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At least 811 records · Page 45Linked to original sources
PubMed2004

Nurse-patient interaction: a review of the literature.

AIMS: The aims of this paper are to review a theoretical model useful for developing nursing knowledge related to nurse-patient interaction, review the literature on nurse-patient interaction, and discuss areas for further research. THEORETICAL MODEL: Goffman's theory of face work. RESULTS: Nurse-patient interaction is a central element of clinical nursing practice. This paper shows how Goffman's model can be used as a theoretical framework for understanding nurse-patient communication. RELEVANCE TO CLINICAL PRACTICE: Issues such as power, the social and cultural context, and interpersonal competence are shown to be important in the quality of nurse-patient interactions and nurses need to take cognizance of these factors in their interactions with patients.

Communication↗
PubMed2003

Improving feeding practices: current patterns, common constraints, and the design of interventions.

We propose a set of "best-practice complementary feeding behaviors," which were derived by combining principles of psychosocial care with current knowledge in nutritional sciences. We provide a theoretical rationale for assessing and describing complementary feeding practices in terms of what is fed, how food is prepared and given, who feeds the child, when food is fed (frequency and scheduling), and the feeding environment (where). We also discuss the significance of selected sociocultural determinants of these practices for the design of interventions. We then review 18 case studies in relation to these practices and their determinants. The exercise, in which we abstracted data from ethnographic reports, revealed areas of congruence and deviations from best-practice behaviors. The data on feeding practices are described with a common framework to facilitate comparison across sites. Key themes emerging from the studies include the significance of the larger family, the effects of competing maternal time demands, and the importance of parental perceptions and cultural constructs in affecting complementary feeding practices. Finally, we discuss the implications of the findings for future interventions.

Caregivers↗
PubMed2002

Being a good nurse and doing the right thing: a qualitative study.

Despite an abundance of theoretical literature on virtue ethics in nursing and health care, very little research has been carried out to support or refute the claims made. One such claim is that ethical nursing is what happens when a good nurse does the right thing. The purpose of this descriptive, qualitative study was therefore to examine nurses' perceptions of what it means to be a good nurse and to do the right thing. Fifty-three nurses responded to two open-ended questions: (1) a good nurse is one who...; and (2) how does a nurse go about doing the right thing? Three hundred and thirty-one data units were analysed using qualitative content analysis. Seven categories emerged: personal characteristics, professional characteristics, patient centredness, advocacy, competence, critical thinking and patient care. Participants viewed ethical nursing as a complex endeavour in which a variety of decision-making frameworks are used. Consistent with virtue ethics, high value was placed on both intuitive and analytical personal attributes that nurses bring into nursing by virtue of the persons they are. Further investigation is needed to determine just who the 'good nurse' is, and the nursing practice and education implications associated with this concept.

Ethical Theory↗
PubMedDate not supplied

IV hydration in the terminally ill: ritual or therapy?

The management of dehydration is both a clinical and an ethical problem. Artificial hydration may increase pharyngeal and pulmonary secretions, which causes a choking sensation, nausea and vomiting. Food and fluid have a strong social, cultural, religious and psychological significance. Competent nursing requires expert knowledge and moral skill. The interests of the patient must always be paramount. An ethical decision-making framework provides a systematic approach to ethical problems.

Adult↗
PubMedDate not supplied

Implications of genetic testing for sudden cardiac death syndrome.

The completion of the Human Genome Project in 2003 is shifting the focus of modern health care from disease management based on clinical signs to genomic-based treatment and prevention. Nurses at all levels of practice are going to increasingly come under pressure to deliver evidence-based, competent care to families undergoing genetic testing for hereditary conditions (Skirton and Barnes, 2005). A new chapter added to the National Service Framework for Coronary Heart Disease in 2005 raised awareness of the genetic basis of up to 400 sudden cardiac deaths that occur every year in the UK (Department of Health, 2005). This article addresses some of the clinical and ethical implications for nurses caring for families who may be at risk of an inherited sudden cardiac death syndrome. Nursing practice implications are discussed, concluding that more research is needed to explore how family members cope with genetic information which will shape the provision of future genetic healthcare.

Adaptation, Psychological↗
PubMed1980

Models of man and models of policy: reflections of "Exit, Voice, and Loyalty" ten years later.

The challenge of health care policy is how to combine sensitivity to both consumer preferences (the economic model) and citizen wishes (the political model): what either wants the other may wish to deny him. Competing economic (exit) and political (voice) activities in response to deterioration in the quality of a service, however, may be an inadequate framework to encompass discontent with the complex mix of types of services offered. The "political market" in which decisions about health care are made is suggested for further exploration.

Community Participation↗
PubMedDate not supplied

Nursing education: seeking critical-reflexive education and professional competencies.

The study describes changes that are noted in students during training and which contribute to define a professional profile. We carried out a descriptive-exploratory study with a qualitative approach, based on dialectics as a theoretical-methodological framework. The data was obtained from documented analysis and through focal groups with teachers, students and service nurses. The results show the student's position as an active subject in the teaching-learning process, through a movement of transformation of academic structures. A correlation was found between the movement that seeks students' greater political, active and critical participation as a way of determining and guiding the profile of the generalist nurse and greater social insertion. We conclude that, despite efforts, training guidelines and the definition of the professional profile in the study settings is directed at the demands of the labor market, and that competency-based training is still incipient.

Education, Nursing↗
PubMed2005

A competencies-based mental health training model for health professionals in low and middle income countries.

This paper describes a competencies-based training model specifically created to teach needed mental health skills to health professionals in low and middle income countries (LMICs). The model combines a mental health training needs assessment with the delivery of mental health training modules aligned with national/regional mental health priorities and designed to be used by all health professionals at various levels of the health care system. The model also defines a sustainability framework that involves the creation of a multidisciplinary training team embedded in the national/regional health system. The training program consists of a number of modules, each one designed to enhance specific mental health competencies for a variety of health care workers. These modules are linked to a number of clinically useful tools that facilitate knowledge transfer into clinical care while concurrently addressing health equity issues. This model may provide an efficient and cost-effective alternative to traditional profession-based mental health training approaches, which have to date not been successful at meeting mental health delivery needs and mental health service priorities in LMICs.

Journal Article↗
PubMed1997

Politics and the struggle to define: a discourse analysis of the framing strategies of competing actors in a 'new' participatory forum.

On account of the current wave of environmental consciousness, the state is adapting to the phenomena of systems of negotiations outside of the traditional institutional framework on environmental issues in an attempt to preserve cultural support. However recent experiments in discursive democracy have proven to be a modality for the transmission of productivist culture and for the reassertion of corporatist tendencies. This interpretation finds support here primarily through a discourse analysis based on a three-dimensional framework. The analysis begins by examining the structure of discursive formations of various participating actors at the Irish National Recycling Conference in 1993, and explores the ways in which actors struggled at the symbolic level to define the rules constitutive of this space of play. It argues from the perspective of discourse as social practice and justifies this approach by assessing the degree of synchronization between collective actors' systems of discursivity and the socially structured institutional sites within which they are embedded. Finally, by examining the position of this field vis-à-vis the field of political power, this research will show how broader relations of domination and traditional power asymmetries came to be reasserted in a 'new' participatory arrangement.

Communication↗
PubMed2005

Obligation of clinicians to treat unwilling children and young people: an ethical discussion.

The refusal of a child or young person to comply with a clinician's recommendations for treatment creates a challenging ethical problem. We describe an approach that seeks to balance the clinician's duty of care to their patient with the need to respect and indeed foster the developing sense of autonomy in young people. Central to this approach is a theory in which the standard of competence required of a patient is flexible and commensurate with the level of medical risk inherent in the decision. High-risk situations require an exacting standard for the determination of competence whereas a lower standard may be accepted where risk is relatively minor. The argument also allows that levels of competence may fluctuate as a result of illness itself and be influenced by social and cultural factors to which a child is perhaps particularly prone. The obligations of treating clinicians in these circumstances are complex but we believe that a moral framework can be offered that clinicians will find useful in the treatment of unwilling children.

Adolescent↗
PubMed1994

Journey of change: building a bridge between neonatal nursing education and practice.

Faculty of a post-basic registered nurse preparation neonatal intensive care nursing education program in Canada questioned how well students' knowledge equipped them to handle the demands of the clinical setting. The response to their inquiry prompted the abandonment of traditional teaching approaches and laid the foundation for a modification of the curriculum. The faculty developed a novel way of looking at the program's content, so that it centered on the needs of the neonate. The article introduces a unique neonatal nursing framework and explains how this framework fits with neonatal nursing education and neonatal nursing. This framework has potential usefulness for inservice, orientation, and outreach programs.

Clinical Competence↗
PubMedDate not supplied

Advanced nursing practice: an introduction to physical assessment.

Changing philosophies of clinical management and moves to reduce junior doctors' hours have led to increasing pressure upon nurses to take on the responsibility for assessing and initiating the management of acutely ill patients. Although nurses have been educated to assess, plan, and deliver care in a format known as the nursing process, this does not fully equip them for the demands of their rapidly developing roles. With increased responsibility comes the risk of increased stress and legal accountability, particularly where inadequate support is provided. In an effort to address this matter, this article briefly considers the theory of gaining clinical expertise, and describes a framework to facilitate physical assessment.

Clinical Competence↗
PubMedDate not supplied

Objectives of basic surgical training.

There are a range of skills to be learned in basic surgical training. These include communication and patient management, operating and other technical skills, and audit. Surgical tutors might use such a framework to facilitate education and assessment of their trainees.

Clinical Competence↗
PubMed2002

Implementing a new drug record system: a qualitative study of difficulties perceived by physicians and nurses.

OBJECTIVES: To identify organisational difficulties faced by physicians and nurses when using drug prescribing sheets for recording both drug prescriptions and drug administration. DESIGN: Qualitative interview study. SETTING: Two general internal medicine wards. PARTICIPANTS: Seven physicians and eight nurses. MAIN OUTCOME MEASURES: Difficulties explicitly identified by the participants during the interviews. RESULTS: The implementation of procedures conflicted with existing structure, culture, and routines. Insufficient competence within the system to use the drug prescribing sheets created resistance and made people down the line create their own interpretations and solutions to the problems they faced. A total of nine problems were identified: (1) insufficient knowledge and uncertainty about procedures, (2) ignorance of sources of error, (3) unclear responsibilities, (4) low community spirit, (5) insufficient communication, (6) clinician autonomy and low acceptance of change, (7) strong professional identity, (8) low priority task, and (9) logistical problems. CONCLUSIONS: Unawareness of procedures, insufficient dissemination of knowledge, and insufficient cooperation and skepticism among those who put drug handling into practice is likely to have an impact on the quality of health care. The identification of these obstacles may help managers to improve the quality of the drug handling process on internal medicine wards and make it possible to select a framework for changing the clinical behaviour of doctors and nurses.

Attitude of Health Personnel↗
PubMed1991

Hospice nurses. Caring support for caregiving families.

The purpose of this qualitative study was to examine caring behaviors of hospice nurses, as perceived by family caregivers in a hospice home-care program. Semistructured interviews and participant observations were conducted biweekly with a convenience sample of 10 families. A final interview was conducted 3 weeks after their relative's death. Subjects encompassed a variety of ages and relationships to their dying relatives. The constant comparative method of content analysis was used, with 55 taped and transcribed interviews, in order to search inductively for recurrent themes in families' descriptions of their interactions with the hospice nurses. Scientific rigor was evaluated according to credibility, applicability, auditability, and confirmability. Families identified four areas of caring of the hospice nurses: 24-hour accessibility, effective communication, a nonjudgmental attitude, and clinical competence. The implications for nursing practice include taking time to talk with families openly and honestly, maintaining contact and follow-up regarding concerns, and accepting families' difficulties with caregiving. Future research needs to address these behaviors within a theoretical framework and to study the relationship of such behaviors to families' satisfaction with hospice care and bereavement outcomes.

Adult↗
PubMed2006

Higher order thinking skills competencies required by outcomes-based education from learners.

Outcomes-Based Education (OBE) brought about a significant paradigm shift in the education and training of learners in South Africa. OBE requires a shift from focusing on the teacher input (instruction offerings or syllabuses expressed in terms of content), to focusing on learner outcomes. OBE is moving away from 'transmission' models to constructivistic, learner-centered models that put emphasis on learning as an active process (Nieburh, 1996:30). Teachers act as facilitators and mediators of learning (Norms and Standards, Government Gazette vol 415, no 20844 of 2000). Facilitators are responsible to create the environment that is conducive for learners to construct their own knowledge, skills and values through interaction (Peters, 2000). The first critical cross-field outcome accepted by the South African Qualification Framework (SAQA) is that learners should be able to identify and solve problems by using critical and creative thinking skills. This paper seeks to explore some higher order thinking skills competencies required by OBE from learners such as critical thinking, reflective thinking, creative thinking, dialogic / dialectic thinking, decision making, problem solving and emotional intelligence and their implications in facilitating teaching and learning from the theoretical perspective. The philosophical underpinning of these higher order thinking skills is described to give direction to the study. It is recommended that a study focusing on the assessment of these intellectual concepts be made. The study may be qualitative, quantitative or mixed methods in nature (Creswell 2005).

Attitude of Health Personnel↗