Showing papers in "Journal of Advanced Nursing in 2012"

Predictors of caregiver burden in caregivers of individuals with dementia

Abstract: kim h., chang m., rose k. & kim s. (2011) Predictors of caregiver burden in caregivers of individuals with dementia. Journal of Advanced Nursing 68(4), 846–855. Abstract Aims. This article is a report on a study of the multidimensional predictors of caregiver burden in caregivers of individuals with dementia using nationally representative data. Background. Caregiver burden affects the health of both caregivers and their care-recipients. Although previous studies identified various predictors of caregiver burden, these predictors have not been confirmed in nationally representative population. Methods. Data for this secondary analysis was provided by the National Alliance for Caregiving, American Association of Retired Persons. The data were collected through a telephone survey of randomly selected adults in seven states in 2003 (weight adjusted n = 302). Descriptive statistics, inter-correlation analysis and a hierarchical multiple regression analysis were performed. Results/findings. Disease-related factors were the most significant predictors, explaining 16% of caregiver burden; these were followed by caregiver socio-demographical factors and caregiving-related factors (F = 21·28, P < 0·01). Significant individual predictors were impairment of activities of daily living or instrumental activities of daily living, the number of hours of caregiving, use of coping strategies, co-residence, spousal status and caregiver gender (P < 0·05). Conclusion. Impaired function in care-recipients predicts caregiver burden, and also interacts with demographical- and caregiving-related factors. Thus, it will be beneficial to both care-recipients and caregivers to target nursing interventions and community services to improve the functional abilities of individuals with dementia.

Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals

Abstract: brewer c.s., kovner c.t., greene w., tukov-shuser m. & djukic m. (2012) Predictors of actual turnover in a national sample of newly licensed registered nurses employed in hospitals. Journal of Advanced Nursing68(3), 521–538. Abstract Aim. This paper is a report of a study of factors that affect turnover of newly licensed registered nurses in United States hospitals. Background. There is a large body of research related to nursing retention; however, there is little information specific to newly licensed registered nurse turnover. Incidence rates of turnover among new nurses are unknown because most turnover data are not from nationally representative samples of nurses. Method. This study used a longitudinal panel design to obtain data from 1653 registered nurses who were recently licensed by examination for the first time. We mailed surveys to a nationally representative sample of hospital registered nurses 1 year apart. The analytic sample consisted of 1653 nurses who responded to both survey mailings in January of 2006 and 2007. Results. Full-time employment and more sprains and strains (including back injuries) result in more turnover. Higher intent to stay and hours of voluntary overtime and more than one job for pay reduces turnover. When we omitted intent to stay from the probit model, less job satisfaction and organizational commitment led to more turnover, confirming their importance to turnover. Magnet Recognition Award® hospitals and several other work attributes had no effect on turnover. Conclusion. Turnover problems are complex, which means that there is no one solution to decreasing turnover. Multiple points of intervention exist. One specific approach that may improve turnover rates is hospital policies that reduce strains and sprains.

Work engagement in nursing: a concept analysis

Abstract: antoinette bargagliotti l. (2012) Work engagement in nursing: a concept analysis. Journal of Advanced Nursing68(6), 1414–1428. Abstract Aim. This article is a report of an analysis of the concept of work engagement. Background. Work engagement is the central issue for 21st century professionals and specifically for registered nurses. Conceptual clarity about work engagement gives empirical direction for future research and a theoretical underpinning for the myriad studies about nurses and their work environment. Method. Walker and Avant’s method of concept analysis was used. Nursing, business, psychology and health sciences databases were searched using Science Direct, CINAHL, OVID, Academic One File, ABI INFORM and PsycINFO for publications that were: written in English, published between 1990 and 2010, and described or studied work engagement in any setting with any population. Results. Work engagement is a positive, fulfilling state of mind about work that is characterized by vigour, dedication and absorption. Trust (organizationally, managerially and collegially) and autonomy are the antecedents of work engagement. The outcomes of nurses’ work engagement are higher levels of personal initiative that are contagious, decreased hospital mortality rates and significantly higher financial profitability of organizations. Conclusion. When work engagement is conceptually removed from a transactional job demands-resources model, the relational antecedents of trust and autonomy have greater explanatory power for work engagement in nurses. Untangling the antecedents, attributes and outcomes of work engagement is important to future research efforts.

Time to clarify – the value of advanced practice nursing roles in health care

Abstract: Lowe G., Plummer V., O’Brien A.P. & Boyd L. (2012) Time to clarify – the value of advanced practice nursing roles in health care. Journal of Advanced Nursing68(3), 677–685. Abstract Aim. This article presents a discussion of the importance of providing meaningful advanced practice nursing role definition and clarity to improve international standards of nursing titles and scopes of practice. Background. A plethora of international literature exists discussing advanced practice nursing roles and their contribution to healthcare delivery in various countries. However, lack of consistency around title, role definition and scope of practice remains. Data sources. CINAHL and Medline databases were searched using ‘nurse practitioner’, ‘nurse practitioner role’, ‘nurse practitioner practice’, ‘nurse practitioner in public health’, ‘advanced practice nursing roles’ and ‘development of new nursing roles’ with articles limited to years 1995–2010. Citations used in those articles were also explored. All cited articles were in the English language. Discussion. This article supports the need to strengthen the Nurse Practitioner role in health care and professional clarity is identified as a strategy to enhance this. Themes around role clarity, professional identity, ability to enhance healthcare provision and inter-professional issues are examined. The need to more clearly articulate advanced nursing roles in light of the evolution of the Nurse Practitioner role is highlighted. Much work has already occurred in this domain and a means of adapting and broadening these developments for a wider, more global audience whilst maintaining local context is discussed. Conclusion. Although evidence exists that advanced practice nursing roles are increasing internationally, uncertainty around role clarity remains. This is problematic because the valuable contribution of nursing roles is lost, if the ability to clearly express their function does not exist.

The theory-practice relationship: reflective skills and theoretical knowledge as key factors in bridging the gap between theory and practice in initial nursing education

Abstract: Aim This paper is a report of a correlational study of the relations of nursing students' acquired reflective skills, practical skills and theoretical knowledge on their perception of coherence between theory and practice. Background Reflection is considered a key factor in bridging the gap between theory and practice. However, it is not evident whether reflective skills are primarily generic in nature or whether they develop from a theoretical knowledge base or the acquisition of practical skills. Method This study is a secondary analysis of existing data. The data are part of a student survey that was conducted among third-year nursing students in Norway during the spring of 2007. A total of 446 nursing students participated in this study and the response rate was 71%. Structural equation modelling analyses were performed. Findings The results indicate that students' perception of coherence between theory and practice during initial nursing education is directly influenced by reflective skills and theoretical knowledge. The results also reveal that reflective skills have mediating effects and that practical skills have a fully mediated and theoretical knowledge a partially mediated influence on students' perception of coherence. Conclusion The findings imply that helping students perceive coherence between theory and practice in nursing education, developing students' reflective skills and strengthening the theoretical components of the initial nursing education programme might be beneficial. The results suggest that reflective thinking is not merely a generic skill but rather a skill that depends on the acquisition of relevant professional knowledge and experience.

Quality clinical placements for undergraduate nursing students: a cross-sectional survey of undergraduates and supervising nurses.

Abstract: courtney-pratt h., fitzgerald m., ford k., marsden k. & marlow a. (2012) Quality clinical placements for undergraduate nursing students: a cross-sectional survey of undergraduates and supervising nurses. Journal of Advanced Nursing68(6), 1380–1390. Abstract Aim. This article is a report of a mixed method study of the quality of clinical placements for second year undergraduate nursing students in an acute care hospital. Background. In response to the current and predicted workforce shortages, greater numbers of nursing undergraduate places are being offered at tertiary institutions. This means that requests for clinical places in hospitals to support undergraduate students has risen. Little is known about the impact of increased numbers on the quality of clinical placement as a learning experience and this is of concern as demand grows and the means of assessing capacity is still unknown. Methods. A 5-point Likert Scale questionnaire, including free text fields, was administered to undergraduates (n = 178), clinical facilitators (n = 22) and supervising ward nurses (n = 163) at two time points in 2009. The survey targeted the quality of the clinical placement in four domains: welcoming and belongingness; teaching and learning; feedback; confidence and competence. Findings. The findings demonstrated consistently high scoring of the clinical placement experience by both undergraduates and registered nurses. There were higher ratings of levels of support from clinical facilitators compared to supervising ward nurses evident in data associated with the items on the questionnaire relating to teaching and learning. Conclusion. The results are indicative of the professional commitment of nursing staff to support the next generation of nurses. The findings also give a mechanism to communicate outcomes of undergraduate support to nurses in practice, and highlight steps which can be taken to ensure high quality clinical placement continues.

Do perceived high performance work systems influence the relationship between emotional labour, burnout and intention to leave? A study of Australian nurses

Abstract: bartram t., casimir g., djurkovic n., leggat s.g. & stanton p. (2012) Do perceived high performance work systems influence the relationship between emotional labour, burnout and intention to leave? A study of Australian nurses. Journal of Advanced Nursing68(7), 1567–1578. Abstract Aims. The purpose of this article was to explore the relationships between perceived high performance work systems, emotional labour, burnout and intention to leave among nurses in Australia. Background. Previous studies show that emotional labour and burnout are associated with an increase in intention to leave of nurses. There is evidence that high performance work systems are in association with a decrease in turnover. There are no previous studies that examine the relationship between high performance work systems and emotional labour. Design. A cross-sectional, correlational survey. Methods. The study was conducted in Australia in 2008 with 183 nurses. Three hypotheses were tested with validated measures of emotional labour, burnout, intention to leave, and perceived high performance work systems. Principal component analysis was used to examine the structure of the measures. The mediation hypothesis was tested using Baron and Kenny’s procedure and the moderation hypothesis was tested using hierarchical regression and the product-term. Results. Emotional labour is positively associated with both burnout and intention to leave. Burnout mediates the relationship between emotional labour and intention to leave. Perceived high performance work systems negatively moderates the relationship between emotional labour and burnout. Perceived high performance work systems not only reduces the strength of the negative effect of emotional labour on burnout but also has a unique negative effect on intention to leave. Conclusion. Ensuring effective human resource management practice through the implementation of high performance work systems may reduce the burnout associated with emotional labour. This may assist healthcare organizations to reduce nurse turnover.

The impact of psychological capital on job embeddedness and job performance among nurses: a structural equation approach.

Abstract: sun t., zhao x.w., yang l.b. & fan l.h. (2012) The impact of psychological capital on job embeddedness and job performance among nurses: a structural equation approach. Journal of Advanced Nursing68(1), 69–79. Abstract Aims. The objective of this study was to provide empirical evidence on the relationships between psychological capital, job embeddedness and performance. This paper also seeks to present the theoretical development of psychological capital and job embeddedness in nursing research and their application to nursing practices. Background. Psychological capital was recently identified as a core construct in the literature of positive psychology. However, there is considerably less evidence on its positive effects on job embeddedness and performance among nursing personnel. Methods. Questionnaires were distributed to approximately 1000 nurses employed in five university hospitals in Heilongjiang province in China. Data were collected in November 2009. The response rate was 73·3%. Structural equation modelling was employed to test the proposed relationships. Findings. The results support the hypothesized model. This research outlined a strong relationship between the self-reported psychological capital, job embeddedness and performance of the nurses. The study findings suggest that improving the individual-accumulated psychological state of nurses will have a positive impact on their retention intention and job performance. Conclusions. These findings suggest that higher psychological capital increases the self-reported job embeddedness and performance of these nurses.

The structural relationships between organizational commitment, global job satisfaction, developmental experiences, work values, organizational support, and person‐organization fit among nursing faculty

Abstract: gutierrez ap, candela ll & carver l (2012) The structural relationships between organizational commitment, global job satisfaction, developmental experiences, work values, organizational support, and person-organization fit among nursing faculty Journal of Advanced Nursing68(7), 1601–1614 Abstract Aim The aim of this correlational study was to examine the relations between organizational commitment, perceived organizational support, work values, person-organization fit, developmental experiences, and global job satisfaction among nursing faculty Background The global nursing shortage is well documented At least 57 countries have reported critical shortages The lack of faculty is finally being recognized as a major issue directly influencing the ability to admit and graduate adequate numbers of nurses As efforts increase to both recruit and retain faculty, the concept of organizational commitment and what it means to them is important to consider Design A cross-sectional correlational design was used Methods The present study investigated the underlying structure of various organizational factors using structural equation modelling Data were collected from a stratified random sample of nurse faculty during the academic year 2006–2007 Results The final model demonstrated that perceived organizational support, developmental experiences, person-organization fit, and global job satisfaction positively predicted nurse faculty’s organizational commitment to the academic organization Cross-validation results indicated that the final full SEM is valid and reliable Conclusions Nursing faculty administrators able to use mentoring skills are well equipped to build positive relationships with nursing faculty, which in turn, can lead to increased organizational commitment, productivity, job satisfaction, and perceived organizational support, among others

Why did I become a nurse? Personality traits and reasons for entering nursing.

Abstract: This article is a report of a mixed method study of the association between personality traits of nurses and their reasons for entering nursing Background The worldwide nursing shortage prompts research into better understanding of why individuals enter nursing and may assist in exploring ways to increase their recruitment and long term retention Design A mixed method sequential explanatory design employed semi-structured interviews and a validated personality inventory measuring temperament and character traits Methods Registered Nurses (n = 12) and nursing students (n = 11) working and studying in a regional area of Queensland Australia were purposively sampled for the interviews in 2010 from their participation in the survey in 2009 investigating their personality traits Qualitative data collection stopped at saturation A thematic content analysis of the qualitative data using the framework approach was interpreted alongside their personality trait profiles Results Two dominant themes were identified from the participant interviews about reasons for entering nursing; opportunity for caring and my vocation in life These themes were congruent with key temperament and character traits measured in the participants All nurses and students were very high in traits that exude empathy and altruistic ideals regardless of other characteristics which included highly pragmatic and self-serving principles Conclusions Qualitative and quantitative findings suggest that a caring nature is a principal quality of the nursing personality Recruitment and retention strategies whilst promoting multiple benefits for the profession should not forget that the prime impetus for entering nursing is the opportunity to care for others

Job satisfaction, occupational commitment and intent to stay among Chinese nurses: a cross-sectional questionnaire survey

Abstract: Wang L, Tao H, Ellenbecker CH & Liu X (2012) Job satisfaction, occupational commitment and intent to stay among Chinese nurses: a cross-sectional questionnaire survey. Journal of Advanced Nursing68(3), 539–549. Abstract Aim. This study was designed to identify the level of nurses’ job satisfaction, occupational commitment and intent to stay among mainland Chinese nurses, to explore the relationship among them. Background. Little is known about the magnitude of Chinese nurses’ intent to stay. Understanding the association among demographic characteristics and job satisfaction, occupational commitment and intent to stay among Chinese nurses is most important in a time of nurse shortages. Methods. A descriptive correlation design was used to examine the relationship among variables related to intent to stay. Data were collected by a self-administered survey questionnaire from 560 nurses working in four large hospital facilities in Shanghai in 2009. Results. The mean scores for nurses’ job satisfaction, occupational commitment and intent to stay were 3·25(0·48), 3·11(0·40) and 3·56(0·65), respectively. Job satisfaction and occupational commitment were significantly related to intent to stay. A statistically significant positive correlation was found between occupational commitment and job satisfaction. Age and job position were significantly related to job satisfaction, occupational commitment and intent to stay. Conclusion. Levels of job satisfaction, occupational commitment and intent to stay reported by nurses in this study can be improved. Suggested strategies for improvement are: increasing salaries, decreasing workloads, modifying task structure, cultivating work passion and creating more professional opportunity for nurses’ personal growth development and promotion. Enhancing nurses’ job satisfaction and occupational commitment are vital to improve nurses’ intent to stay and for strategies to address the nursing shortage.

Hope, older adults, and chronic illness: a metasynthesis of qualitative research.

Abstract: duggleby w., hicks d., nekolaichuk c., holtslander l., williams a., chambers t. & eby j. (2012) Hope, older adults, and chronic illness: a metasynthesis of qualitative research. Journal of Advanced Nursing68(6), 1211–1223. Abstract Aim. To report a metasynthesis review of qualitative research studies exploring the hope experience of older persons with chronic illness. Background. Hope is a psychosocial resource used by persons to deal with their chronic illness experience. Data sources. A comprehensive search of multiple databases for studies of the hope experience (published 1980–2010) was completed. Inclusion criteria were included qualitative studies of the hope experience of persons (all genders; mean age 60 years and older), with chronic illnesses, and publications in any language and country. Review methods. The metasynthesis followed four procedural steps: (a) comprehensive search, (b) quality appraisal, (c) classification of studies, and (d) synthesis of findings. Results. Twenty studies were included in the metasynthesis representing research from a variety of different countries and populations with differing medical diagnoses. The characteristics of hope included: (a) dynamic or situational nature, (b) multiple co-existing types, (c) objects that were desirable realistic possibilities, (d) future-focused, and (e) involvement of choice/will. Hope as ‘transcending possibilities’ represented the integration of two processes of transcendence and positive reappraisal. Reaching inwardly and outwardly and finding meaning and purpose were sub-processes of transcendence, whereas re-evaluating hope in light of illness and finding positive possibilities were sub-processes of positive reappraisal. Conclusions. The concept of hope may differ for older adults vs. younger adults in its interaction with suffering. Resources for hope are both internal and external. Finding meaning and positive reappraisal are important strategies to help older adults with chronic illness maintain their hope.

Patient and visitor violence in the general hospital, occurrence, staff interventions and consequences: a cross-sectional survey

Abstract: Aim. This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs’ interventions and the consequences of violence for different professions are investigated. Background. There is a lack of studies describing the factors influencing the occurrence of patient and visitor violence, intervention strategies and consequences. Existing studies often focus on nurses’ experiences and single interactive factors between staff and patients/visitors involved. Design. A cross-sectional survey. Method. The survey was conducted in 2007 including 2495 staff working on different wards in a Swiss university general hospital. The questionnaire used was the Survey of Violence Experienced by Staff German Version-Revised. Findings. Half of the staff experienced patient and visitor violence in the past 12 months and 11% in the past week. The age of the staff and the length of experience in their present workplace influenced the exposure to patient and visitor violence. Violence occurred mainly when staff carried out tasks involving close personal contact. Only 16% of the staff was trained in aggression management. The feeling of confidence in managing patient and visitor violence depended significantly on the organizational attitude towards violence. The principal interventions used were calming and informative discussion. Conclusion. To prevent patient and visitor violence and improve management strategies, training which focuses on communication skills, which is specific to the professional context and which emphasizes patient centeredness, need to be designed and implemented. A strong organizational commitment is imperative to reduce violence.

Nursing the patient with complex communication needs: time as a barrier and a facilitator to successful communication in hospital

Abstract: hemsley b., balandin s. & worrall l. (2012) Nursing the patient with complex communication needs: time as a barrier and a facilitator to successful communication in hospital. Journal of Advanced Nursing68(1), 116–126. Abstract Background. Effective nurse–patient communication is an essential aspect of health care. Time to communicate, however, is limited and subject to workload demands. Little is known about how nurses manage this ‘lack of time’ when caring for patients with developmental disability and complex communication needs, who typically communicate at a slow rate. Aim. The aim of this study was to investigate nurses’ expressed concepts of ‘time’ in stories about communicating with patients with developmental disability and complex communication needs in hospital. Method. In 2009, 15 hospital nurses from a range of wards in two metropolitan hospitals participated in interviews about barriers to and strategies for successful communication with patients with developmental disability and complex communication needs in hospital. The data were analysed using narrative inquiry methodology and the stories verified with the participants. Results. Nurses identified ‘time’ as a barrier and a facilitator to successful communication. Time as a barrier was related thematically to avoiding direct communication and preferring that family or paid carers communicated on behalf of the patient. Time as a facilitator was related to valuing communication, investing extra time, and to applying a range of adaptive communication strategies to establish successful communication. Conclusions. Time is perceived by nurses as both an enemy and friend for improving communication. Nurses who perceive that communication takes too long may avoid communication and miss opportunities to improve communication through increased familiarity with the person’s communication methods. Those who take time to communicate narrate applying a range of strategies to achieve success in basic needs communication.

Job demands, job resources and long-term sickness absence in the Danish eldercare services: a prospective analysis of register-based outcomes

Abstract: clausen t., nielsen k., carneiro i.g. & borg v. (2012) Job demands, job resources and long-term sickness absence in the Danish eldercare services: a prospective analysis of register-based outcomes. Journal of Advanced Nursing68(1), 127–136. Abstract Aim. To investigate associations between psychosocial job demands, job resources and cases of registered long-term sickness absence among nursing staff in the eldercare services. Background. Research has shown that psychosocial work environment exposures predict sickness absence in healthcare settings. However, only few studies have longitudinally investigated associations between specific job demands and job resources and risk of long-term sickness absence. Methods. Questionnaire data were collected in 2004 and 2005 among all employees in the eldercare services in 35 Danish municipalities and were followed in a National register on payment of sickness absence compensation for a 1-year follow-up period (N = 7921). Three psychosocial job demands – emotional demands, quantitative demands and role conflicts – and three job resources – influence, quality of leadership and team climate – were investigated to predict risk of sickness absence for eight or more consecutive weeks in the follow-up period. Data were analysed using Cox proportional hazards model. Results. A percentage of 6·5 of the respondents were absent for eight or more consecutive weeks during follow-up. The analyses showed that emotional demands, role conflicts, influence, quality of leadership and team climate were significantly associated with risk of long-term sickness absence. In an analysis with mutual adjustment for all job demands and job resources, influence constituted the strongest predictor of long-term sickness absence (negative association). Conclusions. Job demands and job resources are significantly associated with risk of long-term sickness absence. Interventions aimed at improving the psychosocial work environment may, therefore, contribute towards preventing long-term sickness absence in the eldercare services.

The relationship between clinical indicators, coping styles, perceived support and diabetes-related distress among adults with type 2 diabetes.

Abstract: This is the pre-peer reviewed version of the following article: Karlsen, B., Oftedal, B., & Bru, E. (2012). The relationship between clinical indicators, coping styles, perceived support and diabetes‐related distress among adults with type 2 diabetes. Journal of Advanced Nursing, 68(2), 391-401., which has been published in final form at: DOI:10.1111/j.1365-2648.2011.05751.x.

An empowerment framework for nursing leadership development: supporting evidence.

Abstract: macphee m., skelton-green j., bouthillette f. & suryaprakash n. (2012) An empowerment framework for nursing leadership development: supporting evidence. Journal of Advanced Nursing68(1), 159–169. Abstract Aim. This article is a report on a descriptive study of nurse leaders’ perspectives of the outcomes of a formal leadership programme. Background. Effective nurse leaders are necessary to address complex issues associated with healthcare systems reforms. Little is known about the types of leadership development programmes that most effectively prepare nurse leaders for healthcare challenges. When nurse leaders use structural and psychological empowerment strategies, the results are safer work environments and better nurse outcomes. The leadership development programme associated with this study is based on a unifying theoretical empowerment framework to empower nurse leaders and enable them to empower others. Methods. Twenty seven front-line and mid-level nurse leaders with variable years of experience were interviewed for 1 year after participating in a formal leadership development programme. Data were gathered in 2008–2009 from four programme cohorts. Four researchers independently developed code categories and themes using qualitative content analysis. Results. Evidence of leadership development programme empowerment included nurse leader reports of increased self-confidence with respect to carrying out their roles and responsibilities; positive changes in their leadership styles; and perceptions of staff recognition of positive stylistic changes. Regardless of years of experience, mid-level leaders had a broader appreciation of practice environment issues than front-line leaders. Time for reflection was valuable to all participants, and front-line leaders, in particular, appreciated the time to discuss nurse-specific issues with their colleagues. Conclusion. This study provides evidence that a theoretical empowerment framework and strategies can empower nurse leaders, potentially resulting in staff empowerment.

Stress resiliency, psychological empowerment and conflict management styles among baccalaureate nursing students.

Abstract: pines e.w., rauschhuber m.l., norgan g.h., cook j.d., canchola l., richardson c. & jones m.e. (2012) Stress resiliency, psychological empowerment and conflict management styles among baccalaureate nursing students. Journal of Advanced Nursing68(7), 1482–1493. Abstract Aims. This article is a report of a Neuman Systems Model-guided correlational study of the relations of stress resiliency, psychological empowerment, selected demographic characteristics (age, ethnicity, semester in school) and conflict management styles. Background. Emerging evidence suggests that stress resiliency and psychological empowerment can strengthen student nurses in academic achievement and coping with stress. Little is known about conflict management styles of students and the relationship to empowerment, resiliency and the implications for managing workplace conflict. Methods. A correlational study was conducted in Spring 2010 with 166 baccalaureate students. Most participants were female, single, Hispanic and 25 years old. The data collection instruments included the Stress Resiliency Profile, the Psychological Empowerment Instrument, the Conflict Mode Instrument and a demographic inventory. Descriptive and inferential correlational statistics were used to analyse the data. Results. Students scored in the high range for focusing on their deficiencies in conflict situations; they scored above the 60th percentile for avoiding and accommodating behaviours and were less likely to use competing or collaborating strategies to manage conflict. Empowerment scores were significantly correlated with stress resiliency scores. Students with high scores on empowerment had high scores on the skill recognition subscale of the Stress Resiliency Profile suggesting more resilience; high scores on empowerment were related to high necessitating subscale scores of the Stress Resiliency Profile suggesting a predisposition to stress. Conclusions. Neuman Systems Model may provide guidance for educators to strengthen student nurses’ management of stressors in the workplace.

Nurses’ decision-making in cases of physical restraint: a synthesis of qualitative evidence

Abstract: goethals s., dierckx de casterle b. & gastmans c. (2012) Nurses’ decision-making in cases of physical restraint: a synthesis of qualitative evidence. Journal of Advanced Nursing68(6), 1198–1210. Abstract Aim. This article is a report of a review that aimed to synthesize the available qualitative evidence on nurses’ decision-making in cases of physical restraint. Background. The use of physical restraint in acute and residential healthcare facilities is a widespread practice in many countries. Decisions about the use of physical restraints are complex and ethically laden. The lack of evidence supporting the use of physical restraints, the negative consequences of restraint for patients, and the low availability of alternatives obviously complicate the decision-making. Data sources. Research papers published between January 1990 and January 2010 were identified in Cinahl, Embase, Medline, PsycInfo and Web of Science. Review methods. A systematic review was carried out to obtain a meta-synthesis of qualitative evidence. The process of meta-synthesis was supported by the Joanna Briggs Institute’s guidelines. Findings. The decision-making of nurses dealing with the use of physical restraints is a complex trajectory primarily focused on safety. However, thoughtful decision-making requires nurses to carefully balance different options and associated ethical values. The decision-making process of nurses is influenced by both nurse- and context-related factors. Conclusions. This review provides a deeper understanding of nurses’ decision-making process on the use of physical restraints. Context- and nurse-related factors can hinder nurses from making an ethical decision on the appropriate use of physical restraints. There is an urgent need to stimulate and educate nurses to arrive at an appropriate decision about the use of physical restraints.

Staying in nursing: what factors determine whether nurses intend to remain employed?

Abstract: Aim To test a model of eight thematic determinants of whether nurses intend to remain in nursing roles Background Despite the dramatic increase in the supply of nurses in England over the past decade, a combination of the economic downturn, funding constraints and more generally an ageing nursing population means that healthcare organizations are likely to encounter long-term problems in the recruitment and retention of nursing staff Design Survey Method Data were collected from a large staff survey conducted in the National Health Service in England between September-December 2009 A multi-level model was tested using MPlus statistical software on a sub-sample of 16,707 nurses drawn from 167 healthcare organizations Results Findings were generally supportive of the proposed model Nurses who reported being psychologically engaged with their jobs reported a lower intention to leave their current job The perceived availability of developmental opportunities, being able to achieve a good work-life balance and whether nurses' encountered work pressures were also influencing factors on their turnover intentions However, relationships formed with colleagues and patients displayed comparatively small relationships with turnover intentions Conclusion The focus at the local level needs to be on promoting employee engagement by equipping staff with the resources (physical and monetary) and control to enable them to perform their tasks to standards they aspire to and creating a work environment where staff are fully involved in the wider running of their organizations, communicating to staff that patient care is important and the top priority of the organization

The intention to continue nursing: work variables affecting three nurse generations in Australia.

Abstract: shacklock k. & brunetto y. (2012) The intention to continue nursing: work variables affecting three nurse generations in Australia. Journal of Advanced Nursing68(1), 36–46. Abstract Aims. The aims of the study were to examine how seven variables impacted upon the intention of hospital nurses to continue working as nurses and to investigate whether there are generational differences in these impacts. Background. There is a critical shortage of trained nurses working as nurses in Australia, as in many other Organisation for Economic Co-operation and Development member countries. The retention of nurses has been examined from the traditional management perspectives; however, this paper presents a different approach (Meaning of Working theory). Methods. A self-report survey of 900 nurses employed across four states of Australia was completed in 2008. The sample was hospital nurses in Australia from three generational cohorts – Baby Boomers (born in Australia between 1946 and 1964), Generation X (1965–1979) and Generation Y (1980–2000). Results. Six variables were found to influence the combined nurses’ intentions to continue working as nurses: work–family conflict, perceptions of autonomy, attachment to work, importance of working to the individual, supervisor–subordinate relationship and interpersonal relationships at work. There were differences in the variables affecting the three generations, but attachment to work was the only common variable across all generations, affecting GenYs the strongest. Conclusion. The shortage of nurses is conceptualized differently in this paper to assist in finding solutions. However, the results varied for the three generations, suggesting the need to tailor different retention strategies to each age group. Implications for management and policy planning are discussed.

Testing an integral conceptual model of frailty

Abstract: Gobbens R.J., van Assen M.A., Luijkx K.G. & Schols J.M. (2012) Testing an integral conceptual model of frailty. Journal of Advanced Nursing68(9), 2047–2060. Abstract Aim. This paper is a report of a study conducted to test three hypotheses derived from an integral conceptual model of frailty. Background. The integral model of frailty describes the pathway from life-course determinants to frailty to adverse outcomes. The model assumes that life-course determinants and the three domains of frailty (physical, psychological, social) affect adverse outcomes, the effect of disease(s) on adverse outcomes is mediated by frailty, and the effect of frailty on adverse outcomes depends on the life-course determinants. Methods. In June 2008 a questionnaire was sent to a sample of community-dwelling people, aged 75 years and older (n = 213). Life-course determinants and frailty were assessed using the Tilburg Frailty Indicator. Adverse outcomes were measured using the Groningen Activity Restriction Scale, the WHOQOL-BREF and questions regarding healthcare utilization. The effect of seven self-reported chronic diseases was examined. Results. Life-course determinants, chronic disease(s), and frailty together explain a moderate to large part of the variance of the seven continuous adverse outcomes (26–57%). All these predictors together explained a significant part of each of the five dichotomous adverse outcomes. The effect of chronic disease(s) on all 12 adverse outcomes was mediated at least partly by frailty. The effect of frailty domains on adverse outcomes did not depend on life-course determinants. Conclusion. Our finding that the adverse outcomes are differently and uniquely affected by the three domains of frailty (physical, psychological, social), and life-course determinants and disease(s), emphasizes the importance of an integral conceptual model of frailty.

Kangaroo Mother Care helps fathers of preterm infants gain confidence in the paternal role

Abstract: Aim. This article is a report on a descriptive study of fathers’ experiences of providing their preterm infants with Kangaroo Mother Care.Background. During neonatal intensive care, fathers describ ...

Promoting patient care: work engagement as a mediator between ward service climate and patient-centred care.

Abstract: ABDELHADI N. & DRACH-ZAHAVY A. (2012) Promoting patient care: work engagement as a mediator between ward service climate and patient-centred care. Journal of Advanced Nursing68(6), 1276–1287. Abstract Aims. To test a model that suggests the ward’s climate of service facilitates nurses’ patient-centred care behaviours through its effect on nurses’ work engagement. Background. Organizational efforts to promote patient-centred care focused on interventions aimed to improve nurses’ communication skills, or to improve patient’s participation in the decision-making process. These interventions have been only partially successful, as they do not take the ward context into account; so caring professionals who attend workshops can rarely apply their newly acquired skills due to the daily pressures of the ward. Method. A nested cross-sectional research design (nursing staff within wards) was adopted, with three measures of the care behaviour of nurses. Data were collected in 2009, from 158 nurses working in 40 wards of retirement homes in northern Israel. Nurses’ work engagement, ward’s climate for service and control variables were measured via validated questionnaires. Patient-centred care behaviours were assessed by structured observations. Results. The findings supported our model: service climate proved a link to nurses’ work engagement and patient-centred care behaviours. Nurses’ work engagement mediated the service-climate patient-centred care behaviours. Conclusion. The research is pioneering in demonstrating a close relation between ward service climate and patient-centred care. In practice, to improve patient-centred care managers should invest in facilitating ward service climate, highlighting the importance of service to the organization through appropriate rewards, guidance and administrative practices.

Nurses' use of situation awareness in decision-making: an integrative review.

Abstract: Aim. To critically review the literature related to situation awareness and clinical decision-making by nurses. Background. International recognition that situation awareness positively contributes to clinical decision-making has led to a growing body of healthcare literature. To date, research has predominately focused on anaesthetists and surgeons using measurement frameworks from the aviation industry. The evidence focussing directly on situation awareness in decision-making by nurses remains limited. Data sources. Databases: PROQUEST, Web of Science, CINAHL, and PUBMED. Review methods. An integrative review was undertaken following an extensive literature search with the date range January 1965 - March 2011. English language literature reviews, primary qualitative, quantitative and mixed method studies describing situation awareness in decision-making by or including nurses were included. Results. Five empirical studies of nurses' situation awareness were reviewed. Of these, three included decision-making and situation awareness by nurses in inter-professional teams; two related solely to situation awareness and decision-making by nurses. Findings from the five studies could be grouped under three themes: individual factors influencing situation awareness, interpersonal behaviours influencing situation awareness and situation awareness improving working relationships and patient care. Conclusion. Further investigation is needed to identify the situation awareness skills that are vital to decision-making by nurses. Elucidating essential skills sets associated with situation awareness may inform the development of education and training to enhance clinical decision-making by nurses.

The image of you: constructing nursing identities in YouTube.

Abstract: kelly j., fealy g.m. & watson r. (2011) The image of you: constructing nursing identities in YouTube. Journal of Advanced Nursing68(6), 1804–1813. Abstract Aim. This article is a report on a descriptive study of nursing identity as constructed in the Web 2.0 site YouTube. Background. Public images of the nurse carry stereotypes that rely on the taken for granted gender category of the nurse as woman. Nursing images represent a form of public discourse that has the capacity to construct nursing identity. Methods. Critical discourse analysis was used to describe, analyse and explain how nurse and nursing identity were constructed in a purposive sample of ten video clips accessed on 17 and 18 July 2010. Results. The ten most-viewed videos depicting the nurse and nursing on YouTube offered narratives that constructed three distinct nursing identity types, namely nurse as ‘a skilled knower and doer’, nurse as ‘a sexual plaything’ and nurse as ‘a witless incompetent’ individual. Conclusion. Nursing identities recoverable from the texts of YouTube images propagate both favourable and derogatory nursing stereotypes. To mitigate the effects of unfavourable nursing stereotypes in such areas as interprofessional working and clinical decision-making, nursing professional bodies need to act to protect the profession from unduly immoderate representations of the nurse and to support nurses in their efforts to maximize opportunities afforded by YouTube to promote a counter discourse.

Educational support for research utilization and capability beliefs regarding evidence-based practice skills: a national survey of senior nursing students.

Abstract: florin j., ehrenberg a., wallin l. & gustavsson p. (2011) Educational support for research utilization and capability beliefs regarding evidence-based practice skills: a national survey of senior nursing students. Journal of Advanced Nursing 68(4), 888–897. Abstract Aim. The aim of the study was to investigate Swedish university nursing students’ experience of educational support for research utilization and capability beliefs regarding evidence-based practice skills. Background. Nursing programmes are offered at 26 universities in Sweden and even though there are common regulations for nursing education at the national level, substantial variations are found in local curricula. Little is known about students’ capability beliefs regarding evidence-based practice skills, particularly in comparison across universities. Methods. A cross-sectional survey design using self-administered postal questionnaires was conducted in 2006. A total of 1440 students (from 26 different universities) participated, constituting 68% of the national population of nursing students in their 6th and final semester. Results. Campus education supported the students to a greater extent than clinical education in following the development of knowledge in an area of interest, using research findings, and acquiring knowledge on how to pursue changes in clinical practice. Perceived support during campus education varied between universities. Students reported high capability beliefs regarding evidence-based practice skills, but large differences were found between universities for: stating a searchable question, seeking out relevant knowledge and critically appraising and compiling best knowledge. Conclusion. The identified differences between universities concerning the students’ perceived support for research utilization and their capability beliefs regarding evidence-based practice skills have implications for curricula, pedagogical perspectives in nursing education and the potential to implement evidence-based practice in healthcare settings. Further studies are warranted to investigate students’ individual characteristics and organizational characteristics as determinants of research utilization support and capability beliefs regarding evidence-based practice skills.

Social justice: a concept analysis

Abstract: buettner-schmidt k. & lobo m.l. (2011) Social justice: a concept analysis. Journal of Advanced Nursing 68(4), 948–958. Abstract Aim. This article is a report of an analysis of the concept of social justice. Background. Nursing’s involvement in social justice has waned in the recent past. A resurgence of interest in nurses’ roles about social justice requires a clear understanding of the concept. Data sources. Literature for this concept analysis included English language articles from CINAHL, PubMed, and broad multidisciplinary literature databases, within and outside of health-related literature, for the years 1968–2010. Two books and appropriate websites were also reviewed. The reference lists of the identified sources were reviewed for additional sources. Review methods. The authors used Wilsonian methods of concept analysis as a guide. Results. An efficient, synthesized definition of social justice was developed, based on the identification of its attributes, antecedents and consequences that provides clarification of the concept. Social justice was defined as full participation in society and the balancing of benefits and burdens by all citizens, resulting in equitable living and a just ordering of society. Its attributes included: (1) fairness; (2) equity in the distribution of power, resources, and processes that affect the sufficiency of the social determinants of health; (3) just institutions, systems, structures, policies, and processes; (4) equity in human development, rights, and sustainability; and (5) sufficiency of well-being. Conclusion. Nurses can have an important influence on the health of people globally by reinvesting in social justice. Implications for research, education, practice and policy, such as development of a social justice framework and educational competencies are presented.

Depressive symptoms among Chinese nurses: prevalence and the associated factors.

Abstract: gao y.-q., pan b.-c., sun w., wu h., wang j.-n. & wang l. (2011) Depressive symptoms among Chinese nurses: prevalence and the associated factors. Journal of Advanced Nursing 68(5), 1166–1175. Abstract Aim. This article is a report of exploration of depressive symptoms and the associated factors among Chinese nurses working at public city hospitals. Background. Hospital nurses are known to work in psychologically and physically demanding work environment, which may lead to depressive symptoms. However, little research has been done to address this problem in Chinese nurses. Methods. A cross-sectional survey was carried out in seven randomly selected city hospitals of Liaoning Province, northeast of China in 2009. Depressive symptoms of the nurses were measured with the Chinese version of the Center for Epidemiologic Studies Depression Scale. Job Content Questionnaire and the effort-reward imbalance, demographic features, life style and work conditions were measured as the related factors. Results. A total of 1592 nurses participated in the study and the effective response rate was 79·5%. The prevalence of depressive symptoms among the nurses was 61·7% (n = 886), of whom 74·9% (n = 664) had mild depressive symptoms. Multivariate logistic regression analysis showed that lower job rank, higher over commitment, alcohol consumption, worse nurse–patient relationship and higher education background were positively associated with depressive symptoms, whereas supervisor support, taking regular meals, doing physical exercises, higher skill discretion and higher job satisfaction were negatively associated with depressive symptoms. Conclusion. More than half of the Chinese nurses had depressive symptoms. As depressive symptoms may adversely affect quality of life and quality of care, consultation for the nurses with healthy life styles, work stress coping techniques and advice to administrator to improve social aspects of the work environment might be helpful to reduce the depressive symptoms in nurses.

Assessing quality of life of older people with dementia: a comparison of quantitative self-report and proxy accounts.

Abstract: moyle w., murfield j.e., griffiths s.g. & venturato l. (2012) Assessing quality of life of older people with dementia: a comparison of quantitative self-report and proxy accounts. Journal of Advanced Nursing68(10), 2237–2246. Abstract Aims. This article reports on a study of quality of life of older people with dementia, as assessed by the person with dementia, family carer and care staff. Background. People with dementia can give meaningful assessments of their quality of life, but these often differ from proxy ratings. In understanding this discrepancy, the influence of age, extent of cognitive impairment and activity limitation has been investigated. A lack of conclusive associations between quality of life ratings and these variables indicates a need for further research. Methods. Fifty-eight triads comprising the person with dementia, family carer and member of care staff from four long-term care facilities were surveyed on the Quality of Life-Alzheimer’s Disease questionnaire between August and December 2007. Results. There was an important difference in the Quality of Life-Alzheimer’s Disease questionnaire total mean scores between groups, with the person with dementia providing the highest ratings. Level of impairment in Activities of Daily Living had an important effect on quality of life ratings, with proxies, particularly care staff, providing lower ratings when there was greater activity limitation. This was not replicated for assessments made by the person with dementia. Age or level of cognitive impairment did not influence any ratings. Conclusion. People with dementia can give assessments of their quality of life. However, discrepancy in ratings, with greater activity limitation affecting proxy ratings but not those made by the person with dementia, indicates the importance of including both self-report and proxy measures in research and care planning.