient during critical situations. Background: Interacting with relatives can be a challenging task, and nurses play a leading role in integrating relatives in ICU. Little is known about how ICU‐nurses cope with this part of nursing Design: Cross‐sectional Method: Sixty‐eight ICU‐nurses responded to a self‐administered questionnaire based on Bandura's self‐efficacy theory adjusted to critical care. Results: The nurses' perceptions of personal knowledge, skills and expectations to the outcome of interacting with relatives were positive. There were disparities in nurses' level of agreement on when to involve relatives in caring activities. Generally, the nurses did not support the presence of relatives in critical situations. Nurses' outcome expectations were correlated to their attitude towards involving relatives in caring activities. No other statistically significant correlations were found between general attitude, knowledge, skills, and attitude of nurses towards involving relatives in caring activities or allowing them to be with the patient at cardiac arrest or acute intubation. Conclusion: The nurses' outcome expectations and self‐efficacy in terms of knowledge and skills interacting with relatives were high. There was considerable variation in the nurses' agreement on when to involve relatives in caring activities or allowing them to be with the patient in critical situations. The self‐efficacy theory was not supported as a result of lack of correlation between nurses' self‐efficacy and outcome expectations and their attitude towards involving relatives in ICU. Relevance to clinical practice: The study provides important knowledge to clinicians, educators and managers on how to educate and supervise ICU‐nurses to support their efforts to interact proficiently with relatives.     

Nursing work in Jordan: an example of nursing work in the Middle East

Aim. The study aimed to investigate Jordanian nurses’ perceptions of their role in clinical practice. Background. The lack of regulation of nursing practice by the profession across the Middle East until now has led to each institution setting its own policies regarding the role of the nurse and the practice of nursing. No study to date has examined the role of the nurse working in the acute hospital environment nor explored the practice of nursing in this region. Design and methods. A cross‐sectional questionnaire survey was conducted using a quota sample. A total of 348 medical‐surgical staff nurses and practical nurses from the three healthcare sectors in Jordan participated in the study with a response rate of 77%. The results were analysed by constructing multiple response tables, chi‐square test, anova and log‐linear analysis. Results. Staff nurses in Jordan were expected to carry out the majority of nursing care activities. The role of the practical nurse was limited to the physical and professional domains of nursing care. Activities requiring higher levels of emotional or intellectual labour and interdisciplinary communication were attributed only to the staff nurse. The majority of the respondents reported nursing had not been their first choice of career. Male nurses had a higher intention to leave the nursing profession. The predominant method of care delivery used by nurses was task‐oriented. Conclusion. There was a general consensus regarding what constituted the nurse's work in the clinical area across the three healthcare sectors in Jordan. Role delineation between the two levels of nurses was also clear. There is a need to move from task‐oriented to patient‐centred care to promote quality patient care. Relevance to clinical practice. This study explores the role of the nurse working in the acute hospital environment in Jordan.     

Relationship between nurses' perceptions of nursing assistant roles and information‐sharing behaviors: A cross‐sectional study

Information‐sharing between nurses and nursing assistants is necessary for appropriate inpatient care. Nurses who perceive nursing assistant roles highly may display positive behaviors related to information‐sharing with nursing assistants. This study aims to examine the relationship between nurses' perceptions of nursing assistant roles and the frequency of their sharing information with nursing assistants. Using a self‐administered, cross‐sectional survey questionnaire, data from 2,642 nurses in 182 hospitals were collected. Nurses' perceptions of nursing assistant roles were measured with a scale containing four factors: (i) improving patients' abilities through daily care; (ii) caring for various patients using broad perspectives; (iii) facilitating co‐ordination and co‐operation among team members; and (iv) increasing the amount of information on patients among team members. Information‐sharing behaviors included “expressing,” “asking,” “linguistic response,” and “feedback.” Multiple regression analyses for each nurse's information‐sharing behaviors were conducted. Nurses' perceptions of nursing assistant roles were positively correlated with the frequency of sharing information with nursing assistants. The degree of the correlations differed, depending on the type of information‐sharing behavior. Therefore, improving nurses' understanding of nursing assistant roles might increase their information‐sharing behaviors.     

Articulating nursing in an interprofessional world

It is essential that nurses in practice clearly articulate their role in interprofessional clinical settings. Assumptions, stereotypes, power differentials and miscommunication can complicate the interaction of healthcare professionals when clarity does not exist about nurses' knowledge, skills and roles. Conflicting views among nurse scholars as to the nature of nursing knowledge and its relationship to practice complicate the task of nurses in explaining their performance and role to others in interprofessional environments. Interprofessionality is potentially misunderstood by nurse leaders, practitioners and educators, isolating nurses in an increasingly inter-disciplinary healthcare system. The theorization of contemporary nursing is explored through the views and perspectives of current nurse scholars. The ability to explain nursing knowledge, skills and roles to others in interprofessional interactions is a nursing competency, as well as an interprofessional one. Nurses, nurse leaders and nurse educators are challenged to engage in interprofessionalism so as to have an influence in the evolution of healthcare education and practice environments.     

Innovations in United States genetics nursing: Practice and research

Aim: Clinical and research applications from human genome discoveries are growing and creating both opportunities and challenges to the integration of genetic concepts into practice and research. Nurses have a long history of caring for individuals, families, and groups with genetic conditions. In the past two decades, a small group of nurses in the USA have used a variety of strategies to further develop the field of genetics nursing. In this paper we identify innovative approaches to identifying genetics‐related nursing roles and opportunities, as well as successful collaborative efforts beyond nursing to address the emerging health and societal challenges related to human genetics discoveries. Methods: The information presented here comes from a variety of sources where the authors or genetics nurses directly participated, including: (i) a systematic literature review of genetics nursing; (ii) a comprehensive research study of models of delivering clinical genetics services and the roles of health professionals; and (iii) participation in numerous national research, planning, programmatic, and advisory groups involved with clinical genetics‐related health services, research, education, and public policy. Results: Genetics nurses in the US have developed innovative responses to genetics‐related challenges within and beyond the profession of nursing. These include: (i) establishing an organization for nurses in genetics and gaining formal recognition of genetics as a specialty of nursing; (ii) defining the scope of genetics nursing practice and developing a new genetics nursing credential; (iii) establishing a multiprofessional genetics education coalition and defining genetic competency for health‐care practice; (iv) creating new clinical practice roles for nurses that integrate emerging genetics concepts and skills into diverse clinical practice areas; (v) expanding nursing involvement in genetics‐related research; and (vi) participation in high‐level genetics advisory groups. Conclusions: The US experience shows that nurses have made substantial progress in expanding their involvement in genetic services through visionary leadership, innovative approaches to challenges, establishing support with nurse colleagues, and engaging in multiprofessional efforts. The most important first step is developing a supportive environment for nurse advancement. In the US, the genetics nurses’ organization known as the International Society of Nurses in Genetics (ISONG) has provided this base.     

Portuguese nurses' knowledge of and attitudes toward hospitalized older adults

Portugal is impacted by the rapid growth of the aging population, which has significant implications for its health care system. However, nurses have received little education focusing on the unique and complex care needs of older adults. This gap in the nurses′ education has an enormous impact in their knowledge and attitudes and affects the quality of nursing care provided to older adults. A cross‐sectional study was conducted among 1068 Portuguese nurses in five hospitals (northern and central region) with the following purposes: (i) explore the knowledge and attitudes of nurses about four common geriatric syndromes (pressure ulcer, incontinence, restraint use and sleep disturbance) in Portuguese hospitals; and (ii) evaluate the influence of demographic, professional and nurses' perception about hospital educational support, geriatric knowledge, and burden of caring for older adults upon geriatric nursing knowledge and attitudes. The mean knowledge and attitudes scores were 0.41 ± 0.15 and 0.40 ± 0.21, respectively (the maximum score was 1). Knowledge of nurses in Portuguese hospitals about the four geriatric syndromes (pressure ulcers, sleep disturbance, urinary incontinence and restraint use) was found inadequate. The nurses' attitudes towards caring for hospitalized older adults were generally negative. Nurses who work in academic hospitals demonstrated significantly more knowledge than nurses in hospital centers. The attitudes of nurses were significantly associated with the hospital and unit type, region, hospital educational support, staff knowledge, and perceived burden of caring for older adults. The study findings support the need for improving nurses' knowledge and attitudes towards hospitalized older adults and implementing evidence‐based guidelines in their practice.