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PubMed2003

[Contribution of professional nurses of ambulatory nursing services to home nursing care].

The meaning and understanding of home care is a leading factor in health care both nationally and internationally. The implementation of the law on care insurance in Germany demonstrates the understanding of home care and shows changes in health care policy. This new context of health care delivery influences the nursing profession. New challenges arise and changes in nursing perspectives are necessary. The presented study focuses on the contribution of nurses in home care situations. Its aim is to illuminate and to understand the perspective of home care nurses. Grounded Theory approach is used. Altogether, nine participants are interviewed. The results show that nurses aim at keeping care recipients in a home care situation as long as possible. In order to achieve this, the contribution of nurses are not just limited to rediscountable benefits. Voluntary interventions such as managing housework and emotional support for care recipients are also being rendered. However, these actions depend on several factors, such as the relationship between the nurse and the care recipient, the home care situation or the professional attitude of the nurse. In this context, nurses have to develop strategies to deal with these various tasks. The discussion emphasizes the legislative framework of home care in Germany as well as factors that influenced the study.

Activities of Daily Living↗
PubMed1997

The future of community nursing in the United Kingdom: district nursing, health visiting and school nursing.

This paper examines the future of community nursing, within the wider framework of a rapidly changing National Health Service. The research was commissioned by the Community Performance Review Network, as part of a series of comparative studies between community healthcare NHS trusts. Three questionnaires were sent to 24 trusts, covering three of the community nursing services; district nursing, health visiting and school nursing. Of the 24 trusts involved in the network, 22 responded to some or all of the questionnaires. A wide range of management structures and working practices were found between trusts, but several common themes and issues of concern emerged. For district nurses, these included the shift from secondary to primary care and the changing demands of the client population served, with increasing numbers of elderly and chronically disabled patients. This led to anxiety over the communication between different providers of care, such as community, acute and social services, and the skills mix and training requirements for nurses. Health visitors and school nurses were concerned about being marginalized in the move towards integrated primary health care teams. As the emphasis changes from treating illness to health promotion, concern was expressed about how performance could be measured on the less quantifiable outcomes of preventative care, and hence how jobs could be justified to purchasers of health care. A central theme was the potential role of the nurse practitioner in provision of primary care, and this formed a focus for other anxieties concerning both the current situation and future of community nursing services.

Community Health Nursing↗
PubMedDate not supplied

Community-based nursing education and nursing accreditation by the Commission on Collegiate Nursing Education.

The purpose of this article is to describe the application of accreditation standards of the Commission on Collegiate Nursing Education (CCNE) in community-based nursing education. In response to changes in the health care delivery system, involving increased implementation of managed care systems, greater use of outpatient services, and increased care provided in community-based settings, baccalaureate nursing education is changing to incorporate student learning experiences in community-based settings. Community-based nursing care is characterized by the development of community-education partnerships, implementation of nursing interventions for prevention and health promotion, and collaboration to ensure continuity of care. Changes in the delivery system to increase community-based care necessitate changes in professional nursing education to ensure that graduates of baccalaureate nursing programs are prepared to practice in community-based settings. Accreditation is a mechanism to evaluate quality in educational programs. Accreditation by CCNE offers a process for assessing the quality of nursing programs while encouraging flexibility and innovation in those programs. The CCNE accreditation standards can be interpreted in the context of community-based education. Descriptions of the CCNE standards and examples of application of the standards in community-based nursing education are included.

Accreditation↗
PubMedDate not supplied

Transcultural nursing practice described by registered nurses and baccalaureate nursing students.

Using Leininger's Theory of Culture Care Diversity and Universality as a framework, this research examined transcultural practices of nurses and students. A survey was administered to a convenience sample of registered nurses and senior baccalaureate students with 767 usable questionnaires returned. Neither group expressed confidence in their ability to care for culturally-diverse patients. Registered nurses (RNs) reported assessing cultural factors and modifying practices more frequently than did students. Respondents reported their beliefs about transcultural nursing were influenced by being with people of other cultures, their own personal values, and education. Analysis of the open-ended questions revealed two major themes. First, both nurses and students perceive an overwhelming need for transcultural nursing. Second, nurses and students respond to cultural challenges by modifying their care. Modifications are based on language and communication, pain perception and relief, religious and spiritual dimensions, gender and family roles, and other values. Results suggest that nurses and students are aware of culture, recognize that culture influences the care they provide, and modify their health teaching and nursing care based on culture. The use of a conceptual framework to help make modifications in care was not mentioned.

Adult↗
PubMedDate not supplied

Ethical events in nursing: Daily activities of nurse managers and nursing ethics committee members.

This study aimed to understand the meaning of nurses' actions related to ethical occurrences involving nursing professionals. Data were collected through interviews with nurse managers and members of a Nursing Ethics Committee who experienced the phenomenon. Data were analyzed in the framework of social phenomenology. The nurses' experiences gave rise to the following categories of meaning, as these professionals seek: the humanization of nursing care; continuous improvement of the care process; professional credibility; patients' satisfaction; demystification of the fear of punishment; partnership in the educational process; respect for ethical secrecy and expectation related to the event being forwarded to the Nursing Ethics Committee. The social typification was described at the end. Nurses' actions in cases of ethical events attract the interest of nursing professionals, who want to ensure a risk or damage-free care and to promote the valuation of these professionals.

Brazil↗
PubMed2006

Risk factors and musculoskeletal complaints in non-specialized nurses, IC nurses, operation room nurses, and X-ray technologists.

OBJECTIVES: To gain more insight into the prevalence rates of musculoskeletal complaints of neck-shoulder and low back and to determine the relation between physical and psychosocial work-related risk factors and the complaints mentioned in non-specialized nurses, operation room nurses, Intensive Care (IC) nurses and X-ray technologists. METHODS: The study population consists of 3,169 employees affiliated to eight university hospitals in the Netherlands. The study was conducted using a cross-sectional survey design. The parameters under study were having or having had (severe) low back or neck-shoulder complaints during the past year. In logistic regression analyses odds ratio's and CI 95% were estimated for all relevant risk factors for each of the four professional groups. RESULTS: In all groups prevalence rates of musculoskeletal complaints were high: low back 76%, neck-shoulder 60%. Operation room nurses perceived more neck-shoulder complaints (12 months prevalence) than non-specialized nurses and IC nurses perceived less severe low back complaints than non-specialized nurses. Four physical risk factors and one psychosocial factor were associated with low back complaints in all groups. CONCLUSIONS: The results of the present study indicate that both low back complaints and neck-shoulder complaints are major health problems in the four professional groups under study. The prevalence rate of neck-shoulder complaints in operation room nurses is higher than in non-specialized nurses and IC nurses, the latter groups having high prevalence rates already. The exposure to risk factors is perceived differently by each of the professional groups. The professional groups under study all are target for preventive interventions; these interventions need to be specified for each of the professional groups.

Adult↗
PubMed1992

Qualified nurse and nursing auxiliary perceptions of their work environment in primary, team and functional nursing wards.

The way in which nursing work is organized has major implications for the role of different staff grades. This paper describes how qualified nurses and nursing auxiliaries perceived their work in primary, team and functional nursing wards. The Work Environment Scale was distributed to 12 qualified nurses and 12 nursing auxiliaries within each organizational mode, and a response rate of 97% was achieved. While differences were found between organizational modes, there was no difference in work perceptions between qualified nurses and nursing auxiliaries within organizational mode. It is argued that this is due to cultures existing within organizational types which transcend staff grade.

Attitude of Health Personnel↗
PubMed1991

Nursing education and definition of the professional nurse role. Expectations and knowledge of the nurse role.

The aim of nursing education is a development of the nursing profession. One way to promote development is to clarify the professional role. The role definition for nursing is mostly transmitted through tacit knowledge. We consider that the professional development of the nursing profession in Sweden requires a clear and well-defined nurse role. Stated goals of professional programmes for nursing do not include the entire body of tacit knowledge. The overall development requires recognition of a professional status together with a clear and well-defined role. We have found a significant change in the distribution of role-conceptions which occurred after the nurses had experienced their first year as registered nurses, and which did not occur during the educational process. This indicates that the conceptions of the need for a more clearly defined nursing role are assimilated during work experience. This confirms the necessity and importance of role modelling, role repetition and interactions with a professional group as part of the educational process.

Adult↗
PubMed1997

Integrative nursing research--an important strategy to further the development of nursing science and nursing practice.

In this paper it is argued that integrative nursing research has a great potential for clarifying the theoretical perspective and substance of the nursing discipline as well as making research-based knowledge more accessible to clinical nurses. Two general kinds of integrative research are introduced and illustration provided of how these have been practiced within nursing. Significant strengths and weaknesses in current practice is highlighted. It is argued that nursing should pay more attention to this kind of research, specifically in terms of developing sound methodological approaches and overcoming the traditional schism between empirical and theoretical research. Sound integrative nursing research promises to improve the development of nursing science as well as making the products of nursing research more easily available for clinical nurses.

Diffusion of Innovation↗
PubMed1997

Nursing, a bridge to peace in our region: opinions on mutual co-operation between Israeli and Palestinian professional nurses and nurse educators.

The purpose of this study was to assess the activities and future direction of mutual co-operation of professional nurses from Israel and Judea and Samaria. Questionnaires were distributed to the participants, nurse educators and professional nurses from Judea and Samaria who were attending a workshop in clinical instruction at the Assaf HaRofeh School of Nursing, in Israel. Most of the nurses polled were interested in continued educational dialogue and expanded educational programmes in various nursing specialties both in education and service. The areas that received priority included: intensive care, operating room and emergency room nursing. Areas that received lower priorities included; midwifery, geriatrics and nephrology nursing. The participants expressed positive reactions to continued joint educational activities such as full length courses, workshops, day seminars and joint educational projects. The results showed an overwhelming interest for continued professional ties. Areas in the fields of clinical expertise and nursing education reflected the needs of their respective communities.

Attitude of Health Personnel↗
PubMedDate not supplied

Toward standard classification schemes for nursing language: recommendations of the American Nurses Association Steering Committee on Databases to Support Clinical Nursing Practice.

The American Nurses Association (ANA) Cabinet on Nursing Practice mandated the formation of the Steering Committee on Databases to Support Clinical Nursing Practice. The Committee has established the process and the criteria by which to review and recommend nursing classification schemes based on the ANA Nursing Process Standards and elements contained in the Nursing Minimum Data Set (NMDS) for inclusion of nursing data elements in national databases. Four classification schemes have been recognized by the Committee for use in national databases. These classification schemes have been forwarded to the National Library of Medicine (NLM) for inclusion in the Unified Medical Language System (UMLS) and to the International Council of Nurses for the development of a proposed International Classification of Nursing Practice.

American Nurses' Association↗
PubMed1991

Nurse Education Tomorrow Conference 1990. Reforming nurse education. 1--The reorganisation of nursing knowledge.

With the development of Project 2000, nurse education is being increasingly drawn into higher education with the expansion of diploma and degree courses. This paper explores the implications of these new relationships, drawing on the sociology of the curriculum and education in its analyses. It examines the impact of these changes on the professional standing of nurses and nursing and the reorganisation of the curricular codes that underpin nurse education. A movement towards higher education will introduce a new educational culture into nurse training and the wide multi-disciplinary base of nursing knowledge and practice will offer new challenges to nurse educators. The changes in nurse education add a new dynamic to the old tensions between academic and vocational training and raise new questions about the relationship of nurse education to the academic tribalism of higher education.

Curriculum↗
PubMed2002

Exploring nursing expertise: nurses talk nursing.

It has become increasingly important for practitioners to articulate their expertise in modern healthcare settings that demand high levels of accountability and evidence-based practice. The material presented within this article has been interpreted drawing from discourse analysis1 to help explore the discourses that shape and influence understandings of nursing practice. What we present are extracts from four of the 35 participant nurses who applied to take part in the Royal College of Nursing Institute's Expertise in Practice (pilot) Project (EPP). The material presented is used to provide a starting point for exploring how nurses talk about and construct expertise in nursing practice. The four nurse participants' clinical practice areas cover palliative care, mental health, intensive care and fertility care. The material reveals high levels of intensity in the nurse-patient relationship, 'maverick' nursing practices and ongoing reflexivity. All of these aspects appear to capitalize on expertise as a 'catalyst' that alters treatment pathways and maximizes patient-centred outcomes. Exploring a discourse of nursing expertise exposes the tacit situated nature of professional practice that is heterogeneous and most difficult to articulate and explain. It is proposed that expertise tends to be understood from traditional and dominant discourses of medicine, management and technology. Explaining expertise in practice exposes non-conventional practice that in itself can be isolating and challenging to the status quo of contemporary health-care.

Clinical Competence↗
PubMed2006

Nurse staffing, nursing intensity, staff mix, and direct nursing care costs across Massachusetts hospitals.

OBJECTIVE: This study describes the distribution of patient-to-registered nurse (RN) ratios, RN intensity of care, total staff intensity of care, RN to total staff skill mix percent, and RN costs per patient day in 65 acute community hospitals and 9 academic medical centers in Massachusetts. METHODS: We conducted a retrospective secondary analysis of the Patients First database published by the Massachusetts Hospital Association for planned nurse staffing in 601 inpatient nursing units in the state for 2005 using a multivariate linear statistical model controlling for hospital type and unit type. Nursing unit types were identified as adult and pediatric medical/surgical, step down, critical care, neonatal level II, and neonatal level III/IV nurseries. RESULTS: Medical centers had significantly higher case-mix index (1.72 vs 1.20, P < .001), longer lengths of stay (5.18 vs 4.19, P < .001), more beds (574 vs 147, P < .001), discharges (31,597 vs 7,248, P < .001), and patient days (161,440 vs 31,020, P < .001) compared with to community hospitals. Medical centers had significantly lower patient-to-RN ratios (3.22 vs 4.64, P < .001), higher nursing intensity and total nursing staff intensity (9.62 vs 7.43/11.75 vs 9.87, both P < .001), higher percent of RN to all staff mix (79% vs 71%, P < .001), and higher RN costs per patient day ($385 vs $297, P < .001) compared with to community hospitals. There were significant differences in adult med/surg units between community hospitals and medical centers for patient-to-RN staffing ratios (5.25 vs 4.08), nursing intensity (5.1 vs 6.2 hours daily), skill mix (67% vs 73% RN), and RN costs per patient day ($203 vs $248, all P < .001). There were no significant differences between the adult step-down units. CONCLUSION: The significant differences between community hospitals and medical centers, unit type, as well as the high degree of variability in patient-to-RN ratios, nursing intensity, skill mix, and RN costs per patient day suggest that nursing resource expenditure at Massachusetts hospitals is complex and affected by case mix, unit size, and complexity of care.

Academic Medical Centers↗
PubMed1985

Has the discipline of nursing developed to the stage where nurses do 'think nursing'?

With the increasing complexity and changing conditions of nursing practice, as well as the encroachment of other professions on nursing's traditional domain, it is becoming increasingly important for nurses to gain insights into the nature of nursing knowledge and practice. This paper attempts to outline the meaning of the expression 'to think nursing' and the factors involved in such a capacity. The work of nurse scholars is then discussed in terms of their contribution towards developing the discipline of nursing to the stage where nurses do 'think nursing'.

Attitude↗
PubMedDate not supplied

Use of the nursing minimum data set to describe nursing interventions for select nursing diagnoses and related factors in an acute care setting.

This study describes the prevalence of nursing interventions across six nursing diagnoses and their related factors using the framework of the Nursing Minimum Data Set (NMDS). Six nursing diagnoses (pain, potential for injury, anxiety, decreased cardiac output, potential for infection, and knowledge deficit) were among the most prevalent in an acute care setting studied in 1991. The NMDS and a nursing information system using standardized classification systems for nursing diagnoses and interventions provided an opportunity to describe nursing practice. Multiple related factors were identified across all six nursing diagnoses; three or four were selected frequently within each diagnostic category. The related factors also influenced the selection of interventions. Implications for the development of nursing classification systems and recommendations for further research are described.

Acute Disease↗
PubMed1996

Classification systems in nursing: formalizing nursing knowledge and implications for nursing information systems.

The development of nursing information systems (NIS) is often hampered by the fact that nursing lacks a unified nursing terminology and classification system. Currently there exist various initiatives in this area. We address the question as to how current initiatives in the development of nursing terminology and classification systems can contribute towards the development of NIS. First, the rationale behind the formalization of nursing knowledge is discussed. Next, using a framework for nursing information processing, the most important developments in the field of nursing on formalization, terminology and classification are critically reviewed. The initiatives discussed include nursing terminology projects in several countries, and the International Classification of Nursing Practice. Suggestions for further developments in the area are discussed. Finally, implications for NIS are presented, as well as the relationships of these components to other sections of an integrated computerized patient record.

Database Management Systems↗