Structural conditions in outpatient care: effects and strategies to guarantee quality of care - results of an explorative study

Since the demand of professional outpatient care increases steadily, the general conditions of care need to be focussed. In particular, the structural conditions of the clients' homes are of considerable importance as they constrain the work of nurses and may reduce quality of care. Thus, the aim of this investigation is to identify the impact of structural conditions on professional care and strategies used by home care nurses to compensate structural barriers. The explorative nature of this topic required a qualitative study design, consisting of ten intensive interviews with home care nurses. Derived from Mayring's approach of systematic data interpretation, a process model for data analysis was developed and adapted to the research question. Eventually, six categories were identified which depict the impact of structural conditions on quality of care. Main aspects for quality of care were found in the working process, and that in turn affects the outcome in terms of high-quality home care. Moreover, five categories were evolved that describe strategies of home care nurses to compensate structural constraints and thus ensure professional care. Essential strategies were ascertained such as applying the nursing process, nurses offering advisory service to clients and work facilitation through auxiliary techniques.     

Clinical nurses' perception of continuing professional education as a tool for quality service delivery in public hospitals Calabar,Cross River State,Nigeria

This study was conducted to determine the perception of nurses on various aspects of continuing professional education (CPE). A mixed method design (quantitative/qualitative) was adopted. A self-explanatory, semi-structured questionnaire was validated and used to collect data in addition to unstructured interview. One hundred and fifty nurses were selected through stratified random sampling from two hospitals in Calabar, Nigeria and served as participants. Participants generally perceived CPE as valuable and worthwhile and participated because it is mandatory and helps them to retain their jobs. The content of CPE were perceived to be more relevant for clinicians than for nurse educators; clinical skills and quantitative research methodology were adequately covered while evidence-based practice, attitudinal issues, nursing theories and patient safety were inadequately covered. CPE was perceived to be fragmented without gaining points, follow-up monitoring and evaluation after CPE which make it difficult to objectively assess the influence of CPE on quality of care. It is recommended that nurse leaders in Nigeria should develop online CPE modules for nursing, and allocate points to them so that participation may contribute to career progression. Effective monitoring and evaluation systems should be put in place to assess impact of CPE on staff competence and patient outcomes.     

The role of nursing journals in the advancement of professional nursing*

From modest developments of‘popular’nursing journals many years ago, there has been a prolific growth in the numbers of nursing journals published each year This growth is particularly noteworthy in the increase in the numbers of specialist interest and scholarly nursing journals The different types of journals have also tended to influence each other's contents, as well as the contents of nursing textbooks Over the years, nurses themselves have emerged as the main contributors to the journals Increasingly the focus of all the journals has been on nursing practice — and the factors associated with professional practice and the professional education and development of nurses Whilst it is conceded that it is difficult to demonstrate that nursing journals have made a direct impact on care, some indirect impact can be claimed This claim is based, among other things, on the contribution of nursing journals to the development of nursing as a profession, their contribution to the individual development of professional nurses, and their contribution to the documentation of the body of nursing knowledge     

Nurses’ experiences of unprofessional behaviors in the emergency department: A qualitative study

The nursing profession is focused on serving others and has high expectations that each member behaves professionally and ethically, as articulated in nursing codes of practice and conduct. Where these are not upheld, inappropriate and unprofessional workplace behaviors follow. Regrettably, unprofessional behavior is neither new nor constrained to the nursing profession, but is known to negatively impact staff and workplace relationships, and importantly, patient safety and care. The aim of this qualitative study was to explore Iranian nurses’ experiences of professional communication between colleagues in the emergency department. Fifteen individual interviews were conducted. The overarching theme to emerge from the data was workplace communication, supported by two subthemes: unprofessional behavior and stressors in the workplace. Individually and collectively, these subthemes demonstrated staff attitudes and behaviors that are inconsistent with expectations of professional behavior and practice. Management proactively addressing unprofessional workplace behaviors is fundamental to establishing and maintaining positive workplace environments and supporting safe, quality patient care.     

Quality assurance of nursing web sites: development and implications of the ALEU method

This article presents a study that evaluated the physical accessibility, readability, and usability of Spanish nursing Web sites and discusses the quality assurance issues raised, which are relevant to the wider nursing community. The Internet is recognized as an important source of health information for both nurses and the general public. Although it makes health-related information universally available, the wide variation in the overall quality of health Web sites is problematic. This raises many questions for the nursing profession: about what constitutes a good-quality Web site, about the nature of the information that nurses are finding and using to support their professional education, research, and clinical practice, and about the impact that Internet information ultimately has on health interactions and nursing care. The process of completing this small study showed that it is possible to usefully assess dimensions of Web site quality and suggested that it may be feasible to develop tools to help nurses evaluate national and international nursing Web sites. More research is needed to understand how nurses use the Internet to support their everyday professional practices, but the development and application of international Web site quality assurance tools may be important for maintaining professional nursing standards in the Internet age.     

Work environment and workforce problems: a cross-sectional questionnaire survey of hospital nurses in Belgium

OBJECTIVES: This study investigated Belgian hospital nurses' perceptions on work environment and workforce issues, quality of care, job satisfaction and professional decision making. METHODS: All eligible nurses in a selection of 22 hospitals received the BELIMAGE questionnaire for a total of 13,958 potential respondents. Of these, 9941 returned study materials (response rate=71.2%) of which 9638 were valid and useable for statistical analysis (valid response rate=69.1%). RESULTS: The study identified several areas of tension in the nursing profession. The commitment to being competent providers of quality care was remarkably strong among the nurses, but they also perceived the barriers in the work environment to be multiple and complex. Concerns about the quality of leadership and management, insufficient staff, time demands and stressful work environment are experienced as obstacles in providing good nursing care. Four out of ten nurses (39.2%) would not choose nursing again as a career and more than half of the nurses (54.3%) have contemplated leaving the profession at some point in time. CONCLUSIONS: To effectively tackle the professional and workforce issues in nursing, investments should focus on redesigning a work environment that supports nurses in providing comprehensive professional care.     

Professional identity in nursing: A mixed method research study

Professional identity is developed through a self-understanding as a nurse along with experience in clinical practice and understanding of their role. Personal and professional factors can influence its development. A recent integrative literature review synthesised factors that influenced registered nurse’s perceptions of their professional identity into three categories of the self, the role and the context of nursing practice. This review recommended that further research was needed into professional identity and how factors and perceptions changed over time. The aims of this study were to explore registered nurses’ understanding of professional identity and establish if it changed over time. A mixed-methods study using a two-stage design with an on-line survey and focus groups was implemented with registered nurses who were studying nursing at a postgraduate level in Australia or Scotland. The reported influences on professional identity related to the nurse, the nursing role, patient care, the environment, the health care team and the perceptions of nursing. Professional development and time working in the profession were drivers of changes in thinking about nursing, their role and working context and their professional identity. Additionally, participants sought validation of their professional identity from others external to the profession.     

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.     

A conceptual analysis of professional commitment

Professional Commitment is an attitude, and it is the core and spirit of professionalism. In addition to increasing personal stability in the profession, it also enables individuals to reach their professional goals in general. Because nurses usually have more opportunities than other health care professionals to be in contact with patients, patients receive most of their information about health care from nurses. If nurses accept professional commitment as early as possible, the quality of patient-care will be improved. That is the reason why professional commitment is regarded as the hallmark of quality in professional care. This paper will use the conceptual analysis framework developed by Walker and Avant (1995) to examine and analyze professional commitment and establish its relationship with nursing. The authors hope that it can provide nurses with the opportunity to understand this concept more fully, to support their own profession, to raise the position of the nursing profession and to guarantee the health of the general public.     

Health care reform and the transformation of nursing in Hong Kong

Health care reform in Hong Kong in the 1990s has brought about dramatic change to the nursing discipline. This paper reports an ethnographic study which aimed at exploring the transformation of nursing in a regional hospital in Hong Kong during this period of reform. In the study, the restructuring of nursing work, its associated dynamics and resulting impacts upon the nursing profession were examined. A methodological triangulation approach to data collection encompassing interviews, participant observation and review of documents was used. The findings in this study suggest that the majority of nurses working in the case study hospital continue to be subject to medical dominance and are under management control. The emphasis on cost-effective care has however, fostered qualified nurses to claim more ownership of their professional judgement and autonomy. The health care reform has confirmed the status of two newly established groups of nurses, the nurse specialists and nurse managers. The development of the nursing profession is found to be closely connected to its work development. The preparation of the new generation of nurses, as revealed in this study, needs to emphasize the cognitive dimension of the professional competence. Some nurses need to be further educated in specialist practice and clinical management to maximize the contribution of nursing in health care delivery.     

Advocacy: From the Patient to the Profession

It is well known that nursing comprises the largest segment of the health care industry at local, state, national, and even international levels. The United States has over 4 million registered nurses, and nursing has been voted the most trusted profession for the past 19 years. With such a vast representation within the health care industry, the nursing profession is well positioned to advocate for legislation that promotes safe and healthy work environments, as well as quality care delivery. Although we have many nurses that have provided insight and thoughtful leadership, we have a long way to go to ensure our voice is heard to create and support policy that is recognized at the same level as our national representation. Successful advocacy and the passage of legislation that promotes professional nursing and safe patient care is a multipronged approach. Establishing and fostering relationships in the political arena require a strong political action committee (PACs), coalitions, and active participation in advocacy efforts.     

Continuing education in nursing: a review of the literature

The literature concerning continuing professional education (CPE) in nursing will be reviewed, with an emphasis on the experience of CPE in the United Kingdom (UK). The reviewed literature will cover aspects of the implementation of CPE, including motivational factors, needs analysis and outcome evaluations, and in addition CPE in the UK will be set in its socio-political context. The literature shows a fragmented, inequitable and poorly funded provision of CPE to date in the UK. The literature has not shown the cyclical nature of CPE, suggesting that a more holistic approach to educational research is needed. There continues to be a lack of research showing the impact of CPE on patient care. If this is not remedied it may be difficult to justify future expenditure of public funds on CPE for nurses.     

The nature of nursing care and rehabilitation of female stroke survivors: the perspective of hospital nurses

Aims and objectives. The aim of this study was to explore the nature of nursing care and rehabilitation of female stroke survivors, as described by hospital nurses. The objectives were to uncover how the nurses perceived the care of female stroke survivors and to explore whether, and in what way, the nurses paid attention to the fact that the patients were women. Background. Nursing care is an important aspect of the rehabilitation of stroke survivors. Little attention has been paid to gender differences in the health care system in general and in the nursing profession in particular, although it is reasonable to think that gender issues may have important implications in the rehabilitation process following a stroke. Design. Design was phenomenological with feminist perspective. Methods. The nurses were interviewed in‐depth. In the data analysing process we were inspired by Giorgi's phenomenological method. Results. The nurses were focusing primarily on functional and practical aspects of the women's situation. They perceived the rehabilitation process predominately from a professional rather than the patient point of view, and from a non‐conscious and primarily gender‐neutral perspective. Conclusions. The results indicate that the nurses perceived nursing care primarily in terms of practical actions to promote the body's functional and practical abilities. Little attention was directed to the stroke survivors’ experiences of their life body, nor to the fact that the patients were women. Relevance to clinical practice. In order to promote care from the perspective of the female stroke survivors, we believe it is necessary to attend to the life experiences of the patient, which also mandates paying attention to how gender has an impact on their diseased bodies, every day life, values and preferences in the situation.     

综合性医院准护士工作压力源的调查研究

目的了解综合性医院准护士的压力源,并探讨压力源的影响因素。方法采用自行设计的准护士工作压力源量表调查上海市两所三级甲等综合性医院的准护士共100名。结果准护士的压力源主要为工作量及时间分配、护理专业及工作、患者护理、学习及考核。准护士继续从事护理工作的意愿及其家庭成员对其工作的支持程度与压力源专业及工作相关。结论准护士面临较多的工作压力源,管理者应在加强其业务与法律知识培训的同时,针对每个人的特点提供有针对性的工作和心理指导,帮助准护士有效应对各种压力源。     

Nurses and occupational violence: the role of organisational support in moderating professional competence.

OBJECTIVE: Occupational violence as experienced by professional nurses has been extensively researched. However, the majority of studies have focused primarily on psychological and emotional outcomes and have not identified any interventions that may reduce the impact of aggressive behaviour on professional competence. The purpose of this study was to investigate the relationship between organisational support, occupational violence and perceived professional competence of professional nurses in Australia. DESIGN: A model testing research design was used to test the hypothesis that organisational support, as experienced by nurses, would moderate the relationship between occupational violence and perceived professional competence. SETTING: Nurses registered in Division 1 of the Nurses Board (Victoria, Australia). PARTICIPANTS: A systematic random sample of 380 registered nurses from the target population of nurses in Victoria was identified. MAIN OUTCOME MEASURE: The relationship between organisational support, occupational violence and perceived professional competence of professional nurses in Australia. RESULTS: The result showed that there was a significant effect of occupational violence on perceived competence. Analysis of the moderating effect of organisational support on the relationship between occupational violence and professional competence showed there was significant organisational support and occupational violence interaction. Overall, the data analysis demonstrated the hypothesis was upheld that the negative effects of occupational violence on perceived professional competence will be moderated by perceived organisational support. CONCLUSIONS: The failure to receive appropriate organisational support may result in lowering professional nurses' competence levels, causing a significant problem for the profession in that a reduction in professional competence has significant implications for patient care. The findings heighten the responsibility of the nursing profession to become more aware of the needs of professional nurses.     

A Role Model of Leadership in and Advocacy for Nursing

Surely most nurses have heard her name. While in undergraduate nursing programs students dutifully study nursing leaders, trying to differentiate their theories and memorize their accomplishments. At the least, they recognize the names. But does the new generation of nurses understand the impact that one nursing leader can have on the profession? Unless one has been privileged to attend NYU, for example, I wonder if today's young nurse realizes what Martha Rogers has accomplished in her career. Does today's nurse know what her advocacy for nursing has meant to our profession? This paper addresses those issues and attempts to explain the leadership and advocacy roles that Martha Rogers has assumed in the practice of professional nursing.